Flare-Ups 101—Prevention, Planning, and Troubleshooting: November 5, 2016



  • Great question. we often see flares after something like exertion and even there, I would argue that in many cases, it is still an example of increased nervous system sensitivity. when we have chronic pain, there is definitely a mechanical change in the muscles, but one of the things that also happens, is that our alarm bell (pain) rings well before damage occurs. this is NOT to say that you should just push through that pain. Not at all. In fact, if we push through that pain, the nervous system responds by saying something like
    "I tried to tell you that this was dangerous, and you didn't seem to hear me. So, now I'm going to yell a lot louder".

    When we push through a lot of pain, the nervous system learns that it is not being vigilant enough (even though it was trying, it still didn't prevent a flare) and so next time, the alarm bell rings earlier.

    By taking regular rests, you offer the nervous system a signal of safety - you can essentially "hack" your nervous system by reducing your muscle tension and slowing down your breath, and the system responds by saying "oh, okay, I guess this wasn't as dangerous as I thought".

    The key to safe exertion is to figure out how much you can do (even if there is some pain) without triggering a flare, and offering plenty of safety signals to your body, like relaxed muscles and breath.

    @Forum_Moderator said:

    And here is a question from Facebook:

    Earlier you wrote that flares are not a new danger and are unrelated to a new problem - I get that - but when you write about flares after exertion, there does seem to be a mechanical issue going on like muscle strain etc. It seems like there is more going on than increased sensitivity and that's why rest or changing position actually helps, right?



  • @kristafriesen
    Very well said. The shoulds and striving for normalcy create much more physical and psychological pain. It's a tough thing to manifest, the level of acceptance required, especially because we want more, there are tasks that need to be done and society pushes the don't let anything stop you attitude on everyone.



  • Honestly, the most common thing that I hear from is that they sometimes know that they should do a little less, or they can feel that their pain is increasing as they are making their way through the aisles of a grocery store, but they feel like they "should" be able to do these things. "Should" is one of the hardest things that we say to ourselves. "I should be able to cook this meal" or "I should be able to sit at my desk for longer than 20 minutes" and so people push through, trying to maintain whatever sense of "normalcy" that they can. Letting go of these "shoulds" is one of the hardest things that I see for people. and I understand it completely.

    There are two responses to this: one comes from how pacing really works - that if a person can figure out those baselines and stick to them, there is a good chance that you will end up with MORE usable hours in a day, and not less.

    The other response is that in order to make progress, we have to be able to see ourselves where we really are. If we get stuck trying to cling to the things we used to be able to do, it is very challenging to see a clear path to move forward - because we are not accepting where we are at. This accepting is pivotal in reducing flares. But note that acceptance is not the same thing as resignation. you can still make progress and take steps forward, even while accepting where you are now.

    @Forum_Moderator said:

    That is good to hear, Krista. At Pain BC, we often hear about the difficulties that people have with managing their pain. They talk about that vicious cycle you referred to earlier. Thinking about the "troubleshooting" part of this talk, what problems do you hear the most often from your clients?



  • And here is a question from Facebook:

    Earlier you wrote that flares are not a new danger and are unrelated to a new problem - I get that - but when you write about flares after exertion, there does seem to be a mechanical issue going on like muscle strain etc. It seems like there is more going on than increased sensitivity and that's why rest or changing position actually helps, right?



  • That is good to hear, Krista. At Pain BC, we often hear about the difficulties that people have with managing their pain. They talk about that vicious cycle you referred to earlier. Thinking about the "troubleshooting" part of this talk, what problems do you hear the most often from your clients?



  • I have had chronic back pain since I was quite young and to be honest, I always just assumed it was normal, especially as it worsened when I was in university. During my graduate degree, I spent almost as much time lying on the floor of my office as I did in my chair at my desk!

    My pain is quite well controlled now, through a lot of movement, relaxation, and definitely pacing. However, I still find that if my stress levels increase, so does my pain - and of course, when my stress levels increase, it is usually related to increased work load and that makes it less likely that I take time to do the things I need to do to manage things!! It is a vicious cycle.

