There is a lot of threat inherent in the statement “I feel like my pain is a ticking time bomb”. Yet, for years, women have been describing their chronic pain like this to me. They feel like everything is fine (or at least better) for a period of days or weeks - like they have a handle on their symptoms - the aches, the muscle pain, the stabbing pain, the brain fog, and the fatigue. They are getting things done, checking things off their list, calling and making plans with their friends, taking on additional tasks at work… and then just like that - they feel like they just lose it the next day or week. They crash, with more physical sensitivity, scared to move, lost motivation, lost productivity, lost confidence in managing their pain. They describe to me that the build-up to this unpredictable point of flare-up was undetectable. It felt sudden to them even though it was probably gradual.

When this difficult scenario happens, we stop and try to figure out:

“What caused my pain?”

“Ugh, what did I do THIS time”

“What was the thing that knocked my back out”.

But we aren’t asking the right questions or focusing on the right things.

Let me redirect this line of questioning for you using the concept of wind-up…

If you’ve been following me for a while, then you know that I talk a lot about how pain is multifactorial as are the factors that increase sensitivity and drive a cycle of pain. These biological (anatomy/sleep/nutrition/injury), psychological (mood, coping), and social (cultural influence, environment, work, everything else) factors can wind up the sensitivity of our nervous system or our pain response. Our pain alarm system becomes more sensitive, resulting in more easily triggered and amplified pain.

So hear this - there likely isn’t any ONE thing that you do or did or that is happening in your body that caused your flare-up or this more sensitive period of your pain.

Because perhaps you had a few nights of poor sleep, you had a lot of deadlines, because of the number of tasks you had going on fueling your body with a good diet was difficult. Your stress level was a little higher than usual - you were worried about disappointing people (or yourself). You couldn’t find time for your walks and found yourself putting exercise off for the week. You finally get through the week and decide to make up for lost time. You jump on your treadmill and go full force, too much too soon, but your body wasn’t used to it after the week you’ve had. You start to worry - “I threw my back out again”, “this hurts really bad, something must be seriously wrong this time”. You spend the rest of the next few days in bed working from home, if at all.

Lifestyle factors: poor sleep, lack of recovery activities, diet.

Physical factors: unaccustomed loading too much, too soon, deconditioning, poor load tolerance.

Psychological factors: Perfectionistic tendencies, worry about disappointing others, internal self-criticism, negative/worst case scenairio beliefs about pain, fear of injury.

High stress levels without activities to counterbalance the stress response.

Big to-do list, less time to prioritize, leading to less ideal coping strategies.

See? It wasn’t just one thing.

To adapt an analogy from Greg Lehman, I’d like us to think about the wind-up occurring because of an “overflowing cup”. Think of your pain experience or your life as a cup. Many biopsychosocial factors have the potential to fill your cup. Our cup is always filling with this or that - we have a life, there are demands, we have things to do. And then additional stress, or an increase in physical or psychological load can tip us over the edge, causing everything to spill over. The spill-over is when we see the often unexpected emergence of pain, at high levels, perhaps a flare-up that lasts hours to days.

Instead of asking “what did I do this time”, you can remember that pain is sometimes delays, that pain occurs in a context, and this concept of an overflowing cup. It isn’t usually just ONE thing.

Instead, ask these questions:

Was there an increase in stress, physical load, or psychological load recently?

How was my sleep/nutrition/movement/lifestyle activities this past week?

As the load was increasing, was I increasing good coping methods or recovery activities to make my cup bigger?

This is a good place to start, especially in terms of thinking about where pacing and lifestyle priorities might lie at that time. The factors that wind up your pain can be completely different than the contributing factors to someone else’s flare-up.

Consider different contributing factors that are unique to you and how they might apply in the sense of an overflowing cup.

Then what?

Unhelpful factors for pain are what fill the cup.

Things that are good for us build a bigger cup.

The amount of pain you have is the result of this balance between the size of your cup and how much is filling it.

Even when you don’t feel like you have much control over what is filling up your cup, we can always find ways to build a bigger cup so that it doesn’t overflow.

So is pain like a ticking time bomb? It can be I suppose! But if you are paying attention to your “ticks” along the way, you can change the way that countdown looks.

Now, this gradual but undetectable and seemingly unpredictable rise of a flare-up is so common. It has happened to me. It has happened to you. It has happened to people you know. And it has happened to other providers who treat pain too. You aren’t alone - at all. You’re an individual with chronic pain experiencing flare-ups, which are very common with chronic pain, and you deserve support. And I can help.

If you’re looking for education and more personalized support, let’s connect!

I have free Facebook group where I talk about all of the things that can push our pain over the edge. I’d love for you to join us!