COVID-19 and Managing Pain Flareups

Michelle Marikos
Certified Peer Support Specialist at Oregon Pain Guidance


What is a flare-up?

As a result of the stress and uncertainty caused by the Covid-19 outbreak, people living with chronic pain and/or living with a chronic illness may experience a flare-up.

For people with chronic pain, flare-ups are common.  A flare-up is when your pain becomes suddenly much more intense than the pain you have day to day.  Sometimes a flare-up lasts for only a few minutes or hours, and sometimes it can last for days. During this time of unusual stress, a flare-up may last longer than normal, or you may experience a series of flare-ups over days or weeks. Sometimes it is clear what caused the flare-up, but other times it can come out of nowhere. It’s important to realize that flare-ups are temporary. You will recover from the flare-up with time. 

What can cause or trigger a flare-up?

Flare-ups can be caused by a variety of things and these can be different for everyone.  It is important for you to know what your triggers are and develop ways to minimize these triggers when you can.  Below is a list of common triggers. As you read through them, you may want to think about which ones apply to you. Identifying your triggers is key to making a plan for how to cope with a flare-up.

  • Stress: Stress is a common trigger for flare-ups. Stress can come from interactions with your family, your work, worries about your pain, listening to the news, and worries about the impact of COVID-19.
  • Overdoing: When you are feeling good, sometimes you can overdo things. This could be something simple like moving boxes around the house, doing a lot of shopping in one day, or playing with your children or grandchildren.
  • Medication changes: It is important to take your medication as prescribed. Changing how much pain medication you use (either taking more or less than prescribed) can lead to a flare-up.  If you are tempted to take more medication for a flare-up, talk to your provider about what other medications you can take safely. Be prepared for the possibility that your provider may not be willing to increase your medication if it is an opioid. This can be particularly difficult during this time of COVID-19 when it is challenging to access other helpful resources such as physical therapy or the gym.
  • The food you eat: Several foods can cause inflammation that can trigger a flare-up. During this time it can be particularly challenging to make supportive food choices given limited options in grocery stores. Foods that can cause inflammation include:
    • Foods with high sugar content
    • Refined carbohydrates – white flour products with low fiber content
    • Some artificial sweeteners
    • Saturated fats – cheese, pizza, red meat, full fat dairy products
    • Processed meats – sausage, ham, smoked meat
    • Drinking excessive alcohol
  • Hormonal changes in women: Menstruation, pregnancy and menopause can cause flare-ups. Be aware and track changes in your menstruation and menopause cycles. Have your hormones checked regularly and have annual check-ups.
  • Other factors that can aggravate flare-ups include: poor sleep, change in weather, changes in season, holidays.

Things you can do to help manage your flare-up:

You probably have a good idea about your flare-up triggers. During this time of COVID-19, triggers may not be avoidable, but here are a list of things that can be done to help manage stress and minimize flare-ups:

