Liz MacLeod is a physiotherapist with a pain management programme. She discusses why it’s so hard to keep those flare ups at bay.

One of the main difficulties faced by chronic pain sufferers who attend our pain management programme is flare up of pain. People often say that if their pain stayed as a constant ache, they would manage to deal with day-by-day activities and would probably not be attending the programme. Flare up, on the other hand, leads to a feeling that the pain is in control and the pain sufferer is left with a sense of helplessness.

FINDING A TOLERANCE LEVEL

One of the main strategies taught on the pain management programme to help people reduce flare-ups is pacing. We ask patients to decide the amount of an activity, task or posture they can manage before the pain kicks in, and set that level as a tolerance level. If they don’t go beyond this level they will keep the pain under control and manageable.

Seems simple? In theory, yes, but in practice it can be difficult. Practical problems with mobility, access to shops or leisure facilities, limited public transport can all lead to compromising tolerances. The demands and expectations of others, friends, family or workmates, can put pressure on the pain sufferer to push into flare up. Some people feel unable or reluctant to ask for help, in case others think less of them for not being able to do what they used to do, or for not "pulling their weight". They may feel patronized or treated differently by friends or family if they have to ask for help. Many pain sufferers are determined that their pain problems are not going to be a negative influence on their children’s lives and they push through pain to, for example, play football with the kids or go on shopping expeditions with teenagers.

Another common reason for ignoring tolerances is that people are angry at their pain and set out to "beat it". They report being unwilling to "give in" to the pain or are determined not to "lie down to it." Others feel they cannot let the pain interfere with basic beliefs, for example, "if a job’s worth doing, it’s worth doing well". "If I start a job, I have to finish it" is another commonly held belief that results in flare up.

There are many more reasons for people having difficulty sticking with tolerances, but even mentioning a few, highlights how resourceful pain sufferers have to be to manage their pain effectively.

LEARNING TO NEGOTIATE

During my work in pain management I have watched as some pain sufferers have made major changes to their lifestyle and reduced their flare-ups, while others have made little or no changes and endure the pain patterns, which result in ongoing distress. The main difference, I believe, is the pain sufferer’s ability to negotiate with their pain. The pain always beats those who see the relationship as a constant battle, which they are always trying to win. Those who negotiate and reach an “I win, you win” situation with their pain, manage their pain and improve the quality of their lives.

LESS OF A FIGHT

Some pain sufferers have found it helpful to think about their pain in the same way as, perhaps a diabetic would consider his or her diabetes. Diabetics have to see their diet as an important part of managing their disease. If they eat the right kinds of foods at the right times of day, their diabetes is under control and they will avoid feeling ill, collapsing or even admission to hospital for therapy. Foods such as chocolate cake might be avoided in favour of a piece of fruit. In time many diabetics would not even consider chocolate cake as an option and would not miss it. Can you imagine trying to eat the cake to “beat” the diabetes? Much more can be gained by negotiating with the condition we have to live with.

Establishing tolerance levels and putting them into practice, is a good negotiating strategy when it comes to dealing with pain. It reduces the chance of flare-ups, and with time and practice, leads to a sense of control over the pain. This sense of control results in a better quality of life. If you think of this kind of negotiation in the same way as diabetics have to view their diet, it may feel easier to ask for help to do a task. It may seem less of a fight if, for instance, you have to slow down a walking pace or divide gardening activities into fifteen-minute chunks of time.

If you need help to negotiate with your pain and want to know which strategies would be best for you, Pain Concern has a useful Factsheet and many members have expertise and contacts that could help. Your doctor would perhaps consider you for referral to a pain management programme where staff would help you to improve your negotiating skills!

Physio Footnotes © Liz MacLeod. All Rights Reserved.