RA Flare vs. Change in Daily Pain
Flare ups are my body’s reminder of just how bad it could be. When you are at a point in your condition that your pain is mostly under control and has been for a few months or more, that 10/10 pain day throws you for a loop. You think back over everything that you did the last couple of days. Did I overdo it? Did I lift or reach for something wrong? Was I on the wrong side of my pillow again? (If you have not experienced this, you will. My condolences.) Regardless of why it is happening, it is excruciating.
But how do you know if you are in a flare or if your daily pain has increased, and why does it matter? Pain is pain, right?
There was a gradual increase in pain the past week, I must admit. Pains in places that I had not experienced lately, and they were different pain sensations than my typical day to day. I could tell something was wrong, but I was not sure what it was just yet. I briefly considered if this could be my daily change and this is just what it would be like until I could figure out what to do to get it back under control, if anything.
Then at 3:30 this morning, I woke up to unbearable pain and knew it was a flare. In a week I had gone from a 4/10 to a 7/10, then in a few short hours a 10/10 with no accident or major change to anything.
Mostly the pain was in one shoulder, the rest of me was a dull ache at first. Getting ready was difficult to say the least, with my right arm frozen to my side and muscles splinting and tightening from my face to my fingertips. My achy hips soon developed sharp pains and I could feel my posture change drastically, slouching forward, fighting gravity. And I stopped to ask: when was the last time that it was this bad?
Fortunately, this time I could say it had been a while. Even the pain I have had has been more localized and I could usually point to a cause. This was different in every way.
(Today was infusion day, so I was in luck! The steroid they give me with my infusion would surely help with the pain and get me through the worst of it a bit quicker. Fingers crossed – if I could.)
If you have been through a flare up before, you know how unpredictable they can be. Sometimes I can be back to my “normal” in a day, sometimes it takes weeks. This is where I feel like the flare causes a change in overall pain; when you have those flares that you never fully feel recovered from. This is where tracking your daily pain and looking at patterns can help determine if your condition is worsening and/or responding to treatment and selfcare.
So why does it matter? Most important for myself, flares respond to different treatment and selfcare methods than my day-to-day pains, so it is important to treat them differently. The most common example I saw as a neuromuscular therapist was in the way people resisted cryotherapy (cold therapy often using ice). While it is true that heat can be soothing to arthritic joints in the long run, sudden onset pain and inflammation like a flare is often better treated with cold, particularly in RA where the inflammation is kind of an error in the body and should be corrected.
This is also why it is important to understand the differences between common medications for pain conditions such as anti-inflammatories, pain killers, muscle relaxers, anti-depressants, sleep aids, etc… Talk to your doctor or pharmacist about how a medication is going to help with your pain. I’ll warn you that they may not always have an answer, and that is ok. Some of the meds I have been on were simply because sometimes they work even if they did not know how. I am not saying you should not try them. I am only saying that this is also important information to have, especially when you are considering whether to stop a medication or not.
The sooner I can get out of a flare, the less likely I am to be stuck at a new pain level for the long term. Check back for posts on selfcare methods and managing pain from home.
Blog written March 9, 2021
Video recorded April 16, 2021
