Pain Flares, Warning signs, and Management 

Flares and Management of Flares

Chronic pain and other symptoms can fluctuate over time and there may be periods where your pain and symptoms are more intense. The purpose of this module is to provide you with information that will help you prevent or self- manage an increase in your chronic pain symptoms. One way to self-manage these symptoms is to become aware of what causes them to occur.

In this module you will learn about: 

  • How to identify warning signs and factors that lead to a pain flare-up.
  • How to manage flares.
  • Developing a flare management plan.
  • Flares

    Chronic pain can fluctuate over time and there may be periods where your pain is more intense. The period when you experience your symptoms more intensely than your normal day-to-day is called a flare and is:

    • A normal part of persistent pain
    • A response to changes in environment, activity, overall health, or stress
    • Increased intensity of pain experience
    • Time-limited
    • Manageable to decrease suffering

    You can think of the pain experience like a rollercoaster: when not being manged well, there can be huge ups and downs with pain. Planning for pain flares is like a kiddie rollercoaster- there are still ups and downs, but they are not as big!

  • Flare-up Factors

    Often (but not always) flare-ups have a pattern. One way to prevent or reduce the intensity of a flare in chronic pain is to be aware of what leads to your pain flare. Pain flare- up factors can be any situation, event, or activity associated with or causing an increase in the intensity of pain.

    • Some factors such as changes in temperature or humidity are easy to identify but difficult to prevent (i.e., not within our control).
    • Other factors that are identifiable and preventable can be divided into two categories: factors related to physical activity (i.e., over activity or under activity) and factors related to tension, stress, or emotional upsets.

    • Can you think of things over the past week that may have led to an increase in pain levels? Try the Flare-up Factor Tracker to help identify your flare-up factors!

    Click here to download- Flare-up Factor Tracker

  • Warning signs

    Warning signs signal you that you might be about to experience a flare. Early detection of warning signs may help you modify the effect of the flare. Sometimes the increase of pain can be reduced by using strategies that you have learned for managing chronic pain such as changing activities, stretching, or relaxation exercises. 

    • Have you noticed any symptoms or behaviors in the past that would suggest your pain is going to flare?

    Some examples:

    Physical sensations: a gradual increase in pain intensity, tension, racing heart

    Moods: feeling irritable or depressed

    Thoughts: "it will never get better"

    Behaviors: or not wanting to engage in social activities the way you normally would

Key concepts:

  • Chronic pain can fluctuate over time and there may be periods where your pain is more intense.
  • Flares are periods that occur quickly and without warning, when your pain is more intense than your normal day-to-day experience.
  • Pain triggers are any situation, event, or activity associated with or causing an increase in the intensity of pain.
  • Identifying early warning signs can function as cues for implementing strategies to decrease or possibly prevent flares in chronic pain.

Self-management of chronic pain flares

There will be times that you experience a flare without recognizing warning signs or being able to identify a trigger. In these situations, it is important to take control and to use alternative coping strategies which may be beneficial for moderating the pain. It is important to remember that the same strategies may not work each time and you will need to try alternative approaches. The following are a few suggestions to keep in mind:

  • Set realistic goals

    • It is important to understand that you cannot totally eliminate pain from your mind during a flare.
    • It is more realistic to try to reduce your awareness of the pain or change the significance you attach to the experience.
  • Act on the pain

    • Try applying hot or cold compresses to painful areas to help decrease the pain.
    • Heat is very soothing and helps relax tense muscles.
    • Cold compresses will help reduce any swelling and temporarily numb the area.
    • Cold should never be applied directly to the skin and should not be applied for more than 20 to 30 minutes.
  • Control your breathing

    • It is natural when you are in pain to start taking quick shallow breaths.
    • This type of breathing can make you feel dizzy and anxious.
    • Using slow, deep breathing techniques (e.g., diaphragmatic or pursed-lip) will help you relax and prevent anxiety or muscle tension from increasing your pain.
  • Gentle activity

