Fibromyalgia is a complex pain disorder that includes other symptoms, such as difficulty sleeping, fatigue, and brain fog on a routine basis.
Along with the typical chronic symptoms of fibromyalgia, many people experience times when the symptoms become worse or different symptoms appear for a while and then return to their baseline state. People often refer to these periods as flare-ups or “fibro flares.”
What causes these fibro flares? Can you treat them or at least decrease their effects on your quality of life? Read on for answers to these and more questions.
What Causes Fibromyalgia Flare-Ups?
Several factors can contribute to the development of fibromyalgia, including genetics, central sensitization, and environmental factors.
Central sensitization occurs when repeated nerve stimulation causes increased activity in the central nervous system. Your brain begins to overreact to pain and pressure. Some people may even develop allodynia. In allodynia, your brain percieves “normal” sensations as painful. For example, something brushing gently against the arm may be painful to someone with allodynia. [1]
By contrast, flare-ups occur when they are “triggered” by a stressor. A study published by the American Academy of Pain Medicine surveyed forty-four people with fibromyalgia. Among the survey participants, the most common triggers for flare-ups included: [2]
- Stress
- Poor sleep
- “Over-doing it”
- Changes in the weather
Everybody is different, and not everyone will have the same triggers, experience the same symptoms, or have flares for the same length of time.
What Are the Symptoms of a Fibro Flare?
During a flare, your typical fibromyalgia symptoms may worsen, or you may have different ones. Some of the more frequently reported symptoms of a fibromyalgia flare-up include: [2]
- dizziness
- low-grade fevers
- sensitivity to touch
- numbness or tingling
- tightness in the muscles
- intolerance to heat or cold
- different or more severe pain
- severe headaches or migraines
- decreased ability to concentrate
- sudden, severe flu-like symptoms
- feeling like your hands or feet are swollen
- more intense emotional reactions or changes in mood
- gastrointestinal symptoms, such abdominal pain, diarrhea, or constipation
How to Treat a Fibro Flare
If you’re experiencing a flare, you may be wondering: What helps fibromyalgia flare-ups?
In the study published by The Journal of Pain Medicine, the survey participants shared several ways they dealt with fibromyalgia flares: [2]
- Rest
- Avoid everything
- Wait it out
- Over-the-counter pain medication, such as ibuprofen (Motrin or Advil) or acetaminophen (Tylenol)
- Massage
- Heat packs or cold packs
- Hydrotherapy
- Gentle exercise
- Meditation
- Deep breathing
- Prayer
- Humor
Your doctor may recommend similar evidence-based approaches to your fibro flares. These may include:
- Mindfulness and stress reduction techniques
- Cognitive behavioral therapies
- Gentle movement
- Massage
- Diet changes and nutrition
Try some of these treatments and see what works best for you. Doctors typically recommend a multi-modal approach to treatment, and may encourage you to explore one or more of these techniques.
Mindfulness and Stress-Reduction Techniques
Mindfulness and stress reduction techniques may relieve some of the pain and discomfort of fibromyalgia symptoms. Mindfulness-based stress reduction (MBSR) programs help participants learn
- breathing techniques
- meditation techniques
- body scanning techniques
- gentle, yoga-inspired exercise
Mindfulness techniques teach you to form a different relationship with your pain and other fibromyalgia symptoms. It helps you stop viewing your pain as harmful or threatening and accept it as a part of you.
Understanding that the pain is there, but you do not need to be controlled by it may help reduce the stress surrounding fibromyalgia and its symptoms. It may also improve sleep quality and overall quality of life.
A review and analysis published in Plos Computational Biology compared and contrasted several fibromyalgia studies and found that mindfulness and acceptance techniques were mildly to moderately successful in treating some fibromyalgia symptoms, especially in women. It may relieve: [3]
- pain
- anxiety
- depression
- negative moods
Stress reduction helps you act purposefully in stressful situations instead of reacting. It lets you better process thoughts, sensations, and emotions in the moment. [4]
Doctors and therapists recommend doing anything that makes your mind focus on something else.
