Ep 15. Anatomy of a Flare
Agency is crucial as a chronic pain patient - especially when you feel most helpless and scared with pain at its worst. Flares are always difficult to navigate, but they don't have to make you feel so helpless and reactive. What are the phases of a flare, and how can you manage each one? This episode is a critical resource to learn how to identify and sooner recognize your own flare patterns so you end up in 'the hole' less, and can navigate your way out more effectively when it does happen.
As a provider, how can you better explain flares and give patients a prevention strategy so they are empowered to impact all the aspects they can control, and more effectively treat the pieces you can help with when they are most vulnerable? Listen to this episode for more tools and a structure you can implement right away.
Anatomy of a Flare: Understanding and Managing Pain Exacerbations
In this episode of "It's not in your head," Dr. Dan Bates and Justine Feitelson (Dan and Juz) delve into the crucial topic of flare management for chronic pain sufferers. Building on their previous discussion about goal setting, they explore the challenging moments when pain intensifies and self-care becomes difficult.
What is a Flare?
A flare is a period of increased pain and decreased functionality that can occur in chronic pain conditions. It's characterized by:
Gradual pain increase, often due to increased sedentary behavior
Weakness leading to potential injury or increased sensitivity
Amplification of anxiety and fear
Normal but potentially problematic catastrophizing
The Anatomy of a Flare
Flares typically follow a pattern:
Trigger/Stressor: This can be stress, mood changes, weakness, injury, or pacing issues.
Initial Phase: Deconditioning begins to set in.
Worsening Pain/Decrease in Self-Care: Pain intensifies, and self-care routines start to slip.
The Hole: Increased fatigue, dysautonomia, and emotional distress.
Digging Out: Reaching out for help and taking initial steps to regain discipline and self-care.
Impact of Stress on Flares
Stress plays a significant role in flare-ups:
Reduces capacity and narrows the window of tolerance
Decreases bandwidth for self-care and communication
Impairs executive functioning
Leads to overwhelm and avoidance
Can result in isolation and increased sadness
Managing a Flare
Immediate Crisis Management
Prioritize survival and emotional support
Address fatigue and focus on low-barrier recovery activities
Reach out for social support (SOS communication)
Redirect resources back to self-care
Long-Term Management
Return to movement (Return to play)
Organize schedule and pacing
Implement stress management techniques (e.g., downregulation, mindfulness)
Make informed choices about interventions
Focus on low-hanging fruit for biggest impact
Recognizing When to Reach Out
Key indicators that it's time to seek help:
Increasing pain levels
Decreasing mood or increasing anxiety/stress
Diminishing capacity and increasing fatigue
Decline in self-care and movement routines
Occurrence of injury or further pain escalation
Takeaways for Listeners
Reflect on your personal pain cycle and identify your flare patterns
Understand how you "fall in" and how you "dig out"
For patients: Label your flare phases and develop strategies for each
For physicians: Recognize crisis presentations and develop appropriate responses
Future Considerations
The hosts suggest future discussions on:
Developing better pain measurement tools beyond the Numeric Rating Scale (NRS)
Investigating sensitizers in various domains (emotional, physical, biological)
Exploring inflammatory disorders and immune system involvement in chronic pain