Chapter 26

Eight Steps for
Handling a Pain Flare

In my experience, one of the most difficult issues that any chronic pain patient struggles with is coping with a pain flare (otherwise referred to as a relapse, or setback). Everyone healing from chronic pain will encounter these occasional episodes periodically. Flares are not unexpected, but can be profoundly disruptive to your healing progress unless you are prepared with knowledge of flares as well as an effective plan for responding to one.

What follows here are specific suggestions for navigating this sometimes-tricky path, beginning with the story of Josh.

Josh, a forty-three-year-old father of two, had suffered from chronic low back pain for ten years following a work-related injury. He has been participating in the ABC method in the past year and was feeling hopeful due to making steady, incremental progress.

At one point he received an urgent call from a close friend who had to move out of his apartment on a deadline and needed help carrying a large chair from the living room. Feeling generally improved, Josh agreed to do it, eager to help. By the next day, Josh’s back pain had increased drastically, causing heightened sharpness and tightness from his right hip, radiating down his right leg. Two weeks later, the pain had remained unchanged. He started to feel not only disappointed, but also increasingly angry. He became self-critical and told me, “If I just hadn’t been so stupid in agreeing to move that chair!” The anger eventually morphed into hopelessness, and he feared that all the progress that he had previously made was now lost.

I explained to him that setbacks are common as part of the path to lasting healing, and that this didn’t mean that his progress wouldn’t continue.

As I discussed earlier in Chapter 10, “Your Healing Map,” the notion of two steps forward and one step back is vital to understand when you are striving for permanent healing for your chronic pain. We humans seem to be hardwired to change in this type of pattern. It’s almost as if once we make a new change, our body/mind system needs a little time to incorporate the change, and then reverts back a little bit to the old way of feeling before permanently moving forward.

Please remember that the changes that you make are not simply a matter of a different pain medication, a different exercise, a different thought, or a different nutritional supplement. The steps you are taking are changing your physiology. They are changing the cascades of neurotransmitters and hormones that influence the communication pathways between all the structures in your pain network. You are taking advantage of positive neuroplasticity, meaning that you are in the process of literally creating new, healthier neural pathways in your brain and nervous system. This takes time, and it more often follows an up and down trajectory, rather than a straight line to a pain-free life.

Eight Steps for Dealing with Pain
Flares and Temporary Setbacks

In my previous book, Trust Your Gut, I described some time-tested strategies for effectively dealing with relapses of abdominal pain, and these steps are equally relevant for responding to flare episodes of all kinds of chronic pain.

1.Breathe. First, take a deep breath. And then a few more.

2.Recognize. Our old friend awareness once again. Acknowledge that a pain flare is actually occurring. Keep in mind that pain flares are a normal part of the healing process. It is common for symptoms to get a little worse after a period of progress, and then improve again.

3.Accept. Once you recognize that you are having a flare episode, the next step is to accept it rather than fight it. Reactions of anger, panic, frustration, and despair are normal, but they can also agitate your sensitized nervous system, heightening the intensity of the pain even more. It is safe to be less afraid of the heightened feelings of aching, burning, stabbing pain, and fatigue that occur with this flare-up. Don’t let them scare you. This doesn’t mean that you’ve lost your progress. It is a temporary one step back.

4.Allow. Make room for whatever difficult emotions may surface. Allow the feeling, remembering that, “This is scary (or sad, or frustrating, or demoralizing), but it’s a normal part of the healing process, and it will pass.” This activates the important capacity for self-soothing of difficult emotions and sensations (refer back to Chapter 24 on “Resolving Difficult Emotions and Their Physical Effects” for useful reminders on how to do this).

5.Get support: Let the people who are close to you know about your ABC healing program and its steps. When a setback occurs, turn to them for support and encouragement.

6.Stay the course. Now more than ever. Get back to the fundamentals and self-care skills of your ABC program. Do Limbic Retraining to sit with the heightened sensations and reduce the agitation. It’s particularly helpful during pain flares. Stick with the foods and nutrients that are part of your individualized plan for healing. Reduce whatever stresses may be flared up in any of the categories of stress you may be experiencing. Make sure that you are allowing enough time for sleep. Use your new skills for taking the sting out of any particularly difficult emotions that may be stirred up during this flare episode.

7.Use the flare episode to your advantage. Although a setback can be worrisome or frustrating, it also allows for the opportunity to gather valuable new information to add to your ABC healing plan. You may become aware of some new and different stresses, physical movements, or activities that may worsen your pain in ways that you weren’t as aware of before the flare. Also, when you practice your Limbic Retraining during the flare episode, you may become aware of a useful clue about something that may have contributed to the flare that you can avoid in the future.

8.Take heart: it will get better.

After getting reassurance and reminders about the steps of getting through a flare episode successfully, Josh calmed down and regained some of his confidence. Dr. Weisberg worked with responding to the symptoms of his pain flare. Starting with Limbic Retraining, he encouraged Josh to find the place in his right hip and leg where the sharpness and tightness were most troubling.

As he had learned to do previously, he imagined that he was going to pull up a chair and sit right next to the sharp, tight sensation exactly the way it is, without trying to change it in any way. Eventually, he was able to do this. After about three minutes, he reported that the sharpness had moved from his right hip to his central low back, and the intensity had reduced from an 8 to a 4. He stayed with the sensation for another ten minutes without trying to change it. After some time had passed, he was calmer. He said, “I still feel the discomfort, but it doesn’t feel as heavy or ominous now. It changed just enough to remind me that all this will pass.”

Josh also learned an important lesson from this flare episode. In his zeal to return to normal life, he agreed to help move a heavy chair without first checking in with his body to tell if he really felt up to it. “At first, it’s depressing to think that I can’t just do any physical lifting that I feel like, whenever I like. But then my common sense kicks in and I realize that I now just need to listen to how my body feels first, before returning to heavy lifting. That’s an adjustment I’m willing to make to feel better!”

At the next appointment, Josh reported, “The pain intensity has reduced a little. I don’t like pain flares any better than I used to, but I’m reassured that they’re a normal part of the healing process. I won’t be quite as scared or discouraged the next time a pain flare occurs.”

As Josh learned, the more you utilize these strategies, the less you will be thrown off track by the ups and downs that are a normal part of the trajectory of healing from chronic pain.