  • Minimize news and media intake! Listening to the news can cause stress. Limiting your news intake can be very helpful during this time.
  • Practice relaxation techniques: Simple deep breathing for several minutes quiets your body’s emergency response system. Quieting your emergency response system helps to minimize pain. Gentle yoga, meditation and mindfulness have all been proven to help calm the body and brain’s response to pain.
  • Consider an online delivery service, pick up or online meal service: The best option is making the best possible food choices with what is available to you.
  • Use heat and cold: Cold packs and/or heat pads may help with your flare-up.
  • Positive self-talk: It’s easy to feel negative, angry, hopeless, and helpless during this time. Negative self-talk can make a flare-up worse. It can be helpful to remember that the world is having similar feelings and that we are in this together. Also, remember that you have had flare-ups before, and you have recovered. Think of some reassuring phrases to say to yourself such as, “This too shall pass,” or “I am safe and I can do this!”  Find a phrase that works for you.
  • Change your schedule: When you are managing through a flare-up, it is important to use your time and energy wisely to reduce the duration and severity of the flare-up.
  • Distract Yourself: Find something to take your mind off your pain. Occupy yourself with something you enjoy. Watch a TV show, listen to music, play a video game, chat on social media, listen to a podcast, work on a craft or some form of art, or play with your favorite pet.
  • Get some rest, but keep moving! Some rest is essential, but avoid long periods in bed or on the couch. The body heals more quickly and you will feel better if you keep moving. Try some gentle stretching. Walk down the hall or go sit outside. Do Tai Chi or yoga. Remember to keep your movements gentle as to not cause more pain.
  • Take care of yourself every day: Are you eating regular meals? Are you drinking enough water, brushing your teeth, showering? Practicing basic self-care can improve your mood and decrease your pain. Be careful to take your medications regularly. Self-care is the best care!
  • Stay connected with friends and family: Being under quarantine is a very difficult situation and being alone may increase focus on your pain. Text a friend. Engage in social media. Ask someone to write you a letter or postcard. You can write cards to your friends and family also.
  • Talk to your pain support group: During this time of isolation, it is critical to have support. If you have friends who have experience with pain or a pain support group, you can talk freely with them, as they understand what you are going through. There are online support groups and conference call lines that you can contact for support.
  • Ask for help when you need it: Let the people in your life know when you need help. If you need something done and can’t do it yourself, ask for help.
  • Journaling: Keeping a journal of your flare-ups can be very helpful. Each time you document your flare-up you are likely to learn something about the possible causes and what helped to get over the flare-up. Here are some potential questions you might ask yourself when journaling:
    • What were the triggers? Write about the stress and anxiety that you are feeling because of the crisis.
    • What else was happening in your life? Are you experiencing work deadlines, family issues, worsening weather, money problems? How is this crisis affecting you personally?
    • Did you overdo some activity? Are you trying to prepare for the quarantine?
    • What did you eat last two meals? Are you worried about having enough food?
    • Did you have changes in your medication? Did you stop your pain medication or more than prescribed?
  • Pace yourself: A flare-up is often caused by overdoing physical activity. We might feel okay at the time but pay for it later with a flare-up.The trick is figuring out how much you can do without causing pain later. A general guideline is to do less than you think you are capable of doing initially. Start small, go slowly, and you will be able to build up your strength and stamina over time.
  • Get better sleep: People with chronic pain often have difficulty sleeping. Lack of sleep can aggravate and amplify a pain flare-up. Good sleep will help with your pain in general and will make flare-ups less likely.

Create a “Flare Up Kit”:

When you are in the middle of a flare-up, the pain can be overwhelming.  It can be difficult to think straight. Creating your own personal Flare-Up Kit is very helpful. To start, find a box and label it in big letters – FLARE-UP KIT!

Contents of a Flare-Up Kit:

  • My flare-up triggers: Make a list of all the triggers that can cause you to have a flare-up  and what you can to do avoid or minimize these triggers.
  • What to do when I am having a flare-up: Create a list of things you can do to minimize your flare-up. Several suggestions have been offered.  Pick which will work for you and create your own suggestions.
  • My flare-up day schedule: Make up a schedule for things to do on a flare-up day.  Include self-care, when to take your medications, when to take rest breaks, gentle activities that get your moving, fun things to do that are distracting, and friends you can contact.
  • Suggestions for your FLARE-UP KIT
    • Your flare-up journal with details of previous flare-ups
    • Books, magazines, comics
    • Crafts and supplies for simple, one-hour projects
    • List of funny movies you really enjoy watching
    • List of favorite music
    • Load some mindfulness and meditation apps on your phone
    • Movement videos – gentle yoga, tai chi, stretching
    • Humor, jokes, pictures – remember the good days
    • Cards – uplifting cards from family or friends, and blank cards to write to friends
    • Heating pad or ice packs (have them in the freezer)
    • Online support groups / conference call line
    • Distraction of cleaning up a small area of your home
    • Distraction of organizing a small area of your home
    • Learning a new skill, baking, cooking, gardening, painting
    • Online free painting classes

When to go to the emergency department:

When experiencing a flare-up, it is common to think that you have injured yourself or that something else is seriously wrong. You may wonder if you should to go to the Emergency Department.

Before going to the Emergency Department, consider asking yourself these questions:

  • Do I have a new serious injury that is not related to my existing chronic pain?
  • Is this a medical emergency, or is it something that can wait until I make an appointment with my regular provider?
    • If the answer is yes to these questions, then go to the Emergency Department to be assessed and treated.
    • If the answer is no, then consider trying the recommendations listed in this document.