Persistent Pain

From time to time, you may find that you experience periods of increased pain, sometimes called flare-ups. Although these flare-ups don't usually last very long, they often come on quickly and without much warning, so they can be difficult to cope with. It may be tempting to go back to your old habits, like taking more medication or going to bed. Try not to do this. Flare ups may happen, and if they do then all we can do is accept that. Coping with flare-ups is a skill and will grow with time and experience. You might also find that preparing in advance for any flare-ups can really reduce your distress.

  • Recognise what is happening
  • Don't panic
  • Take your medications regularly
  • If you are unable to continue with your exercises for a couple of days, start slowly and reset your goals if you need to
  • Try to think positively - negative thoughts can make things worse
  • Be kind to yourself!

If the flare-up carries on for more than a few days, contact your nurse or GP


Calming skills

Deep breathing exercises

Take a mindful walk


Imagine your favourite place

Think of your favourite place

Picture the people you care about

Take a shower or bath

Take a break

Positive self-talk

Say the alphabet slowly


Distraction skills

Reading a book

Write a story


Voluntary work

Baking or cooking

Play a board game

Play video games

Work in your gardening

Work in allotment

Cleaning the house

Relaxation: Learning relaxation techniques can be a very useful skill to help cope with and manage persistent pain. Anxiety, tension and stress can make the pain worse and pain itself can lead to anxiety, tension and stress. So it's a vicious circle. The trick is to break this cycle and relaxation can help you to do this.

Although it sounds easy, learning to relax takes time. Don't be too ambitious when you first start and try to practice every day. It is best not to try the techniques if you're having a really bad day, as they probably won't work.

Once you get better at relaxing, you will be able to use the techniques when you are having a bad day, and you will even be able to practise when you're out and about, standing in a queue, sitting in the car, etc.

You may consider using a relaxation diary to make a note of the type of relaxation exercise you did, when and where you did it, and how it felt. This diary should help you to see an improvement in your relaxation skills.

wk6 relaxation

Relaxation diary

 When did you try the techniques?  Where did you try the techniques?  Type of relaxation techniques  How did you feel?

Quick Relaxation

Use this quick, simple relaxation exercise whenever you feel tense. You can use it anytime, anyplace - when you're sitting down or even in crowded places.

  • Take one good, deep breath
  • Keep breathing slowly and deeply
  • Let your shoulders droop
  • Relax your hands
  • Take slow, deep breaths.
  • Tense and then relax different muscles of the body (e.g. hands, face, arms, and legs).

Deep Relaxation

1  Get prepared:

  • Find somewhere quiet. You might like to play some soothing music.
  • Sit in a comfortable chair or lie down (on your front, back or side). Make yourself comfortable, e.g. you might want to bend your knees.
  • Close your eyes and breathe deeply. Relax your body - let it go all loose and floppy.

2  Relax your muscles:

  • Do these three times, and then move up to your calves, bottom, and so on.
  • Is there any tension? If there is, release it and relax - and at the same time, say 'my feet feel calm and relaxed'.
  • As you breathe in and out, relax all the major muscle groups in turn start with your feet.

3  Calm your thoughts:

  • Stay fully relaxed, and breathe slowly and regularly.
  • Distract your mind by thinking about a relaxing, pleasant scene or playing some soothing music. For example, imagine that you are in the countryside on a sunny summer afternoon. Imagine that you are slowly walking on your own through a field … you can feel the warmth of the sun streaming down from the blue sky.
  • You can see the grass, the trees and the flowers in the field. You can hear the birds singing, and in the distance you can hear children's voices. Feel the ground beneath you as you walk, and walk slowly, looking at everything around you.
  • Think about what you can see, hear, smell and touch. Focus all your thoughts on this scene, and remove any other thoughts or worries that may come to mind.

4  Spend five minutes fully relaxed physically and mentally.

  • When you want to get up, count backwards from four to one.
  • You will hopefully feel refreshed, wide awake and calm.
  • Keep this feeling with you when you carry on with your daily routine, and don't rush around too fast.
  • Stay as calm as possible. You can practise any of the exercises described above on your own, but why not consider joining a yoga or gentle movement group? For example, Dru Yoga is particularly suitable for people with pain or disabilities.

Breathing exercises:

  • The way that you breathe is very important when you are in pain. This may sound strange, as breathing is something we don't usually think about!
  • However, when you are in pain, your breathing may be shallow or you may find that you are holding your breath.
  • This can lead to tension, which may make your pain worse. The trick is to take time to think about your breathing, making sure it is slow and relaxed.

The exercise described below can help you do this. Your diaphragm is a band of muscle that sits just below your lungs. It helps you to breathe by moving up and down, forcing air in and out of the lungs.

Normally, this happens spontaneously, you don't have to think about it. However, there is a technique called 'diaphragmatic breathing', in which you deliberately use your diaphragm to control your breathing.

  • Start off by making sure that you are comfortable
  • Make sure that your back is well supported and put one hand on your upper chest and the other on your tummy
  • Now close your eyes and focus on your breathing
  • Notice how quickly you are breathing and try to slow it down
  • Take a long, slow, relaxed breath in through your nose. Push out your tummy (this helps your lungs to fill up) and feel the air gliding slowly down in to your lungs
  • Hold it there for a few seconds, and then slowly breathe out again through your mouth, with your lips slightly parted. Let your tummy fall - this helps get rid of the air from your lungs
  • Take another long, slow breath in, pushing your tummy out, then breathe out, letting your tummy fall
  • Think about your neck and shoulders - is there any tension there? If there is, bring your shoulders up towards your ears, then slowly lower them back down, loosening any tension
  • Check for signs of tension in any other parts of your body
  • Focus on your breathing again, taking slow, relaxed breaths in through your nose and slow, relaxed breaths out through your mouth. Imagine the tension flowing away with every breath out


Week 6 Managing flare ups and moving forward

Week 6 Pain Management Programme Worksheet 1