Coping with chronic pain: a flare-up plan for Veterans

Before your appointment

A flare can disrupt plans you care about. Having a backup gives you something concrete to try without having to make every decision on a difficult day.

First, check whether something is different

Ask your clinician which symptoms fit your usual pattern and which should prompt a call. New or rapidly worsening symptoms should not automatically be treated as your familiar chronic pain.

Seek urgent assessment for new weakness, fever, or new trouble urinating or controlling your bladder or bowel. Follow any additional warning signs your own clinician has given you. NIH pain guidance.

Make a short plan you can find easily

Use these prompts at your next appointment. Keep the completed version on paper or in a note you can open quickly.

1. My usual pattern: What does a familiar flare feel like? What would be unusual?
2. My first adjustment: Which part of my normal activity should I reduce or change, and for how long?
3. My comfort options: Which positions or relaxation practices have helped and are appropriate for me?
4. My medicine instructions: What does my existing prescription allow? Who do I call if it is not helping?
5. My support person: Who can help with a specific task, such as a meal, a ride, or a phone call?
6. My follow-up: When should I contact the care team if the flare has not settled? What is the after-hours route?

VA’s flare-planning guidance includes noticing patterns, using coping tools, and asking for support. Your own plan should reflect your diagnosis and restrictions. Do not add doses or change prescribed medicines without instructions from the prescribing clinician. VA flare-planning guidance.

Plan activity before a good day turns into too much

If you tend to do everything on a better day and then struggle afterward, describe that pattern to your therapist. Ask about pacing: choosing an amount of activity and planned breaks you can repeat, then adjusting it together.

VA’s CBT-CP program teaches pacing and other pain-management skills with a clinician. Its group guidebook is designed for use during treatment, rather than as a stand-alone exercise program. VA Veteran group guidebook.

A useful question is, “How can I keep some of this activity in my week without repeatedly overdoing it?” Ask for specifics that fit your situation, including what to do during a flare.

Choose a backup for something that matters

In the source talk, Jill Harkavy-Friedman encourages people living with pain to prepare a setback plan and build a support team. You can apply that idea to a daily commitment. Source talk, around 18:14.

For example, if a family gathering becomes too difficult, your backup might be a shorter visit or a call with someone afterward. Agree on the backup ahead of time so you do not have to explain everything while hurting. This is a planning example, not a recommendation to push through symptoms.

Ask for support when pain wears you down

Tell your VA team if pain is affecting your mood, sleep, or ability to cope. Ask whether CBT-CP or another service could help. You can use the Valor chronic pain care guide to prepare for that conversation.

If you are thinking about suicide or feel unable to stay safe, call 988, text 988, or use 988 online chat. Call 911 for immediate danger.

Your next step

Next step: Write down your daytime and after-hours contacts, then ask your VA team to help complete the rest of your flare plan.

Source and scope

Adapted from Living With Pain with Jill Harkavy-Friedman, PhD, uploaded in 2014 for an RSDSA audience. Caption sections 10:06–13:54, 18:14–21:19, and 38:57–40:42 informed the planning and support themes. The talk concerns CRPS and is not a Veteran-specific treatment protocol. Historical statistics and fixed rest schedules were omitted. Automatic captions were reviewed, not audiovisual playback. This guide supports an individual care plan.