    • Avoid long periods of rest such as trying to sleep though the pain during a flare.
    • Reduce the difficulty level of your exercises for a few days. Slowly build back up to where you were before the flare. 
    • Gentle activity is good!
    • Pace yourself with mild stretches and changing positions or activities frequently.
    • Try activities that will take your attention away from the pain and stimulate you with other sights and sounds (e.g., going for a short walk, sitting in the garden).
  • Sleep

    • During a flare it is important to have a good night’s sleep.
    • Try not to rest too much during the day or try to sleep through the pain because this will affect your night time rest.
  • Medications & other therapies

    • Prescription medications should be taken regularly
    • Complementary pain management could include the application of hot or cold compresses
    • Massage and self-massage
  • Distraction

    • Distraction is another effective tool or strategy for managing pain during a flare.
    • One suggestion is to prepare a “Flare Kit” to use when you are experiencing a flare of chronic pain.
    • A “Flare Kit” should contain things that are relaxing and distract you from the pain. Examples include a favorite movie, music that you enjoy, a novel you want to read, a hot water bottle or an ice pack, massage balls, a meditation recording, and cards with instructions on relaxation and breathing and exercises.         
  • Power over pain

    • Sometimes it is difficult to distract yourself from the pain.
    • This may be a time to acknowledge the pain, accept what it feels like, and know where it hurts. Remind yourself that the pain will pass and you are in control of the experience.  
    • Think about all the interesting things you were doing before the flare and plan for future activities (especially pleasurable ones like dinner out and a movie).
    • Thinking positive about the future will help you keep perspective.

Key concepts:

  • Controlled breathing, gentle activity, hot or cold compresses, and distraction are some examples of effective tools for managing pain during a flare.
  • Reduce your exercise intensity and slowly build back up to your normal level of activity
  • Try to gain power over the pain by acknowledging that it exists, accepting what it feels like and focusing on what you can control.
  • It is important to remember that the same strategies may not work each time and you will need to try alternative approaches.

Developing a flare-up plan

When you are not experiencing a flare, it is a good time to think about the best tools and management strategies for the next time you experience a flare. Your plan must work for you! Your plan should be detailed so that you, your family, and your friends all know what you need to cope with a flare.

Keep a copy of your plan in a visible place where it will act as a reminder and help you take back control when your pain starts to increase

 

Remember that the same strategies may not work every time and you need to identify alternative options if the first choice is not effective. 

Tools many people use include: 

  • Medication(s) that your care provider recommended for you to take and instructions
  • Contact information for a supportive person to help you get through the flare
  • Your favourite music
  • Coping thoughts ("I hurt, but I am safe" or "little by little, I will improve")
  • Stretching exercises and instructions 
  • Rest intervals and relaxation techniques (hot bath, comfortable positioning)
  • Hot and cold compresses with instructions for usage
  • Distraction techniques such as a taking a gentle walk, reading/ listing to a book, or enjoying a hobby

Use this resource to help you create your own plan

Key concepts:

  • Have a detailed plan- and share it with others who need to know
  • Remember your box of tools- all of the strategies that you can use
  • Rest when you need to, then resume your activities slowly
  • Discuss with your doctor how to best use medications during and after a flare
  • Managing flares is a skill; the more you practice, the better you will be!

Conclusion

Congratulations! You have completed the flares module. You have learned how to identify factors that lead to your flares and warning signs. You have also learned how to develop a flare management plan. Remember managing your pain is a lifelong journey. As you make changes in one area, you will start to see improvements. Continue to use this module as you need throughout your life.

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TAPMI Hub Clinic

Phone: 416-323-6269 Office Fax: 416-323-2666 Hours: 8:00 a.m. – 4:00 p.m. Monday – Friday

Administration

Dr. Tania Di Renna, Medical Director William Cachia, Administrative Director