Pain flare-up plan

What is a flare-up?

Flare-ups are a very common part of having long term pain, even when you are getting better. Flare-ups can disrupt your normal daily activities and may last from a few days to several weeks. Having a flare-up can make you feel down, disappointed and very frustrated.

What triggers flare-ups?

Flare-ups can be caused by many things such as:

• feeling low or stressed
• having an infection
• falling out with friends
• doing exams
• changing schools
• over-doing exercise
• suddenly increasing activity

Sometimes there does not seem to be a trigger, they can just happen.

Flare-ups are very common but the good news is what you do during a flare-up can make a big difference to the impact on your life, the length of time it lasts and how often they might happen.

How do I manage a flare-up?

Remember that flare-ups are only short term problems.

Do not stop everything and rest. The longer you stop the harder it is to get going again.

Follow your flare-up plan as soon as you notice the signs that a flare-up might be happening. A personal action plan for flare-ups helps you know what to do to stay confident and in control.

Remember to ask for help or advice from people who have helped you before such as doctors, therapists, nurses, teachers friends and family.

Step 1: Noticing

Noticing what is happening when a flare-up starts can provide the first step to managing things effectively. This includes the physical and emotional changes that happen with a flare-up, and also what you and others do to cope with it.

What are the signs that you may be having a flare-up or set back?

For example: your pain feels worse, you notice increasing or new areas of sensitivity, you feel more tired than usual, you are not sleeping so well, you feel more irritable, your mood seems lower, you feel overwhelmed or anxious.

Put your own examples here:

Are you doing things differently?

For example: spending more time in your room, having longer lay-ins, choosing not to see friends or join in with family activities, cutting out sport or clubs, missing more school or falling behind with homework. You may notice you are moving or walking differently, or resting more.

Put your own examples here:

What do other people notice about you?

For example: you are looking pale, you move differently or guard a part of your body, you seem more tired, sleeping in the day, you are short tempered, you have difficulty getting up in the morning, you are missing more school than usual or spending more time in your room, you are choosing not to do things, you seem less talkative or tearful, you are relying on others to help you more than usual.

Put examples from your family and friends here:

Step 2: Checking the bigger picture

Looking at your day to day life may help you understand why a flare-up has happened, and give you clues to help you recover. Not all flare-ups are linked to recent events and sometimes it is hard to find a reason. However, the questions below can still help you get back on track.

Your personal check:

• Have there been any stressful events in your life recently?
• Are you doing more than usual?
• Is your sleep disturbed?
• Have you had any infections or injuries lately?
• Do you have some other health problems at the moment?
• Have you stopped or changed your medication?
• Have you gone back to old ways of coping or got stuck in the ‘pain cycle’?

Step 3: Reminding yourself about pain management

When a flare-up happens it is easy to forget all the information you have learned about managing pain and what has helped before.

When pain or other symptoms flare-up the brain focuses on the problem, and you are more likely to think about the difficulties it causes. This restricts access to other more creative or reflective parts of the brain, making it harder to remember new information or positive things you have achieved.

To help you get back to a more balanced view it helps to remind yourself about pain management ideas:

• Understanding how pain works and what things affect how much pain you feel.
• Accept that you are having a flare-up and that it is a normal part of pain and recovery. Strong feelings of anger or stress can increase pain levels and slow down recovery.
• Having daily routines for sleep, rest, activity and meals.
• Keeping to consistent levels of activity from day to day to help level out good and bad days (the Boom and Bust cycle)
• Keeping up with your exercises to help build your strength and keep you mobile as best you can.
• Using desensitisation strategies regularly including touching and moving sensitive or painful areas.
• Aiming to be as independent as you can. Other people may want to help you more when you are in more pain or upset. This may be necessary at first but you should aim to get back to doing things for yourself as quickly as possible.
• Doing a wide range of different activities such as mental and physical, study, seeing friends and other interests. Do these in manageable chunks. You may need to do things for less time, or in an easier way at first.
• Being kind to yourself (and your pain) allowing yourself time to recover.
• Asking for advice if you need it. These can be from family, friends, teachers, doctors, therapists and other people who you know and trust.
• Holding on to your personal goals and working towards them, even during flare-ups.

Step 4: Creating your own flare-up plan

Using the information from steps 1 to 3 you can now create your own plan to help you when you experience a flare-up (or set-back).

In the first column write down things you and other people notice about you when you have a flare-up. This includes what you feel and do (how your behaviour changes) and what happens. You may want to add things that other people do (like bringing you food in bed for example).

Next to each item, in the right hand column, fill in some ideas that you and other people can do to help you work through the flare-up with confidence. There are some examples to help you at the top of the plan.