    Now when my pain starts to flare, I take a lot of time out to focus on getting good sleep, and working on relaxing - given that my pain is stress-related, it helps to get my stress under control! Having worked pretty hard over the years a figuring out what helps prevent flares, I have changed my work station so that I have a sit/stand desk with multiple chair options for when I am seated (allowing frequent posture changes), and I sign up for registered yoga/pilates classes (so I am less likely to skip them, even when I am busy at work!).

    But the fact is that even with a lot of tools and practice, flares will still happen and then I just curl up in an epsom bath and try to get to bed early :)

    @Forum_Moderator said:

    Those are good tips. You said that you live with chronic back pain. How have you managed to prevent flare-ups? Can you tell us about a particular time?



  • Those are good tips. You said that you live with chronic back pain. How have you managed to prevent flare-ups? Can you tell us about a particular time?



  • Prevention can be a tricky little piece of work, that is true. Oftentimes, flares are related to overdoing activities (and sometimes even underdoing - like sitting for too long) and people may have an indication like a slight increase in pain... and indication they ignore in order to get something done. For example, perhaps you start to sweep your house and about halfway though, you back pain starts to feel like it's getting a little worse. But you ignore it because... well... you want to finish what you started.

    The first key to preventing a flare is listening to that signal. Just because you started a task, does not mean it needs to be finished without a rest.

    What I generally recommend for flares is learning what your baselines are. If you know that you can only stand for 10 minutes before your pain gets worse, and you can only sit for 15 minutes before your pain gets worse, then maybe you sweep for 10 minutes, then sit at your computer for 10-15 minutes, then take a short rest in a lying down position for 5 minutes, and then maybe you can go back to the floors.

    The other key is for those times where you really have no idea why your body decided to flare up. Flares can occur after a few days of doing just a little bit too much, again - this is a pacing principle. Many people with pain fall into the trap of doing a LOT more on their good days, and then paying for it. I always recommend not doing more than 10-15% of anything above normal amounts on your good days. That way it is less likely that the next day is a flare day.

    Pacing or activity journals can help, if you are having trouble figuring out what your baselines are.

    @Forum_Moderator said:

    We never would have thought to have a "flare-up box" ready! Great idea! So we've talked about the "Planning" part of the talk today...what about "Prevention"? It seems difficult/impossible to prevent a pain flare-up, no?



  • We never would have thought to have a "flare-up box" ready! Great idea! So we've talked about the "Planning" part of the talk today...what about "Prevention"? It seems difficult/impossible to prevent a pain flare-up, no?



  • Definitely. I always recommend having at least 2 different flare-ups plans, one for milder flares, and one for more severe flares. I often hear comments from people with pain that when their more serious pain flares hit, they don't even think about all the things that they would normally use to help them feel better, so I suggest actually creating a box with a list of anything you might need to do:
    eg: remember to cancel appointments if you have them.

    • remember to call someone to pick up the kids from school
      etc. These are the things that can go in the list, that is in the kit.

    Then you can put actual items in kit including a heating pad, the phone number for your favourite take out place, a movie you like to watch, a recording of a guided meditation that you like, medications that you might use (if you use them), your favourite tea. maybe even the phone number of a friend you can call to come and help you.

    @Forum_Moderator said:

    Interesting... we have heard that you should have a "flare-up plan" ready to go in the event of a flare-up. Can you tell us a few things to have in this "plan"?



  • Interesting... we have heard that you should have a "flare-up plan" ready to go in the event of a flare-up. Can you tell us a few things to have in this "plan"?



  • Great question. Flare ups can be any sort of shift away from baseline levels of chronic pain (as in - anything that feels like your pain gets worse temporarily). I would say that flares can be categorized as mild, medium, and severe, and each would have it's own set of guidelines for management. In chronic pain flare-ups, it is typically unrelated to a new problem or a new danger in the body, but rather an increased sensitivity in the nervous system - so that means that flare-ups may be painful, and can provoke anxiety, but are not an indication of actual damage.

    @Forum_Moderator said:

    @kristafriesen Hi Krista! Thank you for being here today. We'll start off by asking you a question: For those of us who might not know, how would you characterize a flare-up?



  • @kristafriesen Hi Krista! Thank you for being here today. We'll start off by asking you a question: For those of us who might not know, how would you characterize a flare-up?



  • Hi everyone! I'm Krista and I'll be answering questions about flare-ups today. I'm really excited to be involved in this event, and kicking off National Pain Awareness Week. Thanks PainBC for hosting me!


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