Oh no, not again.

⁠You feel those symptoms start to creep back in.⁠

⁠At first, it feels like a whisper. But the longer you pay attention to it, the louder it gets.⁠

⁠You feel your stomach sink.

How long will it last this time?

How bad is it going to get?

Do I have to start cancelling plans now?

Should I call out of work?

⁠⁠Sound familiar? ⁠

⁠Pain flares are a dreaded part of everyone’s pelvic pain healing journey.⁠

They certainly were part of mine. 

⁠Everyone gets them, and everyone fears them.⁠

⁠Unfortunately, they’re unavoidable. ⁠

⁠However, you don’t have to struggle through them the way you have been.⁠ ⁠

⁠You don’t have to just grin and bear it.⁠

⁠There are tools you can use to ease your suffering during a pain flare.⁠

⁠Not only that, we can use said tools to reduce both the frequency and intensity of your pain flares over time. ⁠

First, there are some things I think are important to understand about pain:

1. Even though we feel pain in our bodies, it is always a product of our brains.
2. Pain is your body’s warning system. Its job is to alert you to threats to safety and well-being. Pain does not equal tissue damage. There can be tissue damage without pain, and there can be pain without tissue damage.
3. Context through past experiences and emotions, as well as the meaning you assign pain all change your experience of pain. Indications of danger make pain worse, while evidence of safety makes pain better.
4. Sometimes the brain sounds the alarm when in reality, despite your VERY REAL pain and discomfort, you’re not actually in danger.
5. When this happens, your nervous system becomes “sensitive.” Meaning, it reacts to stimuli that are not physically harmful, but your nervous system perceives it to be.
6. The threat your nervous system is perceiving doesn’t have to be physical, it could be emotional as well. Your brain cannot tell the difference between an internal threat and an external threat.

There are three domains that influence your experience of pain: Biological, Psychological, and Social. These three domains can be used to REDUCE your experience of pain. You have the power to influence your pain experience!

With this knowledge and understanding, you can prepare yourself with a plan to support yourself with as much comfort and safety as possible during your next pain flare.

We want to address all three domains that influence pain in your Pain Flare Plan:

1. Biological: Although the research is clear that this is the domain least likely to be influencing your pain if your pain is chronic, we don’t want to ignore your body. Pain feels like it’s in your tissues, so we do want to include actions that help to soothe your body. 

2. Psychological: Includes thoughts, emotions, beliefs, expectations, coping behaviors and the meaning we give to pain. Negative expectations amplify pain and positive expectations reduce it. In order to calm a pain flare, we need to address the thoughts you are thinking and redirect your attention away from fear, worry, and focus on your symptoms.

3 Social: Includes environmental context and social support. Isolation sends signals of danger to the brain, which in turn turns up the volume of your pain and can make your pain feel physically worse. Feeling connected to others and feeling supported during a pain flare can play a critical role in reducing symptoms. 

Now, I want to invite you to brainstorm some ways you can soothe yourself in each of those three different categories. 

You can see a filled in sample below of my pain flare plan. Here, I planned different ways I could support myself in each category (biological, psychological, and social). 

I provided a blank sample you can use for yourself.

                                 
Using your Pain Flare Plan not only works to calm your brain and body in the moment, but over time works to create a sense of safety in your nervous system. 

If pain is a danger signal, safety is the solution.

You create safety for yourself each time you use your plan, and over time, you’re directing your nervous system to rewire itself from living in danger to living in safety.

This will reduce your pain in the long term.

I know, trying to figure out how to manage a pain flare in the moment can feel impossible. ⁠

That’s why having a plan set in place ahead of time to help me manage my pain flares was a total game-changer.⁠

⁠I hope you found this helpful!

If you’re interested in exploring a mind-body approach to healing your chronic pelvic pain, I’d love to connect. You can reach out to me on Instagram or email me. I’d love to hear more about your story and see if I can help!

Rachel Gofman is a pelvic health physical therapist and pelvic pain coach. She holds an undergraduate degree in Neuroscience from Brandeis University, and a Doctorate in Physical Therapy from Columbia University.