Today’s Forecast by Cynthia Yolland

Dealing with a flare-up of pain and symptoms is one of the hardest and loneliest aspects of living with severe chronic pain. They can come on for no reason or be triggered by over-activity, barometric changes in the weather, even something as seemingly innocuous as being knocked can ignite a flare-up of pain. The list is of triggers can feel endless. Flares disrupt your life and can leave you feeling helpless and depressed, especially if you have no coping strategy in place.

In the spirit of supporting and caring for my fellow pain warriors and princesses, I have created a Flare-Up Tool-Kit to strengthen your ability to cope with these unwelcome visitors, as well as minimise the chances of flares happening and weather the storm when they do. Sign-up at the top of this page.

You can also see this extended offering on: coping with flare-ups, setbacks & extended flares of chronic pain—with tools to help you manage, recover & cope.

One thing you can do to minimise flare-ups and set-backs is to pace and plan your activities but for all the other times, whether your flare-up lasts a few hours to a few days, preparing a ‘Flare-up Box’ is one thing you can do to help yourself during those bed-bound times of extreme pain.

Flare-ups may occur very suddenly and persist for prolonged periods of time so it is natural that you may feel particularly upset and dispirited, but try not to panic.

Remind yourself that you’ve been here before and have coped. Maybe it’s sending an sms to a friend, doing relaxation exercises, loving a pet or doing visualisation exercises.

Mark this page and read or say the following:

“I am strong. I am getting through this. Remember I have done it before.”

Flares disrupt your life and can leave you feeling helpless and depressed, especially if you have no coping strategy in place. One thing you can do to minimise flare-ups and set-backs is to pace and plan your activities but for all the other times, whether your flare-up lasts a few hours to a few days, preparing a ‘Flare-up Box’ is something you can do to help yourself during those times of extreme and vicious pain.

It is important to have a plan ready ahead of the experience of flaring-up because once a flare begins, it’s far from possible to concentrate on the management of it, which of course only serves to add to the challenges, stress and discomfort. Many pain management experts and patients alike suggest listing an action plan and a flare-up box takes that idea a little further. It’s a brilliant way to ensure that everything you need is on hand.

young woman with a vintage suitcase in the middle of a deserted

Create a flare-up box

A flare-up box should contain various items that calm and please you; this is a time of suffering and providing yourself with comforts is nourishing to the self and helps you cope. Examples would be:

MP3 player (with music and guided hypnosis, relaxation techniques, meditations and audio books), magazines and books, your favourite films, stand-up comedy, inspirational photographs, a journal for these times if you’re able to write, your favourite snacks, beautiful photographs and images, a Kindle or e-book reader, a scented candle (always be careful with flames), things to make you laugh, things to make you calm, things to help ease your suffering. Whatever is personal to you and nurturing.

Acknowledge the Pain

When in a flare of pain it can be difficult to distract yourself from it. When you acknowledge that the pain is there, and accept that it’s awful, accept what it feels like and where it hurts and so on but do not get drawn into this and attached to the negative feelings and thoughts that pain represents.

It will only serve to make you feel worse, which is the last thing you need at such a difficult time. Remind yourself that things will improve again and you with them. Limit the pain’s role by not allowing it to play a role in anymore suffering which can delay your recovery from the flare.

Is it Breakthrough Pain, a Flare-up or a Set-back?

Breakthrough pain is when your usual drugs stop working for anything from a few minutes to a couple of hours and is serious enough to upset the lives of people who are already trying to control chronic pain with one or more drugs. Breakthrough pain is not a new pain but when a more severe episode of your pain ‘breaks through’, and increases.

Another problem is called end-of-dose failure, which happens when a patient is on a long-acting opioid. Although the medication is meant to last 72 hours, for example with a Duragesic Fentanyl patch, in some people it lasts less and must be changed every 48 hours. The person experiences breakthrough pain when the long-acting drug is not effective for the intended length of time, which in the case of fentanyl can also happen if the pain patient is skinny due to limited amounts of subcutaneous fat, which is how the body absorbs the fentanyl.

Flare-ups last longer than breakthrough pain and the worst of all are set-backs, lasting anything from days to months or even longer. Seek your doctor’s help in listing the medicines you can take in times of emergency. Note down the exact dosage and frequency of these medicines so that you obtain the optimum result within the shortest time.

Easing Pain During a Flare-up

When you live with chronic pain there are times when your pain levels will flare up. Sometimes you can determine why, but other times it’s a horrible surprise. No matter why your pain flares up, you need to find safe effective ways to cope with the amplified symptoms. This requires having a good plan in place.

Ensure you have ‘breakthrough’ medication on hand; Hydrate yourself, dehydration increases pain; Take a warm soak using Epsom, Himalayan or Dead Sea salts – it is so soothing to the whole body, especially tight muscles and connective tissue; try relaxation techniques (see below) also be sure to check out the Pain Management page.

