Fibromyalgia Flares: Symptoms, Triggers and Treatment – Living With Arthritis

Fibromyalgia – an example a central pain syndrome – is a chronic health condition characterized by symptoms of widespread muscle pain, fatigue, memory problems and mood changes. As in many chronic diseases, fibromyalgia symptoms can come and go and vary in intensity.

Fibromyalgia Symptoms

While a person with fibromyalgia might experience certain symptoms on a regular basis, when symptoms worsen or happen more frequently for a period of time, it is called a flare.

“A flare is the worsening or exacerbation of symptoms that already exist,” says Daniel Clauw, MD, professor of anesthesiology, rheumatology and psychiatry at the University of Michigan in Ann Arbor. “Patients use different timeframes for what they consider a flare, but it’s generally several days or weeks of worsening symptoms. Anything shorter is considered normal waxing and waning of symptoms that someone with fibromyalgia can expect.”

Symptoms of fibromyalgia include:

• Widespread muscle pain
• Fatigue that makes completing daily activities difficult
• Stiffness, especially in the morning or after a long period of inactivity
• Cognitive difficulties, also known as fibro fog, including problems with memory, concentration and organization
• Emotional issues, such as anxiety, sadness or depression
• Sleep problems, such as taking a long time to fall or sleep, frequent waking or waking up and still not feeling rested

While these are common symptoms among people with fibromyalgia, everyone experiences flares differently.

“People with fibromyalgia do not all experience flares the same way,” Dr. Clauw says. “A good way to explain it is that every person with fibromyalgia has their Achilles heel – their ‘thing’ that really gives them trouble. When their fibromyalgia worsens, that particular thing really gets bad.”

A person’s predominant symptoms during a flare can change over time.

“A person who is flaring might seem to have a worsening of pain in their hips or back,” Dr. Clauw says. “But 10 years ago, that same person could have experienced bad menstrual cramps or headaches as their Achilles heel. The nature of fibromyalgia is that it’s a pain amplification syndrome, and that pain can shift.”

Triggers for Fibromyalgia Flares

One of the best ways to prevent a flare is to determine what might be causing it in the first place. These causes are called triggers. Like symptoms, triggers for fibromyalgia vary by person, but they can include:

• Physical or psychological stress
• Temperature and/weather changes
• Hormonal changes
• Traveling and/or changes in schedule
• Changes in treatment
• Diet
• Poor sleep

“We know that any type of stress – not just psychological, but also physical, immune or anything that disrupts the body’s normal routine – can trigger a flare,” Dr. Clauw says. “Anything from a motor vehicle accident to surgery or another type of stressful life event can cause a worsening of symptoms. Flares can also be caused by behavioral triggers such as not sleeping well, suddenly stopping exercise or overdoing it on activity.”

Some flares are unavoidable, and certain triggers are beyond your control. You can try to identify what aggravates your fibromyalgia symptoms by keeping a log of your activities, what you eat, how you sleep and how all of those factors influence your symptoms. After logging these factors for several weeks, you might be able to see a pattern. This will help you know how to better manage the inputs that might trigger a flare.

Treating a Fibromyalgia Flare

Despite your best efforts, sometimes your fibromyalgia is going to flare. While the urge is to reach for a magic pill, there is no treatment for fibromyalgia that is flaring.

“The truth is we’re far better at preventing flares than we are treating them,” Dr. Clauw says. “There’s no rescue medication for fibromyalgia. The medications approved for fibromyalgia take weeks to start working, and pain medications like opioids don’t work well for a lot of people.”

In the absence of effective medication, Clauw suggests taking a look at the behaviors you’re engaging in that might be affecting your symptoms.

“A lot of people with fibromyalgia tend to overdo it with activity when they’re feeling well,” Dr. Clauw says. “Learning to pace yourself can help get you out of the cycle of doing too much while you’re feeling well and then paying for it later when your fibromyalgia flares.”

While you may be reluctant to add something to your schedule if you’re already tired and in pain, mind-body practices can be great mood lifters and pain relievers. Try meditation, deep-breathing, and forms of exercise that include stretching and relaxation, such as yoga.

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