Ep. 46 Strategies to Navigate the Holidays

Episode Summary:

In this episode of 'It's Not In Your Head' podcast, hosts Justine Feitelson and Dr. Dan Bates discuss challenges faced by chronic pain patients and overwhelmed clinicians during the holiday season. They cover actionable strategies to maintain routine and movement, manage stress, prepare for potential pain flares, navigate travel, and handle family interactions and the particularly challenging emotions like grief and loneliness surrounding holidays. Tune in for practical advice to navigate the holidays this season with more ease and less pain.

Episode Overview:

Dan and Justine take a special deep dive into why the holiday season is uniquely hard for people living with chronic pain and for clinicians under end‑of‑year pressure. They emphasize that holiday challenges are intense versions of the same patterns seen all year: triggers, loss of routine, worsening pain, emotional strain, and flares. The episode provides listeners with practical, actionable strategies to get through holidays with less pain, stress, guilt, and isolation.

The flare cycle and planning ahead

The cycle during the holidays is not different than at other parts of the year: a trigger or stressor leads to loss of routine, which reduces capacity, worsens pain, and drops coping skills until the person “falls into the hole” of a flare. Noticing early signs, accepting that holidays increase flare risk, and having a pre‑planned flare strategy rather than reacting in panic help mitigate this.

It is important to remember that slide‑backs are part of progress, and that you have climbed out of holes before and can do so again, even if it feels awful in the moment. If you miss the early window and end up in a big flare – it’s OK. Focus on the fact that all previous flares have eventually ended and asking a trusted person simply to “sit in the dark” with you when it’s the most difficult.

Core flare management strategies

Having a two‑layered flare plan helps: conservative measures (heat, ice, bracing, soothing massage, mindfulness) plus a medication plan discussed in advance with a doctor, such as combining an anti‑inflammatory with an anti‑neuropathic like amitriptyline instead of reflexively increasing opioids. Match the conservative strategies to the main drivers increasing your pain —poor sleep and circadian rhythm, decreased fuel, increased stress and anxiety, or excessive sedentary time and decreased movement—to make the response targeted rather than random.

Protecting and rebuilding routine

Loss of routine is one of the most powerful drivers of flares during holidays, whether through overwork before vacation, late nights, poor sleep, or letting nutrition and movement slide. Justine talks about noticing her own patterns—protein intake dropping, movement falling off, more sitting—and then deliberately rebuilding structure with small, doable stability work and scheduled pressure‑release points in the day. If you’ve had a period of doing nothing, return at about 50% of your usual exercise volume for a few sessions to avoid overload and injury rather than jumping straight back to your previous load.

Travel, pacing, and using supports

Travel is a common extra challenge during holidays and unfortunately, hope is not a strategy. It’s crucial to have a plan during and to schedule buffer and recovery time after travel or big events instead of going straight back into work or full routines. Enter trips with as much capacity as possible and a clear plan for flares, recovery days, and pacing. Bring your “SOS bag” of soothing items, maintain as many elements of normal routine as possible, and use mobility aids such as airport wheelchairs even if you only need them some of the time. These devices as legitimate pacing tools - not “cheating”, as even if you could technically walk that far, it puts you in a worse position down the line instead of saving those steps and capacity.

Movement “minimums” and flexibility

For movement, we recommend protecting a foundation rather than “all or nothing”: simple stability exercises targeting each person’s core problem areas (e.g., SIJ, scapular stability, CRPS limb desensitization) to prevent deeper slide‑backs. “Movement snacks” and breaking workouts into smaller chunks or focusing more on less‑taxing accessory work when stress, environment, or equipment make full sessions unrealistic. Though it can feel like you slide back quickly, remember you can also make a difference quickly if you re‑engage gently with a gradual ramp‑up to help sensitive nervous systems tolerate renewed activity.

Family stress, boundaries, and “crappy relatives”

Many of us dread crappy relatives and the stress of these triggers can be significant. Remember, you are allowed to limit exposure and treat dose–response as applying to family as much as to exercise. Strategies include setting clear time limits with triggering people, excusing oneself from inflammatory conversations, using mindfulness/breathing as a break and form of pacing for longer events, and going in with a buddy who can help you tap out early, gets you, and makes the event more enjoyable. For invalidating comments, Dan recommends the simple response “Wanna swap?” followed by a pause, inviting others to imagine living with chronic pain without escalating conflict.

Loneliness, grief, and changing life stories

During the holidays, the opposite problem to family overwhelm also exists: intense loneliness, grief, and the sense of living a completely parallel experience to healthier people during the holidays. Justine shares that holidays were a painful reminder of everything she felt she had lost after her brain injury and how stuck and different she felt compared to peers with jobs, partners, and children. She encourages listeners to soften the weight of the holiday symbolism, look for small “glimmers” of meaning, and remember that current circumstances do not have to stay this way, even if it feels permanent.

Gratitude, connection, and finding “your people”

Dan and Justine suggest deliberately shifting attention toward small things to be grateful for and expressing overt gratitude to others as a way to lift mood and build connection. You can’t feel what you don’t make an effort to notice. Reach out to people you feel safe with—family, friends, or online communities—and seek those who both “get it” and also help avoid getting stuck in purely negative, hopeless narratives.

Navigating clinician holidays and system limits

From the clinician side, Dan talks about planning patients’ pain strategies for the coming four weeks, arranging cross‑cover with trusted colleagues, and using an after‑hours phone line so crises can be de‑escalated early rather than allowed to spiral. Doctors are human and need holidays too, so it is important to plan ahead for appointments, prescriptions, and travel chnges rather than waiting until late December and not getting in. It is particularly important to be able to lean more heavily on conservative tools and self‑management strategies when access to clinicians is temporarily reduced. ​

Takeaway for listeners

Accept that holidays will increase stress and flare risk, plan rather than hope, and aim for “good enough” rather than perfection. Protect routines where possible, keep a simple flare plan and movement minimum you stick to, and be proactive about travel, boundaries, and recovery days. Emotionally, the hosts validate both family‑related stress and deep loneliness, while offering practical tools—mindfulness, gratitude, connection, and perspective shifts—to help holidays feel survivable and as enjoyable as possible.