When Everything Gets Louder: Managing Chronic Illness Flares and Ways to Move Through Them

I discovered the eczema on my foot by accident. I was already dealing with my autoimmune hives doing what they do best — staging their worst performances on my legs and feet, that particular brand of itch that makes you want to crawl out of your skin. So I was scratching. And somewhere in there I thought, wait, this feels different. Turns out my dishydrotic eczema, which normally stays on my hands, had quietly migrated south. I only noticed because I was already on fire. That’s a chronic illness flare.

Not just one bad thing happening. Everything flaring at once, taking turns being the loudest.

What Exactly Is a Chronic Illness Flare?

A chronic illness flare is a period when your symptoms intensify — sometimes gradually, sometimes overnight, sometimes for reasons you can identify and sometimes for absolutely no reason you can name. And if you live with a chronic condition, you already know that flares don’t politely limit themselves to one system. They pile on.

Your symptoms flare will look different from mine. That’s one of the most isolating things about chronic illness — we’re all fighting variations of the same war.

What Triggers a Symptoms Flare-up?

Honestly? Sometimes I have absolutely no idea. That’s one of the most frustrating parts — you can do everything right and still find yourself in one.

However, there are patterns. Common triggers include:

• Dehydration — especially critical with dysautonomia, where fluid intake directly affects blood volume and symptoms.
• Poor sleep — my sleep disorder means this is a near-constant factor. When your body doesn’t get the rest it needs, everything becomes harder to manage.
• Missed medications — sometimes unavoidable, especially with gastroparesis when nothing stays down.
• Weather changes — barometric pressure, heat, humidity. Your nervous system notices even when you don’t.
• Overdoing it — the overdo/underdo cycle strikes again.
• Sensory overload — too much noise, light, activity. The nervous system gets overwhelmed and everything escalates.
• Stress — emotional or physical. The body doesn’t distinguish.
• Being sick — a cold or flu on top of a chronic condition is a whole different experience. Your body is already fighting; adding more is a lot.
• Diet — certain foods, not eating enough, or not eating the right things for your conditions.
• The domino effect — one symptom triggers another triggers another. Suddenly you’re not sure where it started.

Your triggers will be your own. Some you can manage, and some you can’t. Knowing them is still worth something — even if only to extend yourself a little grace when a flare arrives uninvited.

Why Does One Symptom Wake Up the Whole Crew?

Here’s something I learned at Spaulding Rehabilitation’s Pain and Functional Restoration Program that genuinely changed how I think about what my body does during a flare.
Your nervous system’s job is to protect you. It has specialized nerves acting as “danger detectors” — constantly sending messages to your brain, which then decides whether to create pain as a warning signal. Under normal circumstances, that’s a brilliant system.
But when you live with chronic illness, something called central sensitization can happen. Think of it like a house alarm that’s been calibrated too sensitive — instead of only going off when someone breaks in, it triggers when the wind blows or someone rings the doorbell. Your nervous system has been on high alert for so long that the threshold for “danger” gets lower and lower. Things that didn’t hurt before now hurt. Symptoms that were manageable now aren’t. Everything is louder.

That’s not weakness. That’s neuroscience.

And during a symptoms flare, that alarm is going off constantly.

So How Do You Manage Chronic Illness Flares?

I’m not going to tell you to take a bubble bath and practice gratitude. If you’re in the middle of a symptom flare-up, you don’t need wellness advice. You need a plan.

Before I share what works for me, I want to say something important: chronic illness is not one-size-fits-all. Not even close. Two people with identical diagnoses can have completely different experiences, completely different triggers, and completely different responses to the same tools. What lives in my toolkit may not live in yours — and that’s okay. The goal is to find your combination, and that takes time, patience, and more than one try. Don’t give up on something after one attempt. Give it a real chance.

That said, here’s what I learned, and what I actually use. Maybe some of it becomes yours too.

Heat and Cold (Pain Control Modalities)

Spaulding calls these PCMs — Pain Control Modalities — and the key thing most people don’t know is that they work best when used proactively, before your pain escalates. During a symptoms flare, you can use them up to every two hours.

• Moist Heat is more penetrating than dry heat. A rice sock — just fill a long sock with dry rice and microwave it for 90 seconds — works beautifully and costs almost nothing. Twenty minutes on, two hours off per body part.
• Cold Packs work differently — they slow pain signal transmission and with ice massage, actually trigger your brain’s natural painkillers. Same timing: twenty minutes on, two hours off.
• Contrast — alternating hot and cold on the same area — can be especially effective for circulation and pain relief.

You can make a cold pack at home with three cups water and one cup rubbing alcohol in a gallon freezer bag. Double bag it. Done.

Physical Counter Maneuvers (POTS-Specific)

Before trying any of these, please check with your care team first — especially if you’re in an active flare, have cardiovascular involvement, or aren’t sure what’s safe for your current situation. This is a starting point for a conversation, not a prescription.

If you have POTS or another form of dysautonomia (I wrote about what it actually feels like here), one of the most immediate flare challenges is simply staying upright and conscious. Spaulding taught me a set of physical counter maneuvers — small, strategic movements that help your body manage blood pooling and keep you functional.one of the most immediate flare challenges is simply staying upright and conscious. Spaulding taught me a set of physical counter maneuvers — small, strategic movements that help your body manage blood pooling and keep you functional.

These aren’t exercises. They’re survival tools you can use in the moment.

