If you've read our earlier article on what a flare-up is, you'll know that a flare-up is a temporary increase in pain — not a sign of new damage or lost progress. Understanding that is genuinely important.
But understanding it and knowing what to actually do when you're in the middle of one are two different things. When the pain ramps up and your whole system is screaming at you, "it's a temporary increase, not damage" can feel like cold comfort.
So this article is about the practical side. What do you actually do when a flare-up hits?
First: what not to do
Before the helpful stuff, a few things that tend to make flare-ups worse — even though they feel instinctive at the time.
Don't go searching for what caused it. The urge to find a specific trigger is strong — "Was it that walk? That meal? The way I sat?" But flare-ups in persistent pain are rarely caused by one thing. They emerge from the interaction of multiple factors — sleep, stress, activity, mood, hormonal fluctuations, even the weather. Hunting for a single cause often leads to unnecessary avoidance of things that are actually fine for you.
Don't catastrophise — but don't beat yourself up for catastrophising either. If your first thought is "I'm back to square one" or "this will never end," that's completely normal. Your brain is doing what brains do under threat. The goal isn't to suppress those thoughts — it's to notice them, acknowledge them, and gently remind yourself of what you know: this is temporary.
Don't stop everything. Complete rest and withdrawal might feel like the safest option, but for most people with persistent pain, shutting down completely feeds the cycle. The system becomes more sensitive, not less. You lose confidence. The world contracts.
What to do instead
Lower the dial, don't hit the off switch
During a flare-up, you probably can't do everything you'd normally do. That's fine. The goal is to reduce your activity to a manageable level — not to stop altogether.
Think of it as adjusting the volume rather than pulling the plug. If you normally walk for thirty minutes, maybe you walk for ten. If you normally sit at your desk all day, maybe you take more frequent breaks. You're still doing things. You're still moving. You're just doing less, temporarily.
Breathe — and I mean this seriously
This isn't a throwaway suggestion. Slow, diaphragmatic breathing is one of the most effective ways to down-regulate the nervous system in the moment. When you're in a flare-up, your breathing tends to become shallow and rapid — which keeps the threat response active.
Try breathing in for four counts, out for six. The longer exhale activates the parasympathetic nervous system — the part that calms things down. Even five minutes of this can make a noticeable difference. It won't eliminate the pain, but it can take the edge off the alarm.
Move gently
Movement during a flare-up doesn't need to be ambitious. A short, slow walk. Some gentle stretching. Changing position regularly. The point isn't exercise — it's showing your body that movement is safe, even when the pain is louder than usual.
For some people, movement in water (a warm bath, a pool) feels more manageable during flare-ups because the warmth and buoyancy reduce the sense of threat.
Use what you know works for you
Over time, most people develop a personal toolkit — things they've discovered that help during difficult patches. That might be a particular breathing exercise, a meditation, a specific stretch, a warm bath, music, being outdoors, talking to someone, or simply changing your environment.
The important thing is to use these strategies early — not to wait until the flare-up has escalated to its peak. The earlier you intervene, the more effective these tools tend to be.
Talk to someone
Flare-ups are harder in isolation. If you have a partner, a friend, or a therapist who understands your condition, reach out. You don't need them to fix anything. Sometimes just saying "I'm having a rough day" out loud takes some of the charge out of it.
If you're working with a physiotherapist or other pain professional, a flare-up is a perfectly good reason to get in touch between sessions. They can help you make sense of what's happening and adjust your plan if needed.
Give it time — and track the pattern
Flare-ups are temporary. They feel permanent in the moment, but they pass. Most flare-ups settle within a few days to a couple of weeks — often faster if you respond with calm, measured strategies rather than panic or complete shutdown.
And here's something worth tracking: as recovery progresses, flare-ups tend to become less frequent, less intense, and shorter-lasting. Research supports this — a reduction in flare-up frequency and intensity over time is predictive of longer-term recovery. So each flare-up that passes is actually data. It's showing you where you are in the bigger picture.
What flare-ups are not
It's worth restating: a flare-up is not a sign that you've caused damage. It's not evidence that your treatment isn't working. It's not a reason to abandon everything you've been doing.
Flare-ups are a normal part of recovery from persistent pain. They happen to almost everyone. And how you respond to them matters more than the fact that they happen.
The people who do best are the ones who learn to ride flare-ups out — with patience, with the strategies they've built, and with the quiet confidence that comes from having been through them before and come out the other side.
Building your flare-up plan
One of the most useful things you can do before a flare-up happens is to write down your plan for when it does. When you're calm, list the things that help you — the breathing, the movement, the people, the strategies. Keep it somewhere accessible.
Then, when a flare-up hits and your brain is foggy with pain and worry, you don't have to think from scratch. You just follow the plan.
If you'd like help building your flare-up plan, or if you're finding that flare-ups are dominating your life and you're not sure how to break the cycle, I'm happy to talk it through.