People with chronic pain talk about episodes of pain flare-ups.
A pain flare-up is a sudden outburst, an episode of intense aggravation of the usual pain.
It may last hours, days or weeks, and then, it subsides, the pain gets back to the usual
pattern and intensity.
Why do these pain flare-ups happen?
Is there anything you can do to avoid them?
Can you do something to shorten the duration of pain flare-ups?
So, let’s talk about pain flare-ups today.
Pain flare-ups are very common.
People with migraines, fibromyalgia, chronic neck or low back pain, and complex regional
pain syndrome usually ask me about flare-ups.
Your life seems to be going okay; your pain is stable and controlled.
And then, one day, with no apparent trigger, no identifiable cause or special warning,
your pain is much worse; it may become incapacitating and debilitating.
It is frustrating.
You had plans for the weekend, and now, you know you will be unable to go.
Or you have an important deadline, a test, or travel, and you worry about how will you
fulfill your obligations in the middle of this flare-up?
So, here is a common train of thought that occurs when people have a flare-up:
At first, you might be thinking: “Is this pain a sign that there is a serious disease
that was missed”, “Is this a sign of cancer?”, “Is this pain a sign that I’m having a
stroke, a neurological injury or an inflammation?”
Second, you might be thinking: “This is going to ruin my plans”, “This flare-up
episode will last days, weeks or even months, or maybe I’ll stay like this forever and
my pain will never return to what it was before”.
Third, you maybe thinking: “I am a failure”, “I’m having this flare-up because I didn’t
take care of myself, I didn’t exercise, or I exercised too much”.
Fourth train of thought: “This flare-up is my doctor’s fault”, “If my doctor
had just given me more painkillers I would not be having this flare-up”.
And fifth train of though: “There is nothing I can do about this flare-up”, “I’ll
just lock up myself in a dark room and stay there many days until it goes away”, “I
don’t want anyone to see my like this”.
Well, before I explain to you how you can resolve a pain flare-up, let’s tackle each
train, let’s look at then and see what is going on.
The first train.
This is the train of false alarm.
They think: “Is this pain a sign that there is a serious disease that was missed”, “Is
this a sign of cancer?”, “Is this pain a sign that I’m having a stroke, a neurological
injury or an inflammation?”
There is a very good chance that this pain flare-up is not a sign of a serious disease
or cancer or stroke or neurological injury or an inflammation.
How do I know this?
I don’t.
But chances are that you had many flare-ups before in your life, and none of them were
a serious disease like one of these, so, this is just one more flare-up in your list.
A person with chronic migraine knows this very well.
Every episode of migraine is a type of “flare-up”.
And they have many episodes like this in their lives.
If they rush to the emergency every time they have a migrane attack thinking that they have
a brain hemorrhage, that would be ridiculous.
A person with migraine knows that.
And they know that if they have a type of headache that is different from their usual
migraine attacks, then it is a good reason to go to emergency.
See my other video about migraine to learn more, more about this.
So, the first train of thought is very deceiving because you may be trapped in the pain-worry
cycle.
This cycle is very simple.
You feel pain, then your amygdala, which is the fear centre in your brain, will be activated,
then you will worry about the pain, and once the amygdala is activated you feel the pain
more intense.
It is almost like increasing the volume dial of your pain, so now, you feel the pain more
intense, guess what, you will start worrying more.
So, here is how you end the first train: In order to end the first train of thought,
you need to tell your brain that there is no need to be worried about this pain.
You need to convince yourself that there is no new danger, no new injury, it is not a
sign of a serious disease.
But how can you know for sure that this is not the case?
You can’t.
That is why you need a good doctor to reassure you of that.
If this is the first time you have a pain flare-up, make sure you connect with your
doctor.
But if this is your tenth or hundredth flare-up then you already know that this is just a
part of having chronic pain.
Flare-ups are very common in people who have chronic pain of nociplastic origin.
If you want to learn more about nociplastic pain, watch my other video here.
BEFORE I CONTINUE, let me remind you that this video is not intended to provide medical
advice, it is for educational purposes only.
If you have a medical condition that requires treatment, please talk to your doctor to get
a treatment plan for you.
And if there is any emergency, please go to the nearest emergency department or call an
ambulance.
The second train: This is the train of catastrophization.
“This is going to ruin my plans”, “This flare-up episode will last days, weeks or
even months, or maybe I’ll stay like this forever and my pain will never return to what
it was before”.
Well.
Some people have a tendency to think the worst of any situation.
They feel safe if they plan for the worse.
They feel like they don’t deserve anything good or that they should not expect good in
life.
They think that if they expect only bad things, then they will not be disappointed when that
actually happen.
This is a personality trait.
People are people and they are different.
However, we know from many research studies that people who have a tendency to catastrophize
have higher risk of more chronic pain, especially after surgery, a fracture, or an injury.
It is almost like priming the brain to expect the worst, and then, the brain will actually
produce the worst outcome.
