Most of us will experience a flare up at some point in our lives. By definition, a flare up is an exacerbation or worsening of existing or recurrent symptoms and stretches far beyond musculoskeletal conditions, occurring in neurological, cardiovascular and mental health amongst others. The focus of this article is on helping people with chronic pain, an aspect of healthcare that is becoming more prominent, as more of the population are requiring on-going treatment and often struggling to engage with their own management.

Allow Pure Physio to be your Flarey Godmother and guide you through 10 practical tips of wrestling back control of your condition and inching closer to optimism in being able to manage your symptoms.

Please be aware that there are themes of mental health throughout this article. If you feel that you need more information on how to manage this, then please consult a GP or other health professional.

1. Pace Yourself

With longstanding pain, it is not uncommon to find ourselves in ‘boom and bust’ cycles. After an extended period of time experiencing pain, eventually we’ll wake with a seemingly magical reduction in our symptoms. This can prompt us to try and fit in as much as possible to that day, be it shopping, gardening, housework or physical exercise, for we have no idea how long this ‘pain-free’ joy will last. The issue with this approach is that during the period of time we are experiencing pain we are usually more restricted in what we can do and therefore our bodies may not be used to tolerating this amount of exertion, in which case we are more likely to provoke our ‘inflammatory cycle’ to restart and usher in a new period of discomfort with it. Over a period of time of being stuck in this cycle, the length of time that our pain-free rays of sunshine become shorter and less frequent, whilst the dark clouds of pain and suffering tend to stick around for longer.

To counter this, we recommend setting goals for yourself (short and longer term) that you can measure and are achievable for you to aim for to provide you with a focus. Furthermore, at the beginning of each day or week, write down a list of ‘must, should, could’ tasks to make it clear to you what each day holds, so you can prioritise your chores. The key to these tasks are that all of them should be in your control. For example, if you set yourself a must task of clearing the leaves in the garden but it’s pouring down, then it will seem unpleasant, daunting and if you don’t complete it, then it can sometimes lower our mood. Tasks like making yourself a healthy meal, meditating or running the vacuum over one room of the house are all manageable and in our control.

2. Don’t Panic

Waking up in pain can be scary, especially when unexpected. If it’s a recurrent pain, then we can think back to the discomfort we’ve suffered before and we think ‘its back and I’m never going to get better’. It’s natural to feel anxious and worried when we’re in pain, but with that concern we have more hormones in our body, such as cortisol and adrenaline, that can then contribute to making us feel more pain. Furthermore, in states of panic we naturally visit the flight, fight or freeze stage, all of which comes with a side of tensed muscles, raised heart rate and reduced motivation, likely aspects that contribute towards further pain. It’s important to recognise that these symptoms will pass as they have done previously. Using the above actions, this helps to clear the fog that can arise with the onset of recurring pain and help navigate the hours, days or weeks of worsened symptoms until you feel better.

3. Pain Medication

Most people who experience longer standing pain will have a supply of pain medication, which should always be prescribed by a GP if not readily available over the counter. It’s worth confirming with your GP and/or a pharmacist before taking anything for the first time or if you have had any changes to your prescriptions or general medical history since last taking a particular medication. If the level of pain is especially interrupting your sleep, preventing you from working or engaging with your self-management exercises, then this would suggest that it would be appropriate to consider a short course of pain medication to give you a helping hand in restoring you to your pre-flare function. For more information, please liaise with a GP.

4. Do Things You Enjoy

To break out of the chains of pain and associated mental health conditions, such as depression and anxiety, it’s key to make sure there’s easy access to doing something that you really love to do. This can involve watching a movie that makes you laugh, painting, knitting, listening to an artist you love or going on a particularly scenic walk near the house alone or with your dog. These happy past times cause an influx of endorphins to lift your mood. When we’re not in the clutches of a flare up, it can be a good idea to even make a readily available ‘flare up box’ and add in photos, letters and other things that can stimulate happy memories. Our brains are unable to fully separate life in the present and the past and so if we spend time concentrating and reliving beautiful experiences, this can illicit the same release of ‘feel good’ hormones, the same ones that would be released if we were actually living it in reality. You could also save particular posts on social media into a folder and then allow yourself to bathe in more pleasant situations. Sometimes we can feel guilty for taking time out of our day to do things we genuinely enjoy, but now please feel free to do this without any pangs of worry as it’s been advised by a health professional!

