Coping with flare-ups

A flare-up refers to a period of increased pain which is felt more severely than the day-to-day pain. These flare-ups may take days or weeks to settle. Having a prepared plan in order to cope with flare-ups is an important coping strategy.

Things to consider

Cut down on activity, but not fully:

• It is still really important to keep moving. Stopping activity altogether during a flare-up is more likely to prolong the increased pain as you can become stiff. If you need to sit/lie and rest then do so, but make sure you get up and move about often too.

Use your pain relief methods:

• What have you found works for you to ease your pain? It may be heat or cold therapy, medication, hot baths, exercises or something else. It is important to remember what works for you and continue to use these methods.

Relaxation techniques and distraction:

• May also be beneficial during flare-ups. Muscles naturally become tight and tense when experiencing pain. Therefore, relaxation techniques can help you to focus your body on relaxing and relieving tension and stress in the body and mind. Try to take your mind away from the pain by focusing on something else, like doing something you enjoy or thinking about a happy or positive time when you felt good. Use a combination of techniques if needed and remember to do what works for you.

What triggers your flare-ups?

It can be really helpful to try and notice when you have flare-ups – think about what you have been doing that day or on the days preceding the pain. Is there a particular activity (or inactivity) that you have done recently which may have triggered the flare-up? Sometimes flare-up triggers are easy to spot and on other occasions you may not be able to work out the cause of increased pain. Keeping a diary of your activities and pain scores can help.

What would be a good plan for good spells? What would be a good plan during a flare- up?

Progress exercises and goals

Add new goals

Reduce medications

Enjoy yourself

Plan ahead

Stay active

Practice relaxation

Unhelpful thoughts

If you are experiencing a lengthy flare-up of pain you may start to develop unhelpful patterns of thinking.

For instance, you may have worrying thoughts around the future:

• ‘if it is like this now, it will only get worse’

• ‘I may not be able to work and will lose my income’

• ‘my partner will get fed up with me’

• ‘I won’t be able to play with the grandchildren’ and so on.

You may also be worried that there is a serious underlying condition, feel that something has been missed, or you may be unhappy that you have not been offered a treatment which you feel could sort out the problem.

These are all common thoughts encountered by individuals with persistent pain. As you can imagine, thoughts like this can have some really unhelpful effects – they generate feelings of anxiety, fear, tension, stress, anger or hopelessness.

We may well not be aware of it but these feelings have a major influence on our actions and the choices we make in a given situation. Here is an example:

Carry on

Review baseline

Review medication

Enjoy yourself

Relaxation

Allow personal time

If possible, identify triggers, learn from it and plan for next time. However, often there is no cause. It is important that this does not frustrate you.

You experience an increase in pain when lifting something.

You think: ‘I’ve hurt myself; I shouldn’t be doing this’ (thought).

You feel anxious: ‘I feel worried that lifting is risky and a potential source of pain’ (feeling).

As a result, you might decide not to do any lifting at home or at work: ‘I won’t do any lifting – that way I will stay safe’ (action).

This sort of thinking is really unhelpful as it results in and can reinforce a negative cycle which is difficult to break out of. Negative effects might include a withdrawal from working, social or family life, and avoidance of just the sort of activities which might keep us fit and strong and flexible. Being able to recognise our own typical patterns of unhelpful thinking can help, especially if we are able to challenge these thoughts.

For instance, if you experience pain when lifting something, think: ‘I’ve hurt myself, my joints are stiff and my muscles are weak. I will do some stretching and build up my confidence lifting smaller objects. There is no reason why I can’t lift.’