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Monday, 20 November 2017
This page aims to answer some of the questions you may have about the Chronic Pain Management Service and coping with your pain. If cannot find the answer you need, you can contact us on 01473 703435 and we will do our best to answer your query.

Chronic Pain Management Service FAQs

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My pain is really flared up. Why? What should I do?

Water being poured onto flames

We use the term ‘flare-up’ to describe times when the pain level is rapidly ‘turned up to maximum’. This can be very distressing and frightening and often people are not sure what to do for the best.

Flare-ups are NOT caused by damage or injury to the body. It is the same pain you normally experience, but at a much higher level. In almost all cases this is caused by a triggering event which aggravates the body’s sensitive pain system. Flare-up usually happens either immediately after the event, or within about 24 hours.

Triggers include:

  • overdoing an activity (such as standing, walking);
  • sitting or lying for too long;
  • inactivity (such as when you’ve been ill in bed);
  • a sudden jolt to the body (such as coughing/sneezing, tripping up);
  • an event or situation which causes you to feel stressed, low/depressed, angry, frustrated or worried;
  • a change that affects your posture (such as new/different bed, shoes, chair); or
  • a change in medication.

Once a flare-up has started, there are things you can do to settle it:

Don’t panic!

Although flare-ups are extremely unpleasant, they are temporary, and they are not causing you any harm. A flare-up is due to your nerves becoming over-sensitive in response to some event. Remind yourself that this is a TEMPORARY increase in pain which should settle within a few days. You have successfully calmed other flare-ups in the past, and you can do the same now.

Pace

Your tolerances will be smaller in a flare-up. Pace your activities into smaller chunks, regularly changing activity or position. If you are resting because of the flare-up, remember not to stay sitting or lying for too long. Break tasks down into smaller stages than usual. Do everything for shorter periods of time than normal.

Stretch

Do so more frequently than usual, and more gently than usual, using ‘mini-stretches’. This will help loosen and relieve tight, tense muscles.

Distraction

If you are able to take your mind off the pain, even for a little while or just by a small amount, do. TV, radio, DVDs, books and conversations can all help with this.

Involve other people

Let them know (ideally in advance), how they can help, so they are not adding to your stress. Reassure them about what a flare-up is (remember that they are likely to be concerned about you), and what the most useful things they can do to help are.

Cut back

By pushing on and trying to do the same amount as usual, you will only keep your system flared-up. Cut back on your activities, and prioritise your ‘to do’ list by using the ‘4 Ds’ approach: identify what you have to do, what you can dump, what can be delayed until the flare-up is over, and what tasks you can delegate to other people. Do not feel bad about this – it is a necessary part of managing a flare-up.

Relaxation

This helps calm your pain system, and relax your body and mind. Use ‘stop and flop’ regularly, and other relaxation techniques if you find them helpful (note: these will be more effective in a flare-up if you practice them regularly in everyday life). Breathe slowly and evenly, and be aware of trying to release tension in your body.

Be kind to yourself

Giving yourself a hard time will only increase your stress and increase the ‘lifespan’ of the flare-up. Give yourself a break, be kind to yourself and allow others to give you the support you need. If in doubt, think ‘what would I say to a loved one if they were in this situation?’, and treat yourself the same way you would them.

Medication

Talk to your GP or Pain Consultant about having a ‘breakthrough’ medication you can take during a flare-up. This might be a larger dose of a usual medication, or a different medication to your usual ones. In combination with other techniques, this can help calm the flare-up. Remember to come off the medication gradually as the flare-up settles.

Anything you know helps!

If you find heat / ice packs, a warm shower, or TENS, use them. Likewise, if you have any particular ways of managing pain which work for you, add them to your flare-up plan – every little helps!

Don’t delay…

In using your flare-up plan. The longer you wait to use these techniques, the more established the flare-up becomes and the harder it can be to settle. If you identify the flare-up early and start using these techniques, it will be a lot easier to bring under control.

Remember that as your overall pain management improves, flare-ups will happen less often, and become less severe. Pain management should be Plan A – managing a flare-up is Plan B.

Often it can seem as if a flare-up happens after only a very small trigger (such as bending or stretching more than usual, or tripping up). Usually though, it is a combination of factors which combine to make a flare-up is more likely – and the single triggering event is the one that ‘tips it over’ into a flare-up. For example, if you are stressed, tired and have been overdoing things, then a small jolt to your body may be all it takes to trigger a flare-up.

Sometimes people feel as if flare-ups come completely out of the blue, but this is rarely the case. More usually, there will have been an identifiable cause. Think through what has been going on the last few days, and what you have been doing – can you identify any possible triggers? If so, you can be more aware of them, and try to do things differently next time.

Please note: Usually a flare-up feels like a worsening of the pain you already have: it will feel like the same type of pain, but much worse than normal. If you experience pain which is different from your usual pain, you should visit your GP as it may be a separate problem from your chronic pain problem.