Pain flare ups are a common occurrence with both acute injury or chronic pain. Knowing how to manage them well can be the difference between being able to maintain a high quality of life or not.
Pain flare ups, simply put, are a normal part of being a human in pain. Sometimes, they are related to something you have or haven’t done, but many times, there is no discernable cause for a pain flare up.
Most pain flare ups are short term – be it a few days or weeks – which can, at the time, seem like they will never end, leading you to pursue options for relief that are ineffective, costly and possibly even dangerous.
Instead, with this article, I hope to show you some strategies you can use immediately, or store away for reference in the (unfortunate) event of a pain flare up.
Why do pain flare ups occur?
Biological systems are non-linear, complex systems. Whilst it is easy to think of recovery as a straight line from injury to repair, in reality, things are a lot more up and down. (2)
In fact, I wrote about this in the last newsletter (you can subscribe at the end of this post, so you won’t miss any future issues).
This fact alone means pain flare ups are an expected, yet unpredictable phenomenon, but beyond saying that flare ups are inevitable, there are more issues at play.
Sensitisation is the increased sensitivity of the nervous system to stimuli, whether it is at a peripheral level (nerve endings throughout the body), a spinal level or in the brain itself (3).
Because of this process, what was once a pain free task can become painful over time.
Biologically this is designed to protect us from further harming an injured area, which works well in acute injuries, but with chronic conditions, where pain and tissue damage become poorly correlated, it’s not so useful.
Lowered tissue tolerance
Whilst similar to sensitisation, lowered tissue tolerance occurs when you do not use/load body tissues appropriately over time and they decondition.
Whereas sensitisation is purely neurological, tissue tolerance is related to structural changes as well as a heightened sensitivity. The two often go hand in hand.
An easy way to understand this is with the example of muscle wasting caused by immobilisation. There is a reduced tolerance for load, and exceeding this can cause pain.
With both acute injuries and chronic pain, often the loading on the affected area is decreased, either consciously or unconciously, which leads to decreased tolerance of the tissues to loading.
Often people with pain, whether acute or chronic, expect certain things to hurt them.
I was wearing heels all day yesterday because I had a wedding, so I knew I’d be sore today.
What’s interesting about expectation, is that is a self-fulfilling prophecy.
If you think something will hurt, it probably will, thus confirming your thoughts.
That’s not to downplay the involvement of the activity in question, but there are studies that show simply priming (3) someone with “old” words and thoughts causes them to walk more slowly, without even realising it.
With this in mind, if you are expecting the worst, then chances are you’ll get it. (4, 5, 6)
What to do about pain flare ups
Every strategy to manage pain needs to be individualised to the individual – no one thing works for everyone, nor does anything work the same from person to person.
Acceptance and Commitment Therapy (ACT) is becoming more and more popular in treating/managing pain, because it is so effective (7).
What is so powerful about ACT, is that accepting flare ups will happen, and that you will be in pain, takes away their biggest weapon – frustration and disappointment.
In ACT, thoughts and feelings are not considered to be “helpful” or “unhelpful”. This is important during pain flare ups, because pain can cause us to think negatively, painting situations into worse than they are within our minds.
In essence, ACT is a form of mindfulness.
This is probably the most challenging thing to master, but when you do, the results are profound, both in the context of pain, but also in the greater context of your life.
Modify your activities
Whilst in the long term, avoidance strategies aren’t very successful, because they simply reduce what you are capable of, in the short term, as a management strategy, modifying or even ceasing activities that hurt is a viable option.
Ideally, you will continue as best you can, with what you want/have to do, but it is completely reasonable to put things off.
This makes intuitive sense: if you have low back pain and it hurts to bend, then you will likely avoid bending when it hurts.
However, as mentioned, simply avoiding bending forever is not a solution, and actually makes things worse.
A better approach is to see if you can modify how you bend, and how much you are bending in the short term, whilst working to restore the ability to bend freely in the long term, using a graded approach.
Use pain relieving techniques that work for you
When in pain, it’s natural to want to get rid of it as soon as possible, no matter the cost.
Unfortunately, there is no one medication/therapy/product that can effectively eliminate pain in everybody, all the time.
So, instead of chasing a magic bullet that drains all your time, money and energy, it makes sense to stick with proven strategies.
Once you have found your “recipe” for relieving pain, you can seek to optimise it, with less conventional methods, if they are safe.
Things you can try, which do have effectiveness to varying degrees are:
- Physical therapies (hello osteopathy)
- Exercise (this can be a double edged sword, because it can flare some people up in the short term)
- Distraction therapy
- Heat packs/patches
- Medication (it’s important to know which medications are appropriate for your pain, so speak to your doctor first)
- Topical creams like capsaicin
- TENS machines (electrical stimulation)
- Approriate nutrition and supplemenation
Focus on what you can do
It’s really hard to stay positive during pain, the whole point of pain, from a biological perspective, is to over-ride our consciousness to take alternative/evasive action from our current situation.
This means a stress response, and a stress response, physiologically, is designed for action, black/white thinking.
What this can do, is cause you to focus on negative thoughts and emotions, setting of a vicious cycle making things worse over time.
If you focus on what you can do – with both a macro and micro perspective – then you completely shift the way you are living.
After all, if you can’t control whether you experience a pain flare up, wouldn’t you at least want to control your thoughts and activities?
BONUS TIP: Spend time in nature to calm stress
Just as I was editing this, I realised it was hard to find pictures of “pain flare ups”, so instead I went for a calming picture of nature, because spending time in nature is quite beneficial for a multitude of reasons, but simply put, time in nature calms our bodies and our minds, which is a massive key for anyone in pain.
Pain flare ups are a massive challenge for patients and practitioners alike, for many reasons.
As with most things, there is no quick fix, but you can definitely improve your experience of pain flare ups in the short term, whilst in the long term, a tailored pain management strategy can help reduce or even eliminate them.
This blog post is meant as an educational tool only. It is not a replacement for medical advice from a qualified and registered health professional.