A pain flare, also known as a pain exacerbation, is a temporary but significant increase in pain intensity. It's like a storm rolling in, intensifying your usual chronic pain. When this happens to me, my pain is so high it’s hard to think straight and I become visibly distressed. There comes a point though that your body starts screaming it can’t do this anymore, and this is where my brain sort of shuts down. I need silence, a dim room, and to just have nothing going on in my brain. I close my eyes and imagine a black hole and it’s vast nothingness. When I reach this point, my pain tormenting me, my brain is not capable of coming up with any thoughts. I literally have so much pain that I can’t think. My mind literally goes blank.
Definition: A pain flare is a period where your chronic pain becomes more severe than your baseline level of pain. This increase can be sudden or gradual and can last for hours, days, or even weeks. I usually experience a few pain flares every autumn and winter, so I’m used to them by now, but each time it happens, each time I get a pain flare, I never quite go back to my normal pain level afterwards, my pain just sorta stays where it is and I’m not sure if it goes back down, just higher than before the flare, or if I just get used to it being that high.
What Happens During a Pain Flare?
When a pain flare hits, it can feel overwhelming. Beyond the intensified pain, you might experience a range of other symptoms, including:
Increased Sensitivity: Everyday sensations like touch or temperature changes can become excruciating. For CRPS, this might mean increased allodynia (pain from a stimulus that doesn't normally cause pain) or hyperalgesia (an increased response to a stimulus that is normally painful), as the user has previously researched.
Excessive sweating: Sometimes, the pain is so bad that I break out into sweats. My hair and shirt can be soaked within minutes when a pain flare is bad enough.
Changes in Pain Characteristics: The type of pain might shift. It could become sharper, more burning, throbbing, or widespread. Mine intensifies, the shooting pains get more shocking and brutal and my legs throb so bad if the room is quiet, I can hear my legs pulsing from inside my body. I know that must sound weird, but it’s true. Some days my legs beat like a heart.
Functional Limitations: Activities you normally manage might become difficult or impossible. Mobility can decrease, and simple tasks can feel like monumental efforts. Everyday chores, they start to pile up, because you just don’t have the energy to do any of it, but they need to get done.
Emotional Toll: Pain flares can lead to increased frustration, anxiety, depression, and a sense of helplessness.
Sleep Disturbance: The intensity of the pain often makes it hard to fall asleep or stay asleep, further compounding the physical and emotional distress. I read somewhere the other week that an able-bodied person would have to go withOUT sleep for 3 nights before they would feel as tired as someone with severe chronic pain or chronic fatigue.
Fatigue: The effort your body exerts to cope with the increased pain can lead to significant fatigue and exhaustion.
For individuals with CRPS, pain flares can be particularly intense and unpredictable. They might involve:
Increased Burning Pain: The hallmark burning pain of CRPS can become searing and unbearable. Your legs literally feel like they are being scalded from the inside out.
Temperature and Color Changes: The affected limb might experience more pronounced fluctuations in temperature (hot or cold) and color (red, blue, or white). My legs and feet are swollen and have a purplish mottled look to them. The hair on my legs also got thicker, which is a symptom, and now I’m losing the hair in certain areas of my legs.
Swelling: Swelling in the affected area might worsen. If I’ve been on my feet for too long, my shoes and socks feel even tighter because my legs swell up.
Muscle Spasms and Tremors: These can become more frequent and intense during a flare. I also clench and tense my legs and don’t realize I’m doing it until they start to cramp up.
Hypersensitivity: As mentioned, sensitivity to touch, pressure, and even slight movements can dramatically increase your pain symptoms, often in a sharp electrical firey jolt kind of way.
It's important to remember, that there are resources available to you, many at no cost, that can help you form a plan and get support. One of the best resources for support with chronic pain is Pain BC. They emphasize that while a flare-up is distressing, it doesn't necessarily mean new damage has occurred. However, it's crucial to listen to your body and have strategies in place to manage these challenging flares. The following link is a list of links to Pain BC services that any resident in BC suffering from chronic pain can utilize:
https://painbc.ca/find-help/self-management
It is also worthy to note that Pain BC has a pain support hot line that Pain Warriors can phone Monday’s to Friday’s from 9:00am to 4:00pm. You leave a message and someone calls you back. To clarify though, this is not a crisis line, it is a support line. If you are in crisis go to your nearest hospital.
https://painbc.ca/find-help/pain-support-line
Drawing from my years of experience in doing specific pain relief methods and self-care, I’ve built a personalized toolkit to help me navigate a pain flare:
Comfort Measures:
Heat or Cold Packs: Depending on what provides you with the most relief. I personally can’t take cold packs, it’s too painful, but can use gentle heat. I have temperature sensitivities as well as sensitivities to touch, so anything cold I don’t want anywhere near my legs, it’s too painful.
Comfortable Clothing: Loose, soft clothing to minimize pain and irritation to sensitive skin is especially important with CRPS.
