Fibromyalgia is a chronic condition characterized by widespread pain, fatigue, and cognitive difficulties. It is a prevalent disorder, affecting up to 8% of the population.
Fibromyalgia is the second most common rheumatologic disease, following osteoarthritis. Approximately five million adults in the United States have been diagnosed with this disorder, which can affect people of all ages.
As a pain management physician, I often encounter patients with chronic pain, and fibromyalgia is a common cause of such pain.
One of the most puzzling aspects of this condition is the unpredictability of flare-ups.
In this article, we will explore the causes of fibromyalgia flare-ups.
By understanding the factors that contribute to these flare-ups, we can develop strategies to reduce their frequency and severity.
The Glass Analogy
To understand fibromyalgia flare-ups, we use an analogy of a glass filled to the brim with water. In this scenario, the water represents the various dysfunctions and underlying issues experienced by a fibromyalgia patient.
When the glass is filled to capacity, even the slightest disturbance, such as the addition of a tiny pebble or a change in external conditions, can cause the water to overflow.
This overflow is analogous to a fibromyalgia flare-up.
Multiple Layers of Dysfunction
Fibromyalgia sufferers often experience multiple layers of dysfunction, which contribute to their symptoms.
The two most prevalent symptoms of fibromyalgia are chronic widespread pain and severe fatigue. Patients often describe their pain as being all over their bodies, coupled with a debilitating fatigue that makes it difficult to function throughout the day.
Some common issues include gastrointestinal dysfunction, irritable bowel syndrome, leaky gut syndrome, autoimmune diseases, food sensitivities, thyroid and adrenal dysfunction, environmental toxicity, and emotional and physical stress.
These problems, when combined, create a heavy physiological load on the patient’s body, making them highly susceptible to flare-ups.
Causes of Fibromyalgia and Flare-Ups
The exact cause of fibromyalgia remains unclear, but it is believed to involve multiple factors such as injury, trauma, or hereditary genes.
Family history plays a strong role in fibromyalgia development, with studies showing that patients with a family history are eight times more likely to develop the disorder than those without.
Twin studies suggest that up to 50% of the risk of developing fibromyalgia is genetic, while the other 50% is environmental.
Triggers of Flare-Ups
A fibromyalgia flare-up can be triggered by a wide range of factors, which may differ from one individual to another.
Some common triggers include changes in weather, increased physical activity, emotional stress, consumption of certain foods, exposure to environmental toxins, cigarette smoke, and even strong smells like perfumes.
Due to the complex interplay of these factors, it can be difficult to pinpoint the exact cause of a flare-up for each individual.
Five expert-recommended strategies for managing flare-ups in Fibromyalgia
1. Don’t Panic
When experiencing a flare-up, the first and most important step is to try not to panic. Although pain can be overwhelming, panic may exacerbate the situation[1]Clauw DJ, Arnold LM, McCarberg BH. The science of fibromyalgia. InMayo Clinic Proceedings 2011 Sep 1 (Vol. 86, No. 9, pp. 907-911). Elsevier..
Flare-ups can be triggered by various factors, such as increased activity levels, changes in temperature, or elevated stress levels. Understanding that flare-ups are part of the process can help alleviate anxiety and make it easier to manage.
2. Keep Moving
While the instinct may be to rest or curl up in pain, research indicates that remaining active is crucial for managing flare-ups[2]Busch AJ, Webber SC, Brachaniec M, Bidonde J, Bello-Haas VD, Danyliw AD, Overend TJ, Richards RS, Sawant A, Schachter CL. Exercise therapy for fibromyalgia. Current pain and headache reports. 2011 … Continue reading.
Continuing to move can help prevent the pain from intensifying and may even shorten the duration of the flare-up. Although it might be difficult, make an effort to maintain some level of activity during a flare-up.
3. Practice Meditation
Meditation can be an effective tool for managing chronic pain, as it has been shown to change the brain and, consequently, the perception of pain.
If you haven’t already incorporated meditation into your daily routine, consider doing so to help manage flare-ups and improve overall well-being.
A systematic review published in the Annals of the New York Academy of Sciences found that findings from recent studies demonstrated that mindfulness meditation significantly attenuates pain through multiple, unique mechanisms—an important consideration for the millions of chronic pain patients seeking narcotic‐free, self‐facilitated pain therapy.[3]Zeidan F, Vago DR. Mindfulness meditation–based pain relief: a mechanistic account. Annals of the New York Academy of Sciences. 2016 Jun;1373(1):114-27.
Zeidan F, Vago DR. Mindfulness meditation–based pain relief: a mechanistic account. Annals of the New York Academy of Sciences. 2016 Jun;1373(1):114-27.
4. Focus on Breathing
When in pain, it’s common to hold your breath, which can lead to increased anxiety and heightened pain perception. Instead, focus on maintaining steady and controlled breathing during a flare-up to help manage pain and reduce anxiety.
5. Engage in Enjoyable Activities
During a flare-up, it might seem counterintuitive to participate in activities you enjoy. However, engaging in pleasurable activities can help reduce pain levels. If you’re unable to participate in an active hobby, consider watching videos or looking at pictures of yourself engaged in the activity, or plan for the next time you’ll be able to enjoy it.
Surrounding yourself with positive stimuli, such as pictures of loved ones, can also help alleviate pain and improve your mood during a flare-up.
Reducing the Frequency and Severity of Flare-Ups
To reduce the frequency and severity of fibromyalgia flare-ups, it’s crucial to lower the level of physiological stress on the body. This process involves careful evaluation, consultation, and examination, addressing each layer of dysfunction one at a time, similar to peeling an onion.
By systematically addressing these issues, fibromyalgia patients can effectively lower their physiological stress levels and reduce the likelihood of experiencing flare-ups.
The Role of Exercise in Fibromyalgia Treatment
Exercise is a crucial component of fibromyalgia treatment. A combination of strengthening, stretching, and aerobic exercises can help manage symptoms. Maintaining a healthy weight may also help control symptoms, as being overweight or obese can trigger fibromyalgia.
Conclusion
Fibromyalgia flare-ups can be unpredictable and debilitating, but understanding the factors that contribute to them can help patients take steps to reduce their frequency and severity.
By addressing the multiple layers of dysfunction and managing potential triggers, fibromyalgia sufferers can work towards a better quality of life.
By maintaining a healthy lifestyle, incorporating exercise, and working closely with a healthcare provider, patients can manage their symptoms and improve their quality of life. If you have any questions or concerns about fibromyalgia, don’t hesitate to reach out to a medical professional for guidance and support.
MD, PhD. Physical Medicine & Rehabilitation Physician from São Paulo - Brazil. Pain Fellowship in University of São Paulo.
References
| ↑1 | Clauw DJ, Arnold LM, McCarberg BH. The science of fibromyalgia. InMayo Clinic Proceedings 2011 Sep 1 (Vol. 86, No. 9, pp. 907-911). Elsevier. |
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| ↑2 | Busch AJ, Webber SC, Brachaniec M, Bidonde J, Bello-Haas VD, Danyliw AD, Overend TJ, Richards RS, Sawant A, Schachter CL. Exercise therapy for fibromyalgia. Current pain and headache reports. 2011 Oct;15:358-67. |
| ↑3 | Zeidan F, Vago DR. Mindfulness meditation–based pain relief: a mechanistic account. Annals of the New York Academy of Sciences. 2016 Jun;1373(1):114-27. |