Fibromyalgia Flares and Attacks
What is a fibromyalgia attack?
Fibromyalgia is a chronic illness that causes pain and fatigue throughout the body. The pain tends to be in the muscles and joints, and it can come and go over time. People with fibromyalgia may be unusually sensitive to pain, which is called central sensitization.
Fibromyalgia flares or attacks are when the pain is so bad that it interferes with your day-to-day activities. Flares are often triggered by difficulty sleeping, emotional stress, or a recent illness, though sometimes there is no obvious trigger.
Other common symptoms include fatigue, insomnia, morning stiffness, depression, anxiety, and cognitive problems (forgetfulness, concentration difficulties, mental slowness, and memory and attention problems).
Some people think that having fibromyalgia means they cannot function normally in the world. Although there are good days and not-so-good days, for the most part, people can live normal lives. This includes being able to work, volunteer, have hobbies, etc. —Dr. Sara Penn
Fibromyalgia occurs in 2% to 4% of the population, and is more common in women than men. The exact cause is unknown, but some factors can increase the risk of getting it, such as genetics (a close family member has or had it), negative life events, or physical trauma.
Although there is no cure for fibromyalgia, there are many treatments and ways to reduce chronic pain and how often you have flares. Over time, your doctor can help determine what combination of treatments work best for you.
Common flare-up symptoms & what it feels like
A flare can be over in 1 to 2 days or last as long as a few weeks. Here are some of the most common symptoms of fibromyalgia:
- Muscle achiness: often in the neck, back, arms, and legs
- Joint pain: in your knees, hips, hands, etc.
- Joint stiffness: difficulty moving your joints smoothly and sensing your joints when you move
- Muscle tenderness: unexpected pain when you’re touched lightly, such as when you’re hugged
- Mental fog: hard to think clearly and concentrate
- Sleep disturbance: difficulty falling asleep, staying asleep, or both
- Digestive problems: abdominal pain, bloating, or constipation
These are two good resources you should know about: National Fibromyalgia and Chronic Pain Association and American College of Rheumatology. —Dr. Penn
What triggers fibromyalgia flare-ups?
Specific triggers vary from person to person, but there are two common categories they fall under. One is emotional stress, like if depression or anxiety spikes. It could also be triggered by a stressful event, like losing a job, moving, or experiencing the death of a loved one, according to a study in Pain Medicine.
The other common trigger is physical stress, like if you get an infection, have surgery, can’t sleep, or experience any other kind of physical trauma.
Treating flare-up pain
- Take over-the-counter pain relievers such as acetaminophen (Tylenol), ibuprofen (Advil), or naproxen (Aleve).
- Medications to help with sleep if needed. These include over-the-counter medications like Benadryl or prescription medications like amitriptyline or zolpidem (Ambien).
- Focus on good sleep hygiene by going to bed at the same time each night and avoiding screens (TV, smart phone, tablet) within an hour of bedtime.
- Apply heating pads and take warm baths or showers.
- Pace yourself on days you’re not feeling well. Determine what needs to be done today and what can wait until the flare is over and you’re feeling better.
- Practice meditation and breathing exercises.
- Distract yourself with a good book, TV show, or music.
- See a mental health specialist, who can help you with coping strategies for dealing with the pain and ways to find joy in life, despite the discomfort.
Many medical conditions can cause pain—especially some types of arthritis. Ask your doctor about seeing a rheumatologist to make sure that there isn’t an alternative explanation for your symptoms. Also, please let your doctor know if you are prone to depression or anxiety, or if these are newer symptoms for you. —Dr. Penn
How to avoid flare-ups
- Prioritize sleep: The most important change you can make to avoid flare-ups is to keep to a sleep schedule. Go to bed and wake up at approximately the same time each day (even on weekends) and try to avoid taking naps. Quality sleep is just as important as quantity, so make sure you practice good sleep hygiene, like having a bedroom that’s dark, cool, and quiet.
- Exercise regularly: When it comes to staying active, consistency is key. Start with a little bit of aerobic exercise every day, even if it’s just for 5 to 10 minutes. Once you do that for a week, increase it to 15 minutes a day. Keep increasing the amount until you reach 30 minutes of walking a day. If you push yourself too hard or too fast, your pain may be worse the next day.
- Reduce your stress: A counselor or therapist can teach you strategies for dealing with stressful situations.
- Stay relaxed: Meditation and breathing exercises can help keep your calm, as can practicing yoga and tai chi.
Talk to your doctor about preventative medications: There are several types of medications that can help keep your fibromyalgia symptoms under control and prevent flares. These include:
- Certain antidepressants (amitriptyline, duloxetine, milnacipran)
- Certain muscle relaxants (cyclobenzaprine)
- Certain nerve pain medications (gabapentin, pregabalin)
Dr. Sara (Kaprove) Penn is a board-certified rheumatologist. She received her undergraduate degree in biology from Cornell University (1999) and graduated from SUNY Buffalo School of Medicine and Biomedical Sciences (2003). She completed an internal medicine residency at Beth Israel Deaconess Medical Center (2006) and went on to complete her rheumatology fellowship at the University of Pittsburgh School of Medicine (2008). She excelled as a clinical rheumatologist for around 10 years working at Lahey Clinic and Harvard Vanguard, both in the Boston area. She then worked in the Telemedicine space for 3 years working for Teladoc as a Lead Physician in the Expert Medical Services Division. She is currently serving as an Associate Medical Director at Takeda Pharmaceuticals in their Marketed Products Group. She holds a number of volunteer appointments, and is a rheumatology section lecturer for the MGH Institute of Health Professionals.Dr. Penn is a physician leader attuned to the intersection of industry and clinical care, and she enjoys consulting as a medical writer in addition to her full-time responsibilities.