It is common and natural to have negative and unhelpful thoughts when pain is at its worst. Whilst it may be difficult not to have any negative thoughts, it can help if you at least try to think and talk to yourself in a constructive manner. This can encourage hope that you can manage a flare-up. This is a way of trying to “psych yourself through times of intense pain”. You will need to develop your own words and phrases that help you. Here are some examples that you may find useful:

“I know it hurts right now but I know I can handle it because I have been through this before and it will settle in time.”

“I am calm, and relaxed. Tension isn’t going to help me. I choose to keep breathing slowly and deeply.”

“The pain is bad but I choose to be kind to myself and remember what I have done in the past to help myself.”

“I know that this will be over. I am a warrior, brave, bold and surviving.”

It may well be a challenge to be very positive and optimistic during a flare-up. However, it is important to try and reduce the amount of negative and unpleasant thoughts. These will only make you feel worse when you already have a huge amount to deal with.

Relaxation and Coping Techniques

The many different forms of meditation to body-scan relaxation, autogenic training, progressive muscle relaxation, diaphragmatic breathing (and other breathing techniques), self-hypnosis or guided hypnosis, visualisation and creative imagery. There are many different techniques you can learn; experiment with the above list and find something that works for you. Visit Pain-Relief and Coping Techniques for Severe Pain.

Recognise what is happening
Don’t panic
Take your medications regularly as advised by your prescribing doctor
If you are unable to continue with your pain management exercises for a couple of days, remember to start again slowly and re-set your goals and pacing times if you need to
Try to think positively – negative thoughts can only worsen your pain
Be kind to yourself
If the flare-up carries on for more than a few days and becomes a set-back, contact your doctor

Things to Remember About Flare-Ups and Set-backs

Stay calm! Episodes of more intense pain are a normal part of the experience of chronic pain. Flare-ups will happen.
A flare up is not a time to give up. It is a problem to be dealt with, even though it is always a challenge, you always get through this.
Have a plan about how you are going to manage a flare up (think about this when you’re not having one and try the suggestions above).
Remember your “box of tools”.
Be realistic. You can aim to reduce pain and cope mentally (hoping for no pain is not usually realistic).
Tackle those negative, unhelpful, self defeating thoughts. They only make you feel worse and actually increase your physical and emotional pain.
If you need to, take a complete rest, but only for two to three days and remember to amend your pacing limits accordingly, starting to mobilise slowly by setting yourself some simple goals.
Try to relax with whatever method is best for you – guided MP3s or CDs can be a great introduction to relaxation. Try one of Glenn Harrld’s Hypnosis CDs here from Amazon. Remember that tension just makes pain worse and relaxation therapies are your first line of defence.
Managing pain is a skill – the more you practise the better your life with chronic illness and pain will be but never be disheartened if you feel that you are losing the battle – take a look at the Pain Management page and see why you are having so many flare-ups of pain – it could be that you burn yourself out on your ‘good’ days and collapse in a heap afterwards in agony leading to ‘bad’ days; or your baseline medication needs to be increased. Pain Specialists say that if you are experiencing four or more breakthrough pain episodes a day, your 24 hour/baseline medication needs to increase.
Plan and discuss with your doctor how best to use medication, during and after a flare-up.
If you can, log onto your online support or friends with pain on Facebook, Twitter and other social networks you enjoy. Though obviously, only if the support os not offset by the pain it causes to do so.

Pain Triggers

Work out your pain triggers, for example too much or too little activity, weather changes, staying in the same position for too long, overdoing exercise etc. Also always take note of what has helped in the past. Knowing some of the triggers can help minimise flare-ups.

Knowing what situations or activities induce your pain to become more intense is important for managing your condition. However, identifying these may not always be of benefit, as the idea of prevention only works if you are able to control the ‘triggers’, which is not always possible.

Sometimes you do an activity that you know will result in a painful flare-up, such as a loved-one’s birthday for example. In these instances you weigh-up the consequences but to go will offer you love and connection, which is even more paramount for those living with severe chronic pain and illnesses.

If the weather triggers your pain, you obviously cannot control that or prevent a flare-up. Triggers like ‘over-activity’ or ‘under-activity’ are more under your control and so more preventable. Consequently, sitting or lying still for too long in one position or performing certain repetitive movements may prompt increased discomfort, so knowing that these will activate your pain will allow you to take avoiding action.

Keeping a ‘Pain Diary’ is another vital tool for both you and your doctors and there are now Android and iphone apps to record your pain if you own a smart phone; alternatively, read the section on pain diaries (with links) on the Pain Management page.

Read this wonderful post written by fellow CRPS warrior/angel/pain princess, Lili Wilde: Pain Flare – Taming The Beast. You may also enjoy my post on this topic and coping with extended flares and setbacks here.

Free Flare-Up Toolkit

Sign-up for a free Flare-Up Toolkit and a newsletter with regular tips and coping advice for managing your chronic pain and illness. Additionally, the Princess in the Tower Facebook page is there for YOU, make friends and offer others support when you can, in turn, let others help you when you need it too.

Even the strongest have wobbles from time to time, let yourself be loved.

Gentle hugs,

Princess x

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