Managing a Flare-up
Most of us have a repertoire of things we might do when we are unwell, have a headache, an ache somewhere. But sometimes when pain (wherever in the body) leads to us being unable to move, unable to sleep, we have a tendency to over-think. The system goes into panic and we develop brain-fog.
Pain is a physical and emotional experience. We cannot separate the two entities. Pain is a normal and useful response to most unfortunate incidents as it is an important protecting mechanism. But, we also need to be mindful that the intensity of the pain is regulated by our thoughts and emotions. The easiest way to explain is to use football. Have you ever watched the reaction of the losing side when they are injured? It is soooo way over the top! But, there is anxiety and expectations linked with the injury and the response to the pain experience tends to be magnified.
By recognising that the body works as one, it helps to improve how to manage a flare-up. The brain is amazing as it helpfully forgets previous pain experiences e.g. childbirth and sometimes we need to remind it that we did survive the previous experience.
There are three components to the management of pain:
The body (physiological), the brain (psychological) and then your actions (behaviour).
A good plan will have strategies to manage all three components
1. The Physiological - what is happening locally and within the body.
Thus, things like medication, heat or ice (own preference), massage, rubs, acupuncture/acupen, TENS machine; all change the feedback from the area in different ways.
None of these things will “fix” the pain. In the world of pain medicine, we always say that if there is a 30% difference then it is doing the job.
The one area that no one will consider, is exercise. This is why I like to call it movement and not exercise. Movement is crucial as it helps with
circulation, relieve muscle spasm and is the one thing that you can have total control over. Most important though is the expectation when doing movements – you are not trying to fix it! And following a no pain no gain attitude, can only irritate it more.
Gentle, easy movements in a position that is most comfortable is crucial and sometimes even starting at a different body part can trick the brain into allowing gradual exposure to improve movement. Walking short distances, if able, is a great way to start.
Also, combining it with the other strategies, moving while having an icepack or heat on the part can be really beneficial. Planning it to when the medication has started to work etc.
2. The Psychological - managing your emotional response to the pain
First stop is BREATHE!!! Pain triggers our stress response, (Fight or Flight) as it is a threat. Breathing is very important as first of all it allows us time to respond in a more appropriate way, time to think and secondly, it can alleviate the muscle response. The other two goes hand in hand - first thoughts and then your emotion to your thought. Feeling panic, anger, frustration, sad - all heightens the part of the brain where you experience it. Therefore, it is good to get a “mantra” /self-talk. Possible affirmations to use are “been there done it”,” not the first time” etc. Choose something that reminds you to stay positive, as the last time it did get better.
Distraction is possibly the most powerful painkiller there is. The brain is unable to focus on two things at once. Hence anything that keeps the mind occupied, does not allow for constant body scanning - computer games, television, work, music, reading. Distraction strategies however needs to be done with caution. If we get too engrossed in the activity, we forget to move and only when we are back in the here and now it reminds us that the pain has never gone away in the first place and you and as you did not pay it any attention, it will grumble a 100-fold more.
Endorphins are our body’ happy hormones and a natural morphine in the body. When thinking about your personal plan it is also a good time to reflect on what makes you happy? The above distraction strategies can be combined with things you enjoy – a happy playlist, a funny feel good movie, food with happy memories, photo’s with happy memories and last but not least Chocolate! Even if one does not feel like laughing - it has been shown that just looking at something funny activates the right parts of the brain.
Communication during a flare-up is crucial. Nobody else can feel or experience YOUR pain. Someone might have had similar symptoms, but no two people respond to pain the same way. Do not assume that another person should know how you are feeling. Quite often they would like to help, but feels helpless. But by sharing the plan with them, can act as a helpful reminder in applying the strategies and understanding how to react.
Relaxation done well can be part of relieving the stress response but is also an active distraction strategy.
3. Behaviour - what you do and decide to do
In this section we tend to focus on the p’s.
Plan, prioritise and then pace.
Plan what you think you can do and prioritise what needs to be done. Maybe it is a day of phone calls instead of cleaning etc. rest is not all bad, but if you sleep for prolonged periods during the day, it impacts on the night time sleep pattern.
Pacing is probably the most difficult of all the strategies. Pacing does not mean stop when it hurts. It is a strategy that allows you to manage tasks according to the pain and acknowledges that activities might increase the pain. However, if you manage pain with respect and not push through the tasks but break it up into bite size bits, it might take you longer but it will help you achieve one thing by the end of the day. A timer can be very helpful in case distraction is too powerful.
By using the plan, no individual thing above will fix it. But by using all the known strategies, each of them can make a significant change to maybe make the pain more manageable and allow you to cope.