Managing Fibromyalgia Flare-ups

The course of fibromyalgia is not the same from person to person. Some people may experience ongoing symptoms that never seem to relent. Others experience flare-ups, meaning the symptoms become more intense or severe at unexpected times. There is often no pattern to the flare-ups. In between these incidences, the flare-ups subside and the fibromyalgia may seem to go into remission or the symptoms become much less intense. By definition, a flare-up is when the disease, disorder, condition or syndrome is at its worst.[1]

A flare-up can happen at any time. It may occur after a relatively quiet period during which the symptoms have been mild. A flare-up can also occur while you are already suffering chronic pain, and the result is the pain gets even worse. It may start without warning too, giving no indications that a flare-up is developing. The good news is that fibromyalgia does not damage muscles, organs or joints so the pain should not make you panic about your health.

For some people, the flare-ups may require adjusting lifestyles temporarily or for the long term. For example, it might be necessary to cancel various daily events, planned trips or visits. A nice shopping trip with friends, anticipated for days, may have to be rescheduled. Attendance at a surprise family birthday party is not possible, forcing you to explain to other family members. The reason these typical events are mentioned is to point out that flare-ups can be life disrupting and therefore mentally and emotionally, as well as physically, distressing. Long term lifestyle changes will need to address the triggers prompting the flare-ups.

It may be true that you won’t be able to follow through with plans. It is also quite possible you will have to ask for help with daily chores and certain tasks because life goes on even during flare-ups. However, during a flare-up there are also steps you can take to minimize and better manage the symptoms. Having a self-management plan in place that is ready to put into action on a moment’s notice can make the thought of flare-ups occurring less frightening.

Managing Flare-ups by Yourself – Seeking a Warning Signal

As would be expected, what you do to manage flare-ups should be an extension of what you are already doing on a daily basis to manage this medical condition. The ultimate goal is to prevent the flare-ups in the first place as much as possible. This means it’s important to try and identify possible flare-up triggers. Keeping a daily record is a good way to identify patterns or common events that lead to flare-ups. Keeping an electronic or hand-written journal that records daily activities and notes flare-ups when they occur can give you an excellent idea of what may be triggering these events.

The journal will document the specifics of the flare-up including the following:[2]

  • The time of day for each event recorded including activities, meals and pain twinges
  • The activities undertaken for the day
  • Interactions with people before the flare-up
  • What you ate the day of the flare-up
  • Special events taking place, i.e. argument, sleepless night, non-fibromyalgia illness, caring for a sick child etc.
  • Any distraction or anything out of the ordinary that should be noted, i.e. death of a loved one, divorce, moving, new job etc.

If this is the first journal entry, then try to recall the day before and log the same information. While you may not recognize a link for the initial flare-up, it may be possible to establish a pattern after the second or third event. The journal will help you identify any physical or emotional triggers for flare-ups that you can avoid in the future. Triggers may include:

  • A lack of proper sleep
  • Not enough or too strenuous exercise
  • Experiencing a stressful situation
  • Developing general or specific anxiety
  • Changes in the weather
  • Certain foods or drinks
  • Hormone changes
  • Low blood sugar

Once you establish there is a pattern, it is then necessary to find a way to either avoid the trigger in the future or learn to manage it to reduce its acuity. It is also important to record positive events. Some people will get into a habit of only recording negative things, which can lead to negative thoughts and expections. This would be counterproductive to self-managing your fibromyalgia.

Managing Flare-ups Pharmaceutically

In some instances, you may be able to manage the physical pain of a flare-up through medications. You can take oral medications as prescribed by the doctor or purchase over-the-counter medicines with your doctor’s approval. Medications can help sore and aching soft tissues and relieve or reduce any muscle spasms that are occurring.