• Leg crossing before you stand or while standing
• Heel raises — ankle pumping while sitting or standing
• Forward bend — lean forward and rest your elbows on your knees
• Clasp your hands together or squeeze a ball
• Knees to chest position when lying down
• Whole body muscle tensing — tense everything you can, especially your core and legs. Keep breathing.
• Lie down with legs elevated when all else fails

None of these require equipment. Most can be done without anyone noticing. And they can be the difference between staying upright and going down.

Pacing — The Tool Nobody Talks About Enough

Here’s a pattern that will sound familiar if you’ve ever had a good day with a chronic illness:

You feel better than usual, so you do all the things. Then you pay for it for the next three days.

That’s the overdo/underdo cycle — and it’s one of the most destructive patterns in chronic illness management. On good days we push too hard because we feel guilty about the bad days. On bad days we stop moving entirely. Either way, the result is more pain, more fatigue, more frustration.

Pacing breaks that cycle. It’s not about doing less — it’s about doing consistently, with intention.

A few principles that actually work:

• Take breaks before you need them. Frequent short breaks are far more effective than waiting until you crash.
• Break tasks into smaller parts and set a timer.
• Alternate demanding and gentle activities — something standing, then something sitting. Something physical, then rest with heat.
• Prioritize. Not everything needs to be done today.
• Let go of perfect. Done is enough.

Your Brain Is Listening

This is the part that surprised me most when I went through the program at Spaulding. I spent a lot of time learning tools to manage pain, but then we took it somewhere I didn’t expect. We talked about the language we use.

Your brain responds to danger messages and safety messages. All day long, you’re sending it both — through what you do, what you think, what you say out loud, where you go, who you’re around, and what’s happening in your body.

Danger messages sound like:

• “This is never going to get better.”
• “I can’t handle this.”
• “My body is broken.”

And your nervous system, already hypersensitized and on high alert, responds accordingly.

The alarm gets louder.

Safety messages sound different:

• “This is a flare. I’ve been here before.”
• “I have tools. I have a plan.”
• “This will pass.”

That’s not toxic positivity. That’s not pretending everything is fine. It’s giving your nervous system something to hold onto besides fear. It’s the difference between drowning in a symptoms flare and moving through one.

Spaulding gave us a framework for mapping our own danger and safety signals — the people, places, sensations, thoughts, and beliefs that turn the alarm up or down. It’s one of the most useful things I’ve ever done, and it cost me nothing but time and honesty.

I attended their Pain and Functional Restoration Program twice — the first time, I was referred by my doctor during COVID and attended virtually; the second time, I requested the program myself so I could experience it in person. It was and continues to be a valuable resource for managing my chronic illness flares.

That’s why I write this blog – because there are so many great tools and resources available out there, and I want to share them to motivate you to explore these options, as I remember how I felt when I was first diagnosed. And there’s no doubt, I remember my first symptoms flare, and I want you to have the information I didn’t have so you don’t have to go it alone.

One More Thing Before I Go

Spaulding doesn’t disappear from your life once a program ends — and honestly, you don’t even have to have been a patient to feel held by what they offer. The Spaulding Adaptive Sports Center (SASC) runs virtual classes that welcome people exactly as they are. Some folks join from a chair, some from the floor, some from bed on a day when that’s all they can manage. There’s no pressure to “perform.” It’s just a space where your body is allowed to be whatever it is that day.

They’ve got things like chair yoga, beach yoga, movement and meditation — all free. And the gentle fitness classes (core and stretch, total body strength, adaptive boxing) are five dollars per household, which feels like a kindness in itself.

If you’re near Boston, there are in‑person options too: adaptive swimming, cycling, pickleball, inclusive fitness training — scattered across Charlestown, Quincy, and the North Shore. It’s all built around the idea that you deserve access to movement, even on the days when your body feels unpredictable.

You don’t need to be a Spaulding patient. You don’t need to live in Boston. And you definitely don’t need to be having a good day. Sometimes the softest thing you can do for yourself is show up in whatever body you’ve got.

→ Spaulding Adaptive Sports Center

What’s In My Flare Kit?

This post contains affiliate links. If you purchase through my links I may earn a small commission at no extra cost to you. I only recommend products I actually use and trust. As always, please check with your care team before trying new tools — especially heat, cold, or any physical therapy modalities. What works for me may not be right for your specific conditions.

These are the things I use all the time. Not a sponsored list — just what lives on my shelf and why.

• SacksyThyme Microwave Heating Pad — flaxseed filled, moist heat, made in the USA by a woman-owned small business whose founder created it for her own chronic pain. This is the one.
• iEco Cold Massage Roller Ball— perfect for ice massage without having to hold an actual ice cube. Game changer for nerve pain and tight muscles.
• Fitballz Massage Ball Set — tennis ball massage, lacrosse ball, peanut roller — everything Spaulding taught me to use, in one set.
• OPTP PRO-Roller Foam Roller — soft density, which matters when you’re already in pain. Not the punishing kind.
• Gaiam Exercise Ball — gentle movement, active sitting, core work on good days. By the way, the ball is also great to use for gentle stretching as well.

You Have a Plan. It Will Pass.

Flares are relentless. They pile on, they linger, they make you question everything. But you are not without tools, even when it feels that way.

Start where you are. Try one thing. Give it a real chance. Talk to your care team about your chronic illness flares. And know that somewhere out there, someone else is also in their second month of a flare, electric blanket on, doing their best.

That’s me, by the way. Hi. 👋

💜 Lyn

The tools in this post come from my personal experience with Spaulding Rehabilitation’s Pain and Functional Restoration Program (Medford, MA) and the Benson-Henry Institute for Mind Body Medicine at Massachusetts General Hospital. Always consult your care team before starting any new treatment or exercise program.

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