Liz MacLeod is a physiotherapist with a pain management programme. She looks at flare up planning.

In my leaflet Good Days and Bad Days, I discussed the overactivity-rest cycle and the difficulties it causes. We looked at ways of pacing and spacing activities, which would result in more control and better outcomes. It has been shown that patients who can plan activities by using baseline levels as their guide are less likely to flare up their pain.

The baseline level is the level of an activity you can do before you feel you have to stop. Always remember, that’s before you feel sore. This involves you timing the activity, being practised at judging how much you can do, and it requires you to stick with these levels at all times. Even if you become expert at this, there will still be occasions when you flare up. Situations may arise when you have to respond without being able to plan effectively and you may overdo things. One morning you may wake up after lying in an awkward position and find your pain has flared up.

ACCEPTING THE PROBLEM

Patients on the pain management programme have said that, prior to attending the course, their only way of dealing with a flare up was to give up on activities, rest, take more medication and wait until the pain settles down again. As many of you will recognise, this can leave you frustrated, fed up and feeling that you have little or no control.

SO WHAT ELSE CAN YOU DO? Maybe the first thing to think is that flare up of pain is part of a chronic pain problem and will happen, so perhaps trying to accept this is useful in itself. If you can view the flare up as part of the problem – a real nuisance but not something to worry about – you are less likely to become as agitated and annoyed in the circumstances. And you will be more able to work at managing the situation.

KNOW YOUR TRIGGERS

We ask our patients to think about what may have triggered the flare up. If there is a clear pattern, it’s easier to avoid the same set of circumstances in the future. If you don’t avoid the trigger then you can expect another flare up! Sometimes it is difficult to associate an activity with pain when the flare up occurs the day after you have carried out the activity or maybe even the day following that! If you have difficulty identifying the cause of flare up, it can be useful to keep a diary of your activities and at the same time a score of your pain. You can then look back over your week and see if a pattern arises. We had one patient in our programme who noted that an increase in her pain occurred two days after her baby grandchild came to stay for the morning. She then began to notice that when she was feeding the baby she sat in an awkward posture in the chair for the duration of the feed. She rearranged the seating position, shared the feeding task with granddad and the flare up of pain two days after babysitting no longer appeared! If there is no apparent trigger it will be difficult to know what to avoid; you will have no warning, so it is essential to have a clear plan for coping.

HOW TO MANAGE A FLARE UP

SOOTHE THE PAIN Note the things you do that make your pain easier. Maybe a heat pad or warm bath. What about a visit to your local Jacuzzi? Many of our patients have been surprised at how effective a Jacuzzi can be in helping them relax. The whirling water soothes their tired, painful muscles which feel in spasm or are guarding the pain. If massage helps you then this is the time to use that option. Sometimes lying down for a little while can help. When you have a flare up it is tempting to lie down for longer periods, but too much lying can result in feelings of stiffness, so short periods, often, are more likely to lead to success.


RELAX Have you learned any relaxation techniques? Your muscles hold you tightly and guard more when you have increased pain, so learning how to let go and ease the tension can be really helpful. Relaxation can help you feel calmer and more at ease with the situation. Your local library may be able to lend you a tape or there may be relaxation classes nearby.

DISTRACTION helps too – being able to take your focus away from the pain and think about something else. Examples are counting how many doors in your street are painted black, or trying to make a word from car registration letters! Imagine a situation where you felt peaceful, in control, and happy. Use the image to help you remember how that felt and how enjoyable it was for you.

These are all examples of ways that can help you feel calmer, less tense and more in control of your pain.

CUT BACK ON ACTIVITIES In flare up it’s always a good idea to cut back slightly on your activities, but not to give them up altogether. There is a risk that you will lose fitness for these activities if you stop them. After all, the flare up may last a week or two, which is plenty of time for your muscles to lose tone and your cardio-vascular system to become a bit sluggish. To cut back on activities, you may need to ask for a bit of help from family, friends or work colleagues. As the flare up begins to settle, you will be able to get back gradually to your usual levels of activity.


CATCH THE NEGATIVE THOUGHTS Feeling fed up and frustrated with your situation is normal in times of flare up. It is at this time though that the unhelpful thoughts creep in which lead to anxiety or low mood. Try and be aware of these and nip them in the bud! Remember the flare up will settle and you will get through it.

MEDICATION Hopefully, if you have had success with the above strategies, you will not need to take more pain killers. If, however, you feel some extra medication would help you over this time, you should plan this too. It is useful to have a plan for the dose you will take during the flare up and also know how long you are likely to need your medicine before cutting back. You can use your experience and knowledge of flare up to help you plan this.

Patients who tackle flare up in this way will have worked out a mini plan for a flare up lasting a day or two, and a plan for a longer period of flare up. They know how and when to cut back to get the most effective cover. A flare up is no fun, but if you can plan for it and feel more in control, it may be easier to manage and less stressful. I hope so!

Physio Footnotes © Liz MacLeod. All Rights Reserved.