Fibromyalgia is a chronic pain disorder generally caused by amplification of pain processing in the central nervous system, including the brain and spinal cord. Fibromyalgia is a dynamic condition, meaning that the pain intensity can change from day to day; people with fibromyalgia can have sudden, significant experiences of widespread pain known as fibromyalgia flare ups, or fibro flares.
Research has shed light on the underlying central nervous system mechanisms underlying the symptoms of fibromyalgia, including the presence of fibromyalgia flare ups. Besides chronic widespread pain, one of the primary diagnostic criteria for the condition, many people have additional symptoms that may make their overall picture of fibromyalgia much more severe. Those can include things like stress, cognitive difficulties (often known as “fibro fog”), or fatigue.
Where does fibromyalgia pain come from?
Before we dive in to fibromyalgia, let’s start with some definitions about different types of pain.
Acute Pain versus Chronic Pain
Acute pain is a type of pain that has a very specific onset, often caused by a specific event. Some examples of acute pain triggers could include an injury from a car accident, or pain while recovering from a surgery.
There are many different types of events that can cause acute pain. Typically, those types of pain experiences are initiated by the peripheral nervous system, or nerves outside of the brain and spinal cord.
However, sometimes acute pain can persist even when the onset event or injury has resolved; for example, a patient who has recently had surgery might still experience pain even after the surgery site has fully healed. This is known as chronic pain.
Central Sensitization: Bottom-Up versus Top-Down
Why does chronic pain occur? Unlike with acute pain, the peripheral nervous system may not be delivering pain signals to the central nervous system. Instead, over time, the central nervous system and how it processes pain has changed such that, even after there’s a resolution of that acute issue, the pain persists. We call this change central sensitization, which is known to underlie most chronic pain conditions.
The experience of chronic pain for someone with fibromyalgia may be different than someone who has gone through an infectious process such as COVID-19 or Epstein-Barr virus or Lyme disease. Not everyone with chronic pain acute pain that preceded their chronic pain; for example, someone who had significant stress on the body, either in childhood or adulthood, may experience chronic pain. These types of experiences can lead to the central nervous system becoming activated and hypersensitive without any type of peripheral problem, such as a surgery or an injury. We distinguish those two things as either bottom-up or top-down central sensitization.
What is similar between both forms of central sensitization is that the chronic pain is present, and generally speaking, these types of chronic pain have similar treatment approaches.
Why do fibromyalgia flare ups occur?
Because fibromyalgia symptoms can exist on a spectrum, people can have very significant experiences of widespread pain that vary from day to day, week to week, or even month to month. They can also have very distressing associated symptoms (e.g., fatigue, stress, and trouble thinking), but there may also be times where those symptoms aren’t as severe.
When you think about the central nervous system and how the brain functions, you can think of your brain as a volume control knob on a radio. At times, that knob may be turned way up, as if the volume is on max. This leads to an experience of more painful areas and higher pain severity as well as increased levels of fatigue, fibro fog, and trouble sleeping.
These amplifications, or changes in the “pain volume control,” are how you can think about a fibro flare: the volume level of pain that people with fibromyalgia experience on a daily basis is cranked way up, and often leads to more symptoms.
What triggers fibromyalgia flare ups?
Many different things can trigger a fibromyalgia flare up and increase the pain volume control, including:
- Difficulty sleeping
- Change in the level of stress
- Increase in anxiety
- Having illnesses can increase inflammation in the body
- Weather changes
- Dealing with emotionally difficult events (e.g., illness or death, divorce, etc)
Managing fibromyalgia flare ups
While fibro flare triggers can vary from person to person, people with fibromyalgia can learn how to recognize what their triggers are that lead to their flares, and what self-care practices or other treatment strategies can help them manage their symptoms. Knowing your unique #flare triggers is power, because you can be aware and mindful of when a flare might occur.
Practices like light movement or stretching, sleep and rest, Cognitive Behavioral Therapy (CBT), Acceptance and Commitment Therapy (ACT), breathing and mindfulness work, music or art therapy, and other techniques can contribute to self-care practices to help move through fibro flares.