Facing Pain Flares: Seeing Patterns & Mastering Your Response

If you’ve ever felt ambushed by a pain flare, you’re not alone. Managing chronic pain is tough enough without these sudden spikes that seem to appear out of nowhere. As both Dr. Dan Bates and I have explored, flares are rarely as random as they feel. The good news? You can learn to spot their approach—and respond with confidence.

Flares Aren’t Random

One thing patients often feel is that flares come without warning. It is clear there are almost always signs ahead of time though. It’s all about learning to recognize your personal “pattern of events.” Think back: when was the last time your pain ramped up? Were you exhausted? Had your stress been building? Was your routine off? Did movement or fueling fall off? These clues are there, waiting for you to notice them.

Why We Study Flares

My motivation is to help you become your own expert. Honestly, doctors don’t always get the luxury of digging into every detail of your experience in a busy clinic or office. Yet, in our conversations together, that’s just what we do—break it down, step by step. The goal: to help you catch these flares earlier, see the shape of them – or their anatomy, and learn how to climb out faster. It’s not about preventing every tough moment, but building your skills so “better a little late than never” becomes your new mantra.

Spotting Triggers: Stress, Overtraining, and Life’s Buckets

The concept of “allostatic load”—the sum of stresses that can sneak up and knock you off balance, is crucial to understand in the environment of flares. For you, those triggers may be subtle: a difficult week, a heavy workload, or even social interactions that sap your energy. Sometimes it’s overtraining; sometimes it’s people, places, or things. Take a moment to ask, “What are my buckets or triggers?” You might be surprised by what’s quietly tipping you into a flare.

Skills and Strategies: Responding, Not Reacting

What counts isn’t perfection—it’s preparation and practice. When a flare hits, your job isn’t to blame yourself, but to pause and ask, “What’s happening now, and why?” Reaching out for your coping strategies early—whether that’s rest, gentle movement, or connecting with someone—can make all the difference. Sometimes, noticing the flare is half the battle, and acting on that awareness is your first win.

Building Self-Awareness and Confidence

If you feel overwhelmed, remember: this process is deeply personal. You have the power to recognize and change patterns, little by little. As Dan and I have found, each patient is unique—but the skills and strategies we discuss are universal. We’re here to empower you with practical wisdom, a dose of realism, and a belief in your ability to manage what comes next.

In managing pain flares, your story matters. With the right perspective—curious, honest, and just a bit scientific—you can learn to spot trouble early, interrupt your patterns, and respond with confidence. Every step you take is progress.

Though flares can feel unpredictable, as we’ve discussed together (and with many patients), there’s a clear structure that helps you not only understand them, but handle them with more confidence. Let's walk through the explicit 5-part framework we reference in our conversation.

1. Phase 1: Trigger or Stressor

Before a flare actually hits, there is almost always a “predating” pattern—signs and signals that come first, even if you’re not conscious of them. This is where we encourage patients to look for the things that come before the pain worsens. It’s often small stuff: changes in sleep, extra stress, pushing limits (workload, overtraining), or emotional upsets. Clinically, there’s rarely a flare that actually “comes out of nowhere.” If you get good at noticing these patterns, it’s like catching a storm before the clouds gather. That awareness gives you a head start.

2. Phase 2: Loss of Routine

When the flare strikes, your symptoms intensify. This is when many people feel overwhelmed or out of control. For some, it’s physical pain; for others, it’s emotional fallout. Understanding how your flare presents—in your body and mind—helps you make sense of what’s happening, rather than feeling blindsided. Different people have different warning signs. Your own “presentation” is unique, but once you see it, you can start to anticipate and intervene.

3. Phase 3: Worsening Pain

There comes a moment of realization: Oh my God, it’s happening. Recognizing you’re in it is key to stopping it as soon as possible. This is your opportunity to pause and actually acknowledge the flare. It’s normal to have flares—what’s important is to accept you’re in one so you can begin to take action. Don’t fight yourself or pretend it’s not happening.

4. Phase 4: The Hole

By the time you’re in the hole, there is usually a strong emotional component, natural catastrophization from the fear of being stuck like this or reminded of how bad it can get, as well as isolation or a lack of communication over time from having less bandwidth and being more overwhelmed. Patients often wish they’d responded sooner, but honestly, catching yourself at the dig-in point is still powerful. Better a little late than never. That recognition is what allows you to shift gears, and start helping yourself.

5. Phase 5: Climbing Out: Taking Action

After acknowledgment comes action. What skills and strategies help you climb out?

This is where tools matter—gentle movement, rest, asking for help, downregulating or using stress management techniques. Notice what works, and use it. The climb-out is your recovery phase.

Sometimes all it takes is a small step to begin to create positive momentum—changing your environment, revisiting your priorities, improving what you can control, or simply being kind to yourself. The important thing is not to stay stuck.

The Reflection Point: Learning From the Flare

Once you’ve climbed out, it’s time to reflect. What can you carry forward for next time? We encourage patients to look back: What was the pattern? Did you spot early warnings? Which strategies helped? Reflection brings learning, so each flare can teach you something. Think of each episode as information. The more you learn about your flares and your response, the better prepared you’ll be—and the less power flares hold over you.

Bringing the Structure to Life

This five-part structure is not just a “theory”—it’s a practical guide built from our ongoing work with real people. If you’re living with chronic pain, try walking yourself through these five stages whenever a flare arises and seeing what they mean for you. With practice, you’ll catch patterns sooner, respond with more skill, and recover with greater confidence. Remember: the process is normal, it will get better, and you’re never alone in facing it.

For more insight and practical advice, tune in to episode 15 of It’s Not in Your Head Podcast.