Toolkit - Managing a Flare-Up
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.
Having a condition that fluctuates can exacerbate how we define flare-ups however. Last week I read of a new term coined by Brianne Benness: ‘Dynamic Disability’. She defines it as a disability that tends to fluctuate in severity (whether in terms of pain, energy etc), in a difficult to predict manner. Sometimes an activity may keep you at a pain volume of three whereas another day of doing the exact same things can feel like an eight. I think this can be a really useful way of framing a variable health condition as it could help differentiate between a bad day making things more difficult, and a full-on flare. For example, I know that on a bad day trying to prep and cook a meal can feel like an eight, but I can possibly still manage less intensive activities. A flare would tip that meal prep into a nine or above and would have a severe impact on my ability to do other things as well.
If you’ve used pacing techniques to help you figure out your baselines for activities, it can be a really useful measure to know when you’re perhaps hitting a peak for how long you can manage to do something before triggering a slight increase in pain or when you’ve passed that point and the pain volume dial has gone straight to eleven – a flare-up. Of course sometimes it’s not because you’ve overdone things – flare-ups have a nasty habit of just deciding they’re going to pop in and hang around for a while! Being fully aware and in touch with your own body so that you know the difference and can identify a flare-up is so important though and I’d definitely urge you to spend some time getting really familiar with how it feels different. For me this is the important first step in creating a flare-up plan.
It might be useful to keep an activity diary and think about the following:
1. How often are you experiencing flare-ups?
2. Is there a pattern or trigger them?
3. How long do they normally last for?
4. How long does it take you to recover to your normal levels of pain and activity?
The next step I’d recommend is thinking about what your current normal reaction to a flare-up is. What thoughts and emotions come up? Are there any physical sensations that occur? Finally, what is your behaviour during a flaring up – are there things you do or don’t do?
Frequent thoughts might be things like “This is never going to end”, “I’ve done too much and hurt myself” or “Why is this happening AGAIN?”. You might feel angry or frustrated, upset or even guilty that you can’t manage to do everything you want or need to. Physical manifestations could include tensing parts of your body as a protective measure or your breathing changing. Behaviour wise the temptation is often to stop all activity, giving our bodies time to rest and recover. (I have written previously in my Pacing post about how this last behaviour in particular is one to be avoided so be sure to have a read of that!)
Once you’ve taken some time to think about and maybe journal on what your flare-ups currently look like, the next key question to think about is: is the way you’re currently dealing with them working for you? It’s difficult to change your feelings or the physical sensations you experience during a flare, however, you can try to change your thoughts and what you do. This is where a good Flare-Up Plan comes into its own!
So, instead of thinking “This is never going to end” you could reassure yourself “Don’t panic, remember this is only a flare and in time it will settle”. Instead of resting for a whole day, you could try breaking up periods of rest with gentle stretches and a small, manageable activity you can spread out throughout the day. Psychologically this will help you feel you have ‘achieved’ something despite the pain – particularly useful if like me you put pressure on yourself to be achieving things with your day!
One of the things a good plan should do is allow you to move through the situation smoothly, feeling supported. The last thing we feel like doing when experiencing a flare is engaging our brain to look for solutions right? Which means that planning for it, if and when it happens, takes some of the immediate stress out of the situation. Being specific here is also very helpful: instead of just saying “phone a friend”, think of exactly who might best be able to support you through a flare and ask them if they’d be okay with being your go-to person. If there’s a film that never fails to make you laugh, stick it on the list.
All that’s left to do is try out your plan when you next have a flare and see how well it works for you. If there’s anything that didn’t – swap it out for something else! Play around with it until it feels right for you and keep it somewhere handy. It might also be worth sharing with family and friends who can help you implement it when needed.
Here is a sample Plan that you can use for ideas on the kinds of things you can include – note you do not have to have as many as eighteen points, ten is probably ideal! If you have any other suggestions please leave a comment and let me know!