If you get yourself thinking like this when your pain flare-up starts, stop for a moment,
and think about what you are thinking.
Do a little self-reflection and ask yourself “Is this flare-up actually going to ruin
my plans?”
“Why am I thinking that this flare-up will last weeks or months?”, “Why don’t I
think differently?
“I can change what I am thinking”.
“I am in control of my thought”.
So, here is how you terminate the second train: Write down what you are thinking.
Get a piece of paper and write your thoughts.
Then, re-write these thoughts in a more positive, optimistic view.
If you had written: “This flare-up will last weeks or months”,
then re-write as this “This flare-up will last hours or days”.
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The third train.
This is the train of blaming yourself.
They think: “I am a failure”, “I’m having this flare-up because I didn’t take
care of myself, I didn’t exercise, or I exercised too much”.
People with chronic pain usually feel worthless, devalued, and helpless.
They feel like nobody believe them, and they have to spend a lot of time convincing other
people that their pain is real.
This is really tiring and frustrating.
So, it is easy just to blame yourself for this episode and fall into the trap of self-pity.
So, here is how you destroy the third train: Stop marinating in the misery juice.
You are valuable, you have a lot to contribute to your family, friends, work, to society.
There is no point in blaming yourself.
Give yourself permission to be happy and joyful.
Blaming yourself for this flare-up will not make the flare-up go away faster.
In fact, it may only aggravate it.
Because if you don’t have the energy to get up and enjoy your life, then you are not
getting the energy you need to fight this flare-up.
Go get some sunlight.
Go walk outside.
Listen to your favourite music.
Dance, sing, bike, ride your horse, go fishing, go shopping.
But do something that you enjoy and nurture your body, mind and soul.
The fourth train This is the train of finding someone else
to blame.
They think: “This flare-up is my doctor’s fault”, “If my doctor had just given me
more painkillers I would not be having this flare-up”.
Some people spend a lot of energy trying to find someone to blame for their chronic pain.
When they have a flare-up, they get angry, anxious, mad, and frustrated.
It is really hard for them to calm down.
The energy they spend is in vain, because finding someone else to blame will not make
the flare-up go away.
Actually, when an angry person releases a lot of stress hormones in their body, and
these hormones and neurotransmitters will increase the volume dial of pain intensity.
So, they will feel like the pain is more intense.
So, here is how you extinguish the fourth train:
When you notice you are caught in these train, ask yourself “Does it really matter”,
“What am I gaining with these thoughts?”.
“Can I forgive, forget and relax?”
The sooner you catch up these thoughts the better.
You may need to accept that flare-ups are part of a regular life of a person with chronic
pain.
They do happen from time to time.
They are stressful and frustrating, but worrying about pain, blaming yourself or others will
not help the flare-up to go away.
The fifth train.
This is the train of desperation, hopelessness and helplessness.
They think “There is nothing I can do about this flare-up”, “I’ll just lock up myself
in a dark room and stay there many days until it goes away”, “I don’t want anyone
to see my like this”.
Some people feel disempowered to do anything about their pain.
They can’t think of anything they can do when they are in a flare-up.
They forget anything that has worked for them in the past.
Chronic pain is a disease that causes a lot of people to isolate themselves.
Because chronic pain there is nothing to show, it is like an invisible disease, there are
family members, co-workers, friends, who don’t believe your pain is real.
Then, the person with chronic pain have a tendency to hide their pain, they don’t
even want to tell their friends they have pain.
They have a flare-up and nobody knows.
But because they are suffering in silence, it is hard for them to ask for help.
So, this is how you end the fifth train of thoughts:
Sometimes, just telling a trusted friend or relative that you are having a flare-up will
help.
They may brainstorm some ideas to handle the pain.
They might remind you of what worked for you in the past.
They may bring you some tools for you to use.
Remember the 5M toolbox?
There are many tools you can use for self-management: the main categories are: mind-body, movement,
modalities, manual therapies and medications.
If you have a list of tools that worked for you in the past, it will become easier for
you just to read the list again, and try some techniques this time.
You may keep some relaxation CDs at hand.
Your favorite magazines, books, movies, a TENS machine or a foam roller.
Watch my videos about TENS and foam roller to get some ideas.
If you want to download a list of things for you to remember what to do during a flare-up,
I prepared this list and you can download it for free on my website.
The address is www.doctorandreafurlan.com/mindbody If you know someone with chronic pain, share
this video with them.
There is a share button here.
And don’t forget that during a flare-up it is important that you continue a good sleep
hygiene routine.
Go to bed and wake up at the same time every day.
Don’t forget that you are what you eat.
So, keep an eye on what you put in your mouth.
Don’t eat junk food.
Do some physical movements, go for a walk, and do not overdo it.
Notice what happens to your pain levels and adjust your activities.
I hope you enjoyed this video.
Here are other videos from my channel that you can watch.
See you next time.
Goodbye!