During a pain flare-up, your pain climbs well above its usual level and stays there for hours or days. You tend to ask yourself what to do in the middle of it, at the point when focus and patience are in shortest supply.
That is the case for a plan you write on a good day and work through on a bad one. It fits on a single page, sits on the fridge or lives as a note on your phone. Your pain diary supplies the second half: it shows you what came before your flares, and you add those early warning signs to the plan.
Recognising a flare
Decide in advance when you will call something a flare. Say your everyday scores move between 3 and 5. Your rule could then be: a flare starts when you log 7 or more on two days in a row, or when the pain keeps you awake at night. Signs from daily life work too: you cancel plans, you struggle to get out of bed, or you can't get through the working day. Add two of them to your rule. To keep your numbers comparable, see The 0 to 10 pain scale.
A flare feels familiar: same place, same type, more intensity. Get new or unusual symptoms checked by a doctor before you treat them as a flare.
The plan to fill in
Write each point as a short instruction to yourself. "Hot water bottle, lie down for 20 minutes, then call Sam" is something you can read at an 8. A paragraph of prose is not.
- My flare starts when: ______ (for example two days at 7 or above)
- My early warning signs: ______ (from your diary, see below)
- The first two hours: ______ (what has helped before: heat, a particular position, an exercise from physiotherapy)
- Medication: ______ (only what your doctor has agreed with you for flares, with their instructions)
- What I cancel or move: ______
- Who helps me, and with what: ______ (name, phone number, task such as shopping or school pickup)
- What I still do, in a smaller form: ______ (what you agreed with your doctor or physiotherapist for flare days)
- I get medical help when: ______ (the threshold you agreed, such as no improvement after three days)
Go through the plan with your doctor or pain specialist, above all points 4 and 8. They fill in any doses. Talk point 6 through with the people on it while you still feel well.
Reading your diary for what came before
Memory is poor at finding early warning signs. During a flare you remember the pain, and the days before it blur. With a diary, work through it like this:
- Mark the first day of each flare.
- For each flare, read the three days before it: sleep, physical load, stress, unusual appointments. Write down anything that stands out.
- After three or four flares, put the lists side by side. Anything that shows up before most of them is a candidate.
- Run the reverse check on days that were not followed by a flare. If you have bad nights before every flare but also in every other ordinary week, poor sleep makes a weak warning sign.
One familiar pattern is called "boom and bust": on a good day you catch up on everything, and the flare arrives a day or two later. If your diary shows that pattern, Pacing chronic pain with a diary can help. Step 4 is covered in more depth in Finding your pain triggers, and the diary basics are in How to keep a pain diary.
Setting this up in PainTrack
- Mark the start of a flare under More → Events with an event of type "Other" and the label "Flare". In the Diary, the Events filter lists all your flares, and under All you see the days before each one.
- Add circumstances to an entry with "+ Add tags", for example "slept poorly", "feeling stressed" or "lifted something heavy". Create tags of your own under More → Tags.
- Use the note to record what helped during the flare.
All of that is free. With Pro, the trigger analysis compares your values on entries with and without a tag over 180 days. It needs at least 12 entries, 4 with the tag and 4 without. Delayed effects across several days are still yours to check in the Diary. One thing to know: the event comparison (Pro) looks at up to 28 days before and after an event, and a flare event soon after a treatment start shortens that comparison.
After the flare: sharpen the plan
A few days after a flare, once your head is clear, answer three questions in a note: what helped, what didn't, and how long it lasted. Change the plan while you still remember. Strike points that didn't work during the flare and add whatever you came up with along the way that helped.
Your doctor cares about frequency and duration. "Three flares in two months, four to six days each, twice after long drives" is an example of a sentence they can work with.
Some signs belong in no flare plan. New numbness or weakness, fever, problems passing urine or controlling your bowels, chest pain, or pain after a fall need medical help straight away. In the UK, call NHS 111 for urgent advice or 999 in an emergency. In the US, call your doctor's after-hours line or 911.
Frequently asked questions
What should I do during a pain flare-up? Take out your plan and work through the first steps that have helped you before. Take medication the way you agreed with your doctor. If the flare feels different from usual, get medical advice.
How long does a pain flare-up last? It ranges from hours to weeks depending on the condition. Your diary shows your typical duration. If a flare runs well beyond it, talk to your doctor.
Should I keep logging during a flare? Yes, in the smallest form: one number a day is enough. If the worst days are missing, your history will later look better than it was.
How can I spot a flare early? Through warning signs you read from your own data. Common candidates are poor sleep, unusual exertion or stress in the days before, but your reverse check has to confirm them.
PainTrack is not a medical device and does not replace medical diagnosis or treatment. The app is intended for personal documentation and self-observation.