- Read
- Draw
- Dance
- Take a bath
- Play a game
- Bake a cake
- Take a few deep breaths
- Take the kids or the dog for a walk
Distraction Techniques
As with many chronic pain conditions, people with fibromyalgia may benefit from practicing distraction techniques. Why is that?
Scientists theorize that processing pain requires attention, and distraction techniques work by pulling your attention away from the pain or other unpleasant situations and helping you focus on something or someone else. [5]
Here’s one example: A study published in The Journal of Pain Medicine suggested that Virtual Reality (VR) may be an effective distraction technique for people with chronic pain.
VR immerses you in a simulated world. It requires you to pay attention to this world with your eyes and ears and respond to it with your movements. The total immersion of VR may help distract people with fibromyalgia from the daily pain or help them cope during flares when the pain or other symptoms are heightened. [6]
Not everyone has access to VR, but there are other non-VR distractions techniques you can try. For example, you can try:
- Meditating or guided imagery
- Do something with your hands: knit, bake, or do a crossword puzzle
- Look through a photo album
- Watch a funny movie
- Go for a walk with a good friend
Behavioral Therapies
Doctors and therapists have used behavioral therapies to improve medical and mental health conditions for several decades. Behavioral therapies, such as Cognitive Behavioral Therapy (CBT), and a specialized form called Acceptance and Commitment Therapy (ACT), help people change thought patterns and decrease thoughts that lead to harmful behaviors.
CBT helps identify harmful thought patterns and the harmful responses that have become habits. Once these are identified, a therapist can help you change how you think, which can change how you behave.
This doesn’t mean that fibromyalgia is “all in your head”; research has shown that that’s not the case. However, treatment that includes behavioral therapies can be very beneficial to address our nervous system’s adaptations that occur as a result of chronic pain.
A research review by the International Journal of Environmental Research and Public Health found that CBT may benefit people with fibromyalgia and improve: [7]
- pain
- resilience
- depression
- sleep quality
- mental health
- emotional intelligence
Stanza, a mobile app made by Swing Therapeutics, delivers ACT in a self-guided, 12-week program, to treat fibromyalgia symptoms and practice these techniques wherever you are.
Movement
Movement is one of the most helpful therapies for most medical conditions, and fibromyalgia is no exception.
Aerobics, strength training, and yoga-type stretches, among other types of movement, not only improve general fitness and physical functioning. It can also improve your mental outlook and general well-being.
Many people with fibromyalgia fear exercise or “over-doing it” with too much movement. Many report exercise sets off their flares. A personalized, paced approach to movement can help ease this transition.
One study found that movement decreased fibromyalgia pain by up to 44%. Other research suggests gentle activity has many benefits for people with fibromyalgia beyond pain control, including improvements in
- mood
- overall health
- quality of life
- physical functioning
- psychological functioning
Doctors recommend regular, consistent movement. Keep it gentle and rest when you need to. The key is to find a physical activity you enjoy and can do safely, and then do it consistently.
Research suggests some of the best physical activities for fibromyalgia symptoms may surprise you.
- Aerobic exercise and dancing may help improve memory and motor function and decrease depression.
- Stretching can reduce the risk of injury, increase sleep quality, and reduce pain. [8]
- Water exercises and physiotherapy may reduce fatigue, anxiety, pain, and depression. It may also improve your sleep quality and daily functioning.
If exercising has increased your symptoms or caused flares in the past, CBT or training with a fitness professional may help remove the fear and allow you to move forward with a manageable exercise plan. [9] [7]
Myofascial Physical Therapy
In fibromyalgia, the central nervous system become hypersensitive and hyperreactive to nerve stimulation. When this pain flares in a specific area, these areas are sometimes called “tender points.”
One study found that myofascial release, a type of massage, helped relieve the pain in these areas when it flared.
Therapists and masseurs focus on the tough myofascial tissues that support, connect, and wrap around the muscles. These massages may improve: [7]
- tender point pain
- physical functioning
- the severity of other symptoms
Nutrition
While no specific diet has been clinically validated for the treatment of fibromyalgia, some diets have been studied regarding their role in inflammation and pain.
