Why a Pain Flare Doesn't Mean You're Back to Square One
There's a particular kind of despair that comes with a pain flare after a good stretch. Because at that point, it’s not just about the pain. It’s also about the drop…
I knew it. I was doing too well. This is always where I end up.
That interpretation, that your flare is proof of failure (or that progress wasn’t real) is one of the most common and most costly patterns I see in chronic pain recovery. And it makes a certain kind of sense, given what the nervous system is doing. But it is almost never accurate.
Let’s get into it…
Your Brain is Not an Objective Reporter
Like any system designed to keep you safe, your nervous system is calibrated to flag danger loudly. After all, it’s what keeps the survival train moving, no? This also means that actions and behaviors associated with safety are much less “important,” and so get encoded much more quietly.
This is a really important understanding, because it means bad days get catalogued with weight and precision. It’s a hefty and easy-to-find file when we need it.
And then, good days tend not to register with the same force. They’re the folder with just one piece of paper inside. Heck, sometimes they’re the ignored dust on top of the filing cabinet. Good days are there, but they don’t feel like the same brand of data.
What results is that your running account of good vs bad days is systematically skewed towards the negative. Again, this is normal and expected. However, when coping with chronic stress and pain, it’s like turning that natural prioritization of threat signals into overdrive.
And that makes it very hard to accurately assess your own progress.
Insight Alone Doesn't Update the Nervous System
People who are thoughtful and self-aware (which describes most of the people I work with) often have a particular pattern when things get hard in therapy. They go back to “old habits” or “strong muscles” in their system, which are often the thinking ones. The parts of them that are good at picking apart reasons, finding the logical loops, and making rational sense of a sensation.
And what’s wrong with that? Well the nervous system doesn’t respond just to our insight our how good the argument is. It responds to feeling safe. And it learns by experience. So instead of just talking about or analyzing a sensation, we have to softly attend to it. Feel the edges of it, get to know the emotions underneath it. And yeah, the meaning matters, of course. But that alone will not heal these patterns.
We can’t leave the body behind when treating a mind-body problem.
Negativity bias
The brain is designed to prioritize threatening information over neutral or positive information. It’s a hardwired survival feature that kept our ancestors alive. But in chronic pain recovery, it can keep an unhelpful cycle stuck.
How to Tell When You’re Making Progress
As a nervous-system informed psychologist who specializes in chronic pain, a huge part of my job is to track signs of progress and growth that my clients might not naturally see. Or what they’ve (unconsciously) learned to ignore.
That means when someone tells me they feel like they’re not getting better, or they’re worried that their backsliding, the first thing I want to know is: what data are you looking at? Because the mind is not a reliable narrator of the evidence. And if you’re not used to interpreting nervous system signals with neutrality, than neither is your physiology!
Here’s what I’m actually tracking for signs of progress in therapy:
Bounce-back time. How long does it take to recover from a hard day or a flare? Is it shorter than it was when we started? A spiral that used to last three days but now fades in forty minutes is significant data, even if the spiral still happened.
Texture of catastrophic thoughts. Are they still present? Probably. But are they as loud? Do they last as long? Do they still feel as true? Softening in the intensity or duration of catastrophic thinking is one of the earliest indicators that the nervous system is learning something new and that you’re integrating it across your parts.
Moments of neutrality. We’re not talking about an absence of pain, but rather the capacity to notice other sensations, too. The moments where the body is not actively bracing, not anticipating the next flare, not in a constant state of vigilance. Where your attention goes - and where it stays - matters for your progress.
Agency in decisions. Are you listening to your preferences? Even if your choices haven’t changed (yet), being able to hear your voice more clearly is a win.
And these things don’t show up when someone is helplessly caught in a chronic pain cycle. They show up because you’re breaking out of it.
Why a Bad Day Feels Like Evidence
Here's a core pattern I see do some subtle but pervasive damage in chronic pain recovery:
A flare happens and it immediately becomes proof that nothing has changed.
It’s ironclad, unambiguous evidence that progress wasn't real, and this pain is just how things are.
But then the stretch of several good (or even “okay”) days? You know, the ones that look like:
Three days without a flare
Genuine ease at a social event
Doing a relaxation practice and feeling good for several minutes after
Those good parts get explained away: “I was just distracted,” or “I got lucky,” or “But that didn’t last.”
This asymmetry, where negative data confirms the worst and positive data gets discounted, is a known unhelpful thinking style. It’s called “mental filtering.”
Your filtering mechanism can change. You can interrupt it, which starts with noticing the asymmetry directly.
When the flare is being treated as the only proof, ask: proof of what, exactly?
Then ask, what would it take for a good day to count as equally valid evidence?
I’m not preaching positivity for the sake of it, here. I’m asking you to look on the bright side because you deserve to see the whole picture.
Mental filtering:
when the mind fixates on a single negative detail while filtering out the rest of the picture, leaving you with a distorted sense of reality that confirms the worst, even when the evidence doesn't.
Why Chronic Pain Flares Happen
Any symptom from the body is first a signal. It’s just information. What meaning you make of that information is a totally different thing.
So when you have sharp pain in your right knee, it might mean the nervous system encountered something activating and is lighting up an old spot that it knows you pay attention to. Those activating things can be as subtle as a change in your routine, more noticeable like a bad night of sleep, or really obvious like a trigger related to a known stressor.