5. Keep Active

Following on from the previous point, if you enjoy staying in bed, unfortunately this does not count as something to take advantage of when in pain! It can feel like the easiest thing in the world to close the curtains and spend the day in bed when we’re in pain but that will only result in suffering for longer periods. People often feel that if they get out of bed and experience their pain they are likely causing ‘more damage’ but this is simply not true. The feeling of pain is an incredibly complex, multi-faceted sensation that by definition is caused by ‘actual or potential’ tissue damage. The latter part is key, as it’s often unlikely that by getting out of bed, make yourself a drink and then have a shower, will be causing you any further harm. As an example where pain and tissue damage do not necessarily coordinate, consider a time where you have noticed a bruise and you’ve no idea how you got it. Maybe it had been whilst playing sport or knocking into something whilst socialising, but you weren’t aware of it until you noticed it in the mirror. If pain and ‘damage’ were always connected, then this common scenario would not occur as you’d have been alerted straight away. Give yourself compassion to take longer to complete tasks and avoid any known aggravating positions whilst being up and about.  

6. Explore Mindfulness Options

The body of research behind aspects of mindfulness helping people in terms of their mental and physical health continues to grow and with it comes evidence that this can have an incredibly powerful influence on the management of chronic pain. Breath work costs absolutely nothing and by simply focussing on our inhalation and exhalation, this can relax us. Try inhaling for 4 seconds and exhaling for 6 seconds for a minute or two regularly during the day. ‘Breathing App’ is free to download on your mobile phone and offers a ball that inflates and deflates to visualise on the screen to help to maintain this rhythm. Moreover, guided meditations are available on YouTube, Spotify and over various mindfulness apps, such as Headspace and Calm, both of which have free trials, to offer the chance to trial mindfulness for yourself. Yoga is something that can be done through apps on your phone or using YouTube, which can again stimulate movement, whilst also focussing on the breath. The above examples, as well as taking into account painting, drawing or knitting, are all fantastic and cost-effective ways of helping to ‘deregulate’ and encourage calmness.

7. Speak to a Friend or Family Member

Reaching out and speaking to someone in person or over the phone provides a welcome distraction from feeling in pain- as long as the whole conversation isn’t about your pain! Engulfing yourself in a laugh and a catch up, especially if it’s done in your ‘happy place’, like the local park, café or museum, can again stimulate the release of happiness hormones. Even smiling has been found to make us actually feel better, so discussing your fun future plans, organising further fun events or reminiscing on past events can really play a role in helping to dig ourselves out of chronic pain holes we can trip into.

8. Expressive Writing

Chronic pain usually comes with a whole host of unpleasant emotions, such as frustration, anger, worry and fear, that can be really challenging to make sense of. This feeling can be amplified when we go on social media, watch the news, try to get through all of our emails, whilst also doing the big shop after completing the school run. This can become an incredibly fatiguing process that seeps into all facets of our lives and can manifest as a constant cause of anxiety. Expressive writing and journaling can be a method of offloading troublesome worries that contribute to these feelings once they are written down. Gabby Bernstein, the author and motivational speaker, advises trying ‘rage on the page’ which boils down to writing whatever comes to your mind first thing in the morning. This could be done for as long as you have time for and none of what you write has to even make sense, but by giving yourself time to yourself, can help to understand the hurricane of negative feelings that can swirl around during times we experience pain.

9. Eat Healthily and Drink Plenty of Water

This can be seen as something of a preventative as well as a reactive tactic to deploy in our management of chronic pain. Food can be seen as medicine as whatever we put  inside our bodies will have a significant impact on our physical and mental health. By eating as many fresh foods as possible and following a more Mediterranean diet by favouring fresh fruit, vegetables, nuts, wholegrains, seeds, olive oil and avoiding processed foods (basically anything in a packet), then this is more likely to reduce and maintain low levels of inflammation in our bodies, whilst also lowering the chances of falling back into habitual episodes of pain. Moreover, pretty much all of our body’s processes rely on staying hydrated and so aiming for 2-3 litres of water per day at a minimum is definitely recommended. If you are someone who isn’t a ‘water drinker’ then consider getting a reusable water bottle to bring around with you to help you remember.

10. Identify a Trigger

The most appropriate time to do this is when you feel that you are getting your symptoms under control. Reflecting on the days, weeks and months leading up to the flare up beginning, there is likely something that has occurred in life that may have caused the exacerbation of your pain. Perhaps a change in job or job role, increasing the length of time you spent in the gym, increased amounts of stress or even something as innocuous as a change in footwear, can all contribute towards higher pain levels. Armed with this knowledge, this can allow you to draw up a plan of action to avoid the flare up from happening again, or at least reduce the chances of it being so unpredictable, frustrating and upsetting for when it happens again.

It’s key at this point to confirm that flare ups are completely normal. In the majority of circumstances, it is unlikely that you’ve done anything wrong. Life is unpredictable and sometimes there will come times where you may feel that you are just trying to keep your head above water but the waves continue to come. By taking the steps above, this can act as a life raft for you and hopefully give you some ideas to empower you moving forwards.