Certain types of diets may be more beneficial than others, particularly diets that help you maintain a healthy weight and are high in antioxidants. [10]
Your doctor may recommend:
- Low-FODMAPs Diet (Fermentable Oligo-Di-Mono-saccharides And Polyols)
- Anti-Inflammatory Diets
- Vegetarian Diets
- The Mediterranean Diet
Your doctor may also recommend supplementing certain vitamins or supplements if you are not getting enough from your diet. These may include: [11]
- Vitamins C, D, and E
- Magnesium
- Probiotics
- Antioxidants
- Chloerella pyreinoidosa
- Cellfood
- Coenzyme Q10
- Ginko Biloba
- Ascobigen
- L-carnitine
- S-Adenosylmethionine
- Creatine
- Melatonin
Not all diets, vitamins, or supplements benefit everyone in every situation. Some can even be harmful. Always talk to your doctor before starting a new diet or adding new supplements. Drastic changes to your diet can affect your health, especially if you have an underlying medical condition, such as diabetes or kidney disease. And some supplements can interfere or interact with your medication or may have other unintended side effects.
Not all vitamins and supplements have been researched thoroughly, and some varieties or brands may be unsafe. Always research before buying vitamins and supplements, even if your doctor has approved them.
Summary
Fibromyalgia is a chronic pain condition that is frequently accompanied by other symptoms, such as fatigue or difficulty concentrating. People with fibromyalgia may have flares, when pain or other symptoms worsen, or different symptoms arise.
Flare triggers, symptoms, timing, and length vary from person to person and from episode to episode. Keeping a journal can help you determine your own flare triggers, or when they are most likely to come up.
Treatments for fibromyalgia flares may differ for different flare periods, depending on the symptoms. You may need to continue or increase your regular fibromyalgia treatment plan, or add new ones to the mix to address the new or worsened symptoms.
Talk to your doctor about what you can do to control the flares when they occur. Knowing you have a plan in place helps relieve some of the stress associated with flares, and may even prevent some of these flares from occurring.
Medically reviewed by Dr. Andrea Chadwick, MD, MSc, FASA
Sources
- Lee DH, Rezende LFM, Joh HK, et al. Long-term leisure-time physical activity intensity and all-cause and cause-specific mortality: a prospective cohort of us adults. Circulation. 2022;146(7):523-534.
- Vincent A, Whipple MO, Rhudy LM. Fibromyalgia Flares: A Qualitative Analysis. Pain Medicine. 2016; 10.1111/pme.12676
- Haugmark T, Hagen KB, Smedslund G, Zangi HA (2019) Mindfulness- and acceptance-based interventions for patients with fibromyalgia – A systematic review and meta-analyses. PLoS ONE. 2019; 10.1371/journal.pone.0221897
- Worthen M, Cash E. Stress management. In: StatPearls. StatPearls Publishing; 2023.
- Van Rycheghem DML, Van Damme S, Eccleston C, Crombez G. The efficacy of attentional distraction and sensory monitoring in chronic pain patients: A meta-analysis. Clinical Psychology Review. 2018;59:16-29.
- Gupta A, Scott K, Dukewich M. Innovative Technology Using Virtual Reality in the Treatment of Pain: Does It Reduce Pain via Distraction, or Is There More to It? Pain Medicine. 2017; 10.1093/pm/pnx109
- Cohen-Biton L, Buskila D, Nissanholtz-Gannot R. Review of fibromyalgia (Fm) syndrome treatments. International Journal of Environmental Research and Public Health. 2022;19(19):12106.
- Gómez-Hernández M, Gallego-Izquierdo T, Martínez-Merinero P, et al. Benefits of adding stretching to a moderate-intensity aerobic exercise programme in women with fibromyalgia: a randomized controlled trial. Clin Rehabil. 2020; 34(2):242-251.
- Bhargava J, Hurley JA. Fibromyalgia. In: StatPearls. StatPearls Publishing; 2023.
- Kadayifci FZ, Bradley MJ, Onat AM, Shi HN, Zheng S. Review of nutritional approaches to fibromyalgia. Nutrition Reviews. 2022; 10.1093/nutrit/nuac036
- Pagliai G, Giangrandi I, Dinu M, Sofi F, Colombini B. Nutritional interventions in the management of fibromyalgia syndrome. Nutrients. 2020; 12(9):2525.
