Managing Acute Flare-up of Chronic Pain

Acute flare-up of chronic pain

Chronic pain is typically defined as a pain that lasts for three to six months or longer. Such pain fails to respond to the standard treatment and ultimately begins to interfere with someone’s ability to perform usual daily activities such washing or mobilising. Acute flare-ups refer to sudden worsening of longstanding pain.

Such flare-ups may be described as muscle spasms, jolts of electricity, cramps or sharp and jabbing sensations. Flare-ups are common and may last for a few days or even several weeks. They usually settle with time and do not indicate worsening of any underlying condition. Understanding this will help you cope with your flare up, reduce fear and avoid inappropriate treatments and investigations.

Causes of flare-up

It is important to realise that often there is no trigger, and a flare-up can occur without reason. Sometimes it may have occurred because a person has pushed themselves too hard or fast. Other contributing factors can include:

• under activity
• over activity
• taking on a new exercise/activity
• reduced or imbalanced fitness
• poor postures
• ill health
• stress.

Managing a flare-up

• avoid prolonged bed rest (no more than 24hrs)
• maintain gentle activities
• take regular pain medication
• use heat/ice
• use a Transcutaneous Electrical Stimulation device (TENS)
• continue with daily activities but break up with frequent short rests
• practice relaxation to de-stress and reduce tension
• use distraction techniques
• use mindfulness skills to develop awareness of the present moment and make
  more self-compassionate choices
• control your breathing
• communicate with family, friends or colleagues – you do not have to feel alone
• do not panic – challenge negative thinking, so that you are able to think clearly – the pain will reduce in time.

Lifestyle changes

It is not always possible to avoid flare-up since, as previously mentioned, there may be no trigger. However, there are some lifestyle changes which help to lessen the episodes such as:

• planning activities
• pacing activities and exercise
• avoid overdoing things on good days
• maintaining fitness and correct posture
• managing stress
• balanced regular diet
• taking prescribed medication regularly
• setting realistic goals.

Useful websites

Retrain Pain (retainpain.org)
Click on the pictures in each lesson. For the next lesson, click on the link below the picture

Pain Toolkit (paintoolkit.org)
The ‘tools’ tab on the menu bar gives a good overview of what pain management is about.

Pain Management Network (aci.health.nsw.gov.au/chronic-pain)
This is a good information site for patients with chronic/persistent pain. You will hear from other people, just like you and learn how they too have lived with chronic pain. The website has a number of episodes which should be viewed over several days to weeks.

Pain Concern (painconcern.org.uk)
Information and support for people living with pain and for health care professionals. There are podcasts (radio show with interviews), forum, helpline and videos. There is also a Pain Concern Facebook page.

British Pain Society (britishpainsociety.org)
An organisation that focuses on all issues around pain. Acute and chronic. They have some good guidance documents.

Institute for Chronic Pain (instituteforchronicpain.org)
Good resource for descriptions of different pain conditions.

Flipping Pain (flippinpain.co.uk)

We are Undefeatable campaign (weareundefeatable.co.uk)

Useful videos

Tame The Beast (YouTube)

TEDxAdelaide – Lorimer Moseley – Why Things Hurt (YouTube)

When mental health gets physical (BBC)

Understanding Pain in less than 5 minutes, and what to do about it! (YouTube)

Understanding Pain: Brainman stops his opioids (YouTube)

Stay Active at Home – strength and balance exercises for older adults (YouTube)

Professor Lorimer Mosely, ‘The Pain Revolution (YouTube)

Useful books

Mindfulness for Health” by Vidyamala Burch and Danny Penman

The Explain Pain Handbook – The Protectometer” by GL Moseley and DS Butler

About this leaflet

Author: Daniel Hull, Clinical Nurse Specialist Pain Management
Written: September 2023
Approved: November 2023
Review date: November 2026
Edition: v1

If you have feedback regarding the accuracy of the information contained in this leaflet, or if you would like a list of references used to develop this leaflet, please email patientinformation.leaflets@dchft.nhs.uk