Soothing Environment: Dim lights, quiet sounds, or calming music. Find something peaceful to do. I usually journal or do something creative, and I play gentle meditation music, or if the mood strikes, I do something that some might find an odd way to relax, but I like to crank up the AC/DC and sing some of my emotions out while listening to the Razor’s Edge or Back in Black albums. I also like to colour or draw while listening to the guided meditations in Apple Fitness+. I also use Balance and Headspace for guided meditations. All of these really help when my body is feeling overwhelmed and I’m at the end of my rope.
Weighted Blanket: The gentle pressure can be soothing for some individuals experiencing pain. I love weighted blankets. They are actually quite soothing to sleep with.
Gentle Movement & Positioning:
Pillow Support: Use pillows to support the affected limb in a comfortable position, potentially elevated for CRPS-related swelling. My legs, neck and back are so bad that I have to sleep in my recliner because it is too painful to lay in my bed.
Gentle Range-of-Motion Exercises: If tolerable, very gentle movements can sometimes help prevent stiffness. Consult with a physical or occupational therapist for personalized recommendations.
Mindfulness & Relaxation Techniques:
Breathing Exercises: Slow, deep breaths can help calm your nervous system. I like to do Box Breath and 5-4-3-2-1 senses.
Guided Meditation: Apps or recordings can guide you through relaxation exercises. As said above, I mostly use Apple Fitness+ guided meditations, as well as the apps Balance and Headspace.
Distraction Techniques: Engaging in a calming activity you enjoy, like listening to an audiobook, watching TV, journaling or coloring. All of these things are a calming activity choice for me.
Medications & Supplements (As Prescribed):
Keep rescue medications readily accessible. Understand when and how to use them.
Consider any topical pain relief creams you've found helpful in the past. Topicals like eucalyptus and menthol cream, or my “go to” creams for pain, Kalaya, Liv Relief, or a cannabis rub, can all help in reducing the pain. I also recently got a lidocaine cream compounded for me that contains lidocaine, ketamine and amitriptyline that I find works well in those desperate moments. If you want the percentages to tell your doctor, don’t hesitate to reach out and message me. It’s been a life saver. It’s expensive but worth every penny.
Tracking Tools:
Pain Diary/Journal: Continue tracking your pain levels, triggers (if identifiable), and what helps. Note the time, intensity, location, and any associated symptoms. I created a free downloadable pain tracking 2 page spread that can get you started. If you go to my website https://my.linkpod.site/meredithhutton79 and sign up to my email subscribers list, an email will automatically be sent to you with both the pain tracking pages I created (two versions - colour and black and white), as well as my 200 page ebook, the Household Planner for Pain Warriors. I also have written a Chronic Pain & Wellness Tracker which is available for sale on Amazon (colour http://amazon.ca/dp/1069213039 and black and white https://www.amazon.ca/dp/1069213047)
Communication Support:
Have a list of trusted individuals you can reach out to for support, whether it's a family member, friend, or support group. It is SO important to talk about it. If you don’t, it will build up and erode your mental health until you can’t hold it in anymore.
Your Personalized Pain Flare Action Plan
Having a plan in place can significantly reduce the anxiety and feeling of helplessness that can accompany a pain flare. Here’s a personalized plan you can adapt:
Early Recognition:
Know Your Baseline: Understand your typical pain levels and associated symptoms.
Identify Early Warning Signs: Pay attention to subtle changes that might indicate a flare is starting. This could be a slight increase in pain, a change in sensation, or increased fatigue.
Immediate Actions:
Stop or Reduce Activity: If possible, decrease any activity that might be exacerbating your pain.
Implement Comfort Measures: Immediately reach for tools in your personalized toolkit that have provided relief in the past (heat/cold, comfortable positioning).
Gentle Movement (If Appropriate): If gentle movement usually helps, continue with very light, controlled motions.
Hydration and Nutrition: Stay hydrated and try to eat easily digestible, nourishing foods.
Pain Management Strategies:
Utilize Relaxation Techniques: Practice your go-to breathing exercises or guided meditation.
Apply Topical Relief: Use any prescribed or over-the-counter creams or gels that offer you relief.
Take Medications as Prescribed: If you have rescue medication for flares, take it as directed by your doctor.
Monitoring and Assessment:
Track Your Symptoms: Use your pain diary to note the intensity, location, and characteristics of your pain, as well as what you've tried to manage it.
Assess Effectiveness: Evaluate what strategies are providing some relief and what isn't.
Seeking Support (If Needed):
Know When to Reach Out: Have a plan for when you need to contact your healthcare team. This might be if the pain is unmanageable, if new or alarming symptoms develop, or if the flare lasts longer than you typically experience.
Communicate with Your Support System: Don't hesitate to reach out to trusted friends or family for emotional support or practical help.
Post-Flare Review:
Reflect on the Flare: Once the flare subsides, take some time to review what might have triggered it (if possible) and what management strategies were most effective. This can help you refine your toolkit and plan for future flares.
Pain flares, especially with a condition like CRPS, can be incredibly challenging. Remember that you are not alone, and having a personalized toolkit and action plan can empower you to navigate these difficult times with more confidence and control. By understanding your body, implementing proactive strategies, and seeking support when needed, you can learn to ride the waves of chronic pain and continue to live a meaningful life.