Analgesics are anything that treats pain. They can be as simple as the over-the-counter medications mentioned or a prescription strength opioid. Cortisone is a natural hormone. Corticosteroids are related to cortisone hormones and are synthetically produced to act as an anti-inflammatory. Whether you actually choose to use corticosteroids is up to you and your physician. The application of simple topical analgesics has been found to be of little benefit to fibromyalgia patients.[3]

Managing Flare-ups Naturally

Eliminating triggers you identify may not always be possible. For example, you can’t control the weather. However, you can control the food you eat. If you aren’t getting a good night’s sleep, then you need to implement a plan to promote sleep. The purpose of the journal is to identify all the factors contributing to flare-ups that you can control and then making necessary lifestyle changes or taking action to minimize occurrences. You might:

  • Change your diet and eliminate food or drink that appears to be triggers, paying special attention to processed foods or foods that may have high levels of chemicals or substances including caffeine, MSG, or aspartame
  • Work to eliminate stress in your life through relaxation therapy, counseling, and making changes at work and home
  • Make a plan for improving your sleep patterns
  • Get additional support, if needed, from friends, family, your doctor, a counselor or fibromyalgia group
  • When possible, stay in the house when cold or damp weather is expected

If a flare-up should occur then it’s important to deal with it right away so you can hopefully minimize its impact. Natural methods for managing fibromyalgia symptoms include:

  • Compresses – The application of hot and cold compresses to the painful areas may help reduce inflammation or provide soothing relief.
  • Acupuncture – This method has proven to be an effective pain reliever for some fibromyalgia sufferers. It may be helpful in lowering the number of tender points and the mean pressure pain threshold when used as a complementary treatment.[4] If you don’t like the idea of needles, you can try acupressure.
  • Exercise – Gentle aerobic exercise has proven to be effective at lowering pain levels and promoting less muscle stiffness and fatigue.[5] Water aerobics exercise in a warm water pool has proven to be effective treatment for many fibromyalgia patients. In addition, walking just 3 times a week has also proven to be beneficial.
  • Yoga, Pilates or Tai Chi – These are recommended as general gentle forms of stretching exercises. Research indicates that they can successfully lead to pain reduction and can help you better cope with the mental and emotional distress arising from living with a chronic medical condition.[6]
  • Herbal treatments – Herbs may be helpful for promoting natural sleep, lowering inflammation in the body, and decreasing fatigue. There are many different herbs that are used as complementary treatments to conventional medicine.

Conclusion

Flare-ups are a fact of life for people with fibromyalgia. That doesn’t mean you should just accept them. It is important to prepare a self-management program, map potential triggers through journaling, and then take steps to eliminate those triggers. Though fibromyalgia is a chronic medical condition, there are many ways to take control of the pain, fatigue and other symptoms.

References

[1] Arthritis Foundation (2006). Good Living With Fibromyalgia. Atlanta, GA: Arthritis Foundation.

[2] Chandler, P (2011). Fibromyalgia Basics: A Beginner’s Guide. Mustang, Oklahoma: Tate Publishing.

[3] Imamura, M; Cassius, DA: and Fregni, F (2009). “Fibromyalgia: From Treatment to Rehabilitation.” Eur J Pain. 3(2): 117–122.

[4] Targino, AR; Imamura, M; Kaziyama, HHS; Souza, LPM; Hsing, WT; Furlan, AD; Imamura, ST; and Azevedo Neto, RS (2008). “A Randomized Controlled Trial of Acupuncture added to Usual Treatment for Fibromyalgia.” J Rehabilitation Medicine, 40(7):582–588.

[5] Häuser, W;  Klose, P;  Langhorst, J; Moradi, B; Steinbach, M;  Schiltenwolf, M; and Busch, A (2010). “Efficacy of Different Types of Aerobic Exercise in Fibromyalgia Syndrome: A Systematic Review and Meta-Analysis of Randomised Controlled Trials.” Arthritis Research and Therapy. 2010; 12(3): R79.

[6] Curtis, K; Osadchuk, A; and Katz, J (2011). “An Eight-Week Yoga Intervention is Associated with Improvements in Pain, Psychological Functioning and Mindfulness, and Changes in Cortisol Levels in Women with Fibromyalgia.” J Pain Research, 4: 189–201.

This article was originally published on July 11, 2012 and last revision and update of it was 9/7/2015