And in the moment when the pain spikes, your brain and body are responding in the ways they’ve learned to keep you safe:
(1) something actually or potentially dangerous is present
(2) I need to send a signal as an alarm
(3) Insert pain or other discomfort
(4) Keep ringing until my human addresses the threat
In those moments, the system is doing exactly what it was designed to do (from a survival standpoint). But that doesn’t always translate to thriving.
If your nervous system is very, very good at it’s job of threat detection, you might be missing out on the good stuff for all the energy it’s taking to fire off and tend to alarms.
You might’ve heard before that chronic pain is related to “central sensitization.” And this is exactly the pattern we’re naming. With chronic pain (or related chronic symptoms and discomforts), the necessary survival alarm has become miscalibrated. It’s still doing it’s job of keeping you alive, but it’s not very good at telling the different between danger and discomfort.
Those “misfires” are exhausting, I’m sure. Even when you’re not aware that’s what’s happening, it’s costing you:
mental attention
physical energy
sense of safety
time in recovery
moments of living
What It Means When You Have a Pain Flare
When a flare hits, it's worth knowing what it's actually telling you. Again, the first thing is that it’s giving you information. The second thing is the meaning or interpretation you give that.
Let me clear - I’m not implying you’re making up the pain or the stories that go with it. I’m just acknowledging the places where we have space for changing the pattern.
Depending on your own personal history and experiences, you might discover there’s an area of life you’re holding quite a bit of tension. And that tension is contributing to the overactive threat detection in your nervous system.
You might also discover that when pain flares, it’s actually just the system adjusting to new changes…. ever heard of a learning curve? Or extinction burst? Those are real principles and they apply to chronic physical symptoms too.
When the nervous system is in the middle of learning something new, the old pattern doesn't go quietly. It gets louder first. One last push before it lets go. So the timing that you’ve judged as cruel and unusual punishment—when a flare strikes after a series of good days? It’s actually some of the most meaningful data of all.
And for the part of you that fears a flare means you’re “back to the beginning” or that your progress was never real anyway—it makes sense you’re scared.
But just because you feel bad doesn’t mean something bad is happening. And that difference between information and interpretation is a key part of healing in chronic pain recovery.
Doing Pain Recovery Differently
As a pain psychologist who focuses on integrating your healing across mind, body, emotions, and identity:
this is where the good stuff happens. ✨
If I could give you one powerful shift to take into your days with chronic pain, here it is:
When the flare hits, stop asking “What’s wrong?”
And start asking “What is my system responding to right now?”
Because if you already “get” the mind-body connection with chronic pain, then you already know an actual threat isn’t present. So the go-to question of what’s wrong will just fire up more uncertainty and amplify the danger.
But the new question, what is my system responding to right now, brings neutrality and curiosity. It gives space for your nervous system to be wrong about the presence of danger. And it gives your wisdom a seat at the table—instead of an express ticket to Catastrophic Town.
It also becomes way easier to not jump to the deflating stories about failure or regression, and instead to see your nervous system as the living, malleable being it is. The system that is designed to respond to changes.
Like any responsive system, it can get miscalibrated—and recalibrated—with the right conditions.
For chronic pain recovery, your nervous system needs conditions like:
enough safety to stay curious (and to try again when you mess up)
consistent repetition of new responses
opportunities to learn that discomfort is tolerable
These conditions sound straightforward on paper. In practice, they can be hard to cultivate alone, especially when you've spent years (if not decades), building fast and automatic connections between a symptom and what it means.
A Pain Flare is Not a Moral Failing
If some of this is finding you in places that need to hear it, I’m so glad.
And I also want to invite you to sit with the core idea here: a pain flare is not a verdict on your progress.
It's not evidence that you've failed, that the work hasn't mattered, or that you'll always be in this same place. It's just data from a nervous system that has been working very hard for a very long time. And that same nervous system is capable of learning new things, running a new pattern—given the right conditions and enough time.
I know that’s simple enough for me to say, and that living it out is a different beast. Especially when the nervous systems alarms are very loud (and very convincing). Which is why I believe so strongly that this work is best done with support.
I specialize in chronic pain and the anxiety and worry that comes with it. My approach is integrative; we work across mind, body, emotions, and identity. Not just managing symptoms, but changing the patterns underneath them. For people ready for a more concentrated container, I offer pain repatterning intensives designed for exactly this kind of deep, relational work.
A Personal Note
Something I learned in my own healing process is that relationship is often the missing ingredient.
When we can't trust our own perception because our unconscious beliefs or nervous system processes have been running the same story for so long, it can be hard to see outside of that pattern by ourselves.
We sometimes need another person present to help us locate our own wisdom. To reflect back the agency we can't yet see in ourselves. To hold us accountable to the things we say we want, especially on the days we forget or just want to collapse into the status quo.
If you've been trying hard for a long time and still feel stuck, perhaps something you’re missing too is having another person in the room with you. Someone who believes in your insight, in your agency, and in your capacity to write a different narrative.
“There is no greater source of joy and meaning in our lives than our relationships with others.”
-Ester Perel
Disclaimer: this photo was NOT taken in the ‘90s. Just on a 90’s “kodak” app
Dr. Anahita Kalianivala is a licensed clinical psychologist specializing in chronic pain and the anxiety that accompanies it. If you're navigating chronic pain and want support that goes beyond symptom management, you can learn more about working together at alcovemh.com.