Plan for Flare Ups

It is usual when living with chronic pain that you will experience fluctuations in the intensity and nature of the discomfort. These 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 do not panic.

During bouts of intense pain, opioids and other pain medications can seem to be the only solution. However, although these may be beneficial and necessary, it is wise to pinpoint other non-drug based pain control strategies, that integrate techniques that you generally find helpful in distracting you from the pain, or helping you to relax and enter a positive frame of mind so you remain in control of the pain.


The old adage “prevention is better than cure” is an important notion when seeking to manage chronic pain flare-ups.

Pain Triggers: knowing what situations or activities induce your pain to become more intense is important for managing your condition. However identifying these may not always lead to a satisfactory outcome, since the idea of prevention only works if you are able to control the “triggers” to some extent. Hence, if the weather acts as trigger to your pain there is little chance that you will be able to control it and therefore prevent a flare-up. On the other hand, triggers like “over-activity” or “under-activity” are under your control and so are largely seen as preventable. Consequently, sitting 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.

Early warning signs: another form of prevention involves identifying the early signs of a pain flare-up coming on, and rather than ignoring the signals or resigning yourself to the inevitability of the situation, use these signs to start doing something to modify its impact i.e. relaxation exercises, develop positive visual images, breathing exercises.

Alternative Coping Strategies

Since there may be occasions when increased pain occurs without a trigger or controllable cause, or when you do not succeed in preventing a flare-up that may have been avoidable, it will be necessary to take control of the situation and adopt alternative coping strategies that will be beneficial in the short and long term in moderating any extreme discomfort.

Establish Realistic Goals: it would be idealistic to believe that during a flare-up, the pain will be entirely eliminated from your mind. It is more realistic to aim to reduce your awareness of the pain, or change the significance you attach to the discomfort.

Act on the Pain: use heat pads or cold compresses over sore areas to help relieve pain by reducing inflammation and relaxing muscle tension. Keep altering your position and gentle stretch and rotate your limbs and joints to prevent becoming too stiff and in a worse situation.

Control your breathing: when the pain is intense it is very easy to start taking shallow, rapid breaths which can lead to you feeling dizzy, anxious or panicked. It is important to ensure that you keep breathing slowly and deeply as this will help you to feel more in control of the situation and will keep you relaxed and prevent any muscle tension or anxiety from worsening the pain.

Gentle activity: involve yourself in a gentle hobby or activity which focuses you mid on something pleasant and interesting. Go for a walk somewhere peaceful, sit out in the garden or park, and change your environment so other activities, sights and sounds stimulate you.

Find someone to talk to: whether you telephone a friend, invite someone round or speak to your neighbour, talk about something other than the pain.

Distract yourself: shift your attention onto something else so the pain is not totally ruling your mind. You may choose to do some activity or simply imagine you are doing something you enjoy or find stimulating. You may want to plan something nice to do when you are feeling better i.e. a day trip with a friend, go and see a film at the cinema, redecorate a room.

Acknowledge the Pain: when in pain it can be difficult to distract yourself. Instead, acknowledge that the pain is there, accept what it feels like and where it hurts, however, do not get attached to the negative feelings and thoughts that the pain may represent to you. Remind yourself that things will start to improve and you will therefore not allow it to play a role in anymore suffering which will delay your recovery.

Hold onto the good times: during periods of intense pain time may seem to drag and everything can seem insurmountable and impossible. It is therefore useful to reflect on activities what you may have been doing a few days ago, a week ago or when the pain was less intense. This can help you to restore a more realistic perspective of time and reassure you that you will be able to survive and return to doing those activities.

Look positively at the pain: The pain flare-up may be an indication that you exceeded your limitations and pushed yourself too hard- so what positive lessons can be learned to reduce it happening again. You may feel that the pain is defeating you and there is nothing that you can do to stop it.- it will only defeat you if you allow it to isolate you from other people, destroy your relationships with family and friends and make you bitter and angry. During this period of pain look at what positive lessons you can learn, both about avoid it reoccurring again and about how you need to build up and nurture your friendships, relationships and the things that are important to you, so that you continue to enjoy life in spite of the pain.

Write Out your Flare-Up Plan

When in the midst of a spell of intense pain you may not be able to think of, or work out any effective alternative coping strategies, so it is important to work out a plan in advance. Having a plan to turn to means that you will be assured that you are in control of the situation. The very process of preparing and writing down how you can self-manage your “everyday” pain and the periods of “flare-up” pain, will instil faith and confidence that you will cope and get through the challenging periods. However, bear in mind that the same strategy may not work every time, so you may need several alternatives that you can draw on if what you try first does not appear to be working. Also remember that at the beginning of a flare up, a certain technique may not make a huge difference to the way you are feeling, but it may transform things a little later in the day.

The plan needs to be what works for you, and your pain. Everyone is an individual with their own diverse interests, hopes and dreams so they will be motivated by a variety of different factors The plan needs to be comprehensive and detailed so that someone else can clearly interpret it and understand what you need to do during a pain flare up. Keep a copy somewhere in plain sight so that it acts as a reminder and helps you take back control when things begin to slide.

Examples of things that can be included would be:

Medication: What medication; what dose; how often it should be taken.

Call a friend: Who and their phone number

Listen to a CD: Which one and where to get it

Stretch: Which exercises, how many repetitions.

Lie down: Where, how long and what to do (take deep breaths, think happy thoughts, visualise positive thought provoking images)

Apply Hot/Cold Compress

Distractions. Undertake a hobby e.g. model building, card making, painting etc; go for a gentle walk, write a letter to a friend, read a magazine.