28 September 2015. When I look at this photo all I can see is the sheer exhaustion I was feeling at the time, not fully understanding why it was something that seemed to seep to the very core of my being.

I was 2 months post-op at this point, my body having undergone trauma as my femur broke after surgery, which then required further surgery. I was on a number of pain meds, including morphine. I thought it was just taking a long time for my body to recover, adjust to the meds and for my energy levels to come back up.

By Christmas I was falling asleep literally sat upright and mid-conversation with people and something didn’t feel right. I’d had 24 years worth of experience in operations, strong medication and post-op recoveries by this point and this was just … different.

When I posted recently on Instagram about throwing my back out and putting my flare-up plan in place my thoughts halted. What do we even mean by flare-up? It’s a phrase used so often but do people really understand what it means? And what the heck is a “flare-up plan”?! Let’s dive in …

My pain management programme defined a flare-up as being your usual pain, with the volume turned up to the maximum - not new pains or signs of a new injury.

Given how overwhelming pacing can be to tackle I have broken it down into four key elements: WHAT it is, WHY it is so important, HOW we can do it, and WHEN we should be doing it

Taking it step by step, this will hopefully demystify the process somewhat and make it easier for you to see which of the areas you need to tackle - it may be just one key element that’s missing or you may need a review of all of them, it’s all okay, you start where you need to.

It took until I was in my late teens or early twenties before the concept of a ‘boom and bust’ cycle became part of the pacing vocabulary, and although the idea was talked about theoretically that doing too much led to me doing too little, all that really amounted to was trying to make sure I didn’t fall into the trap of doing absolutely nothing on recovery days. Ideas such as baselines were still not in the picture and I was still clueless about pacing my actual activities.

In all I probably spent about fifteen years trying to figure out pacing on my own: no small ask!

What actually prompted this post is the fact that a few weekends ago, I ran out of two of my pain meds. I messed up and so did my GP in changing the quantities I was prescribed, which unfortunately I didn’t catch in time. I had 3-4 days of withdrawal effects as I was essentially going cold turkey – never, ever, ever recommended. It took the better part of a week to get back to ‘normal’; however one thing I did note was that I had absolutely no increase in pain levels.