Unfortunately, living with fibromyalgia often means dealing with pain flares from time to time. Flares can occur when there has been a period of stress, an injury, hormonal changes, poor sleep, a lot of extra demands being placed on you or not being able to follow your usual nutritional regimen amongst other reasons.
The duration of flareups varies but it can be for days, weeks or months. Along with an increase in pain and stiffness, fibromyalgia sufferers may experience heightened fatigue, gut issues, brain fog, anxiety, depression and sleep disturbances during a flare.
There are measures one can take to try and avoid flares in the first place or to reduce their severity, along with having an overall health plan for managing your fibromyalgia. These measures centre around foundational aspects such as sleep, movement, stress management, nutrition and also knowing your signs of over-exertion and learning to pace yourself.
ADEQUATE SLEEP
Ensure you get to sleep at a decent time each night (before 10pm preferably) and aim for minimum 8 hours sleep. Even on weekends, try and stick to the same sleep and wakeup time. If sleep quality is an issue for you, try sleep hygiene tricks like avoiding screens two hours before bed, having an Epsom salt bath, drinking chamomile or passionflower tea and reading a book to get sleepy. Also steer clear of stimulants like caffeine and alcohol. There are also great herbal medicines and supplements for promoting a good sleep.
BE MINDFUL OF YOUR MOVEMENTS
It is very common for fibro sufferers to experience flareups after extended periods of sitting or standing or from walking for too long. If you must do something that requires long periods of sitting, schedule breaks to stretch and walk around and I recommend back support cushions for those with back pain. Don’t be shy about talking to work managers about your need to get up from your desk regularly or to have an ergonomic desk and chair arranged. If you work on your feet, take regular breaks to do some stretching and to lie or sit down to recover.
REGULAR EXERCISE
Studies show that exercise helps reduce pain and fatigue levels and improve sleep quality in fibro patients. It also increases self-efficacy which is important when fibromyalgia can feel like it is controlling your life.
The key is finding the right type of activity (that you enjoy and will stick to) and knowing your limits. For those who are not accustomed to regular exercise, start low and slow with gentle activity. This could simply be stretching each day if fatigue levels are high. Then consider low impact aerobic activity such as swimming or gentle walking. Pilates and yoga is great for flexibility and strength. Gym work that incorporates resistance training is beneficial for bones, muscle and joint health, particularly as we age. Don’t overdo things to the point of tiring out. Fibro people will know that pushing things too hard can leave you paying the price with pain and exhaustion in the days following. You need to find the “sweet spot” where your heart rate is elevated and where weights or exercises are challenging but not causing total fatigue.
LISTEN TO YOUR BODY
It can often take years of making the same mistakes as a fibro sufferer before you read the signs and start listening to your body. If you are under a lot of stress for example and you feel irritable, overwhelmed and pain is building, pull back. Do what you can to remove obligations from your schedule and source help if you can. Don’t wait until you fall in a heap. If headaches are becoming more frequent or back pain is building, book in to see a massage therapist or acupuncturist or whoever it is that you find helpful. Don’t put it off otherwise it is harder to reduce the pain when it becomes more severe.
PACING
This naturally brings us to the concept of pacing. When you are feeling good, don’t become over-enthusiastic and overdo things. How many people have a good day and frantically clean the entire house only to find themselves bed-bound for days afterwards? Pacing is an important practice that fibro sufferers can use to regulate their energy and maintain a level of activity each day without causing issues. It applies to daily tasks, work, exercising and socialising.
Broadly speaking, pacing involves determining what activities you want to work towards being able to do and establishing your baseline or time limit for being able to do those things comfortably. The aim is to gradually increase from baseline over time. Frequent short breaks need to be incorporated into the day and activities need to be spaced out or broken down into steps. It is important to take breaks before you actually need a break. Pacing is a method that a practitioner can help guide you in implementing.
PLAN AHEAD
Unfortunately, the fibro person is not usually as adaptable as someone without chronic pain or fatigue. We need to know details about events or activities we may be partaking in, details that the average person wouldn’t think twice about. This can include knowing how much time will be spent standing or sitting at an event; what kind of chair will be available; how much of a walk there might be between venues; will there be guaranteed transport home; what time they will be able to leave; type of food available. And trust me, the list goes on! Knowing details like these can help remove some of the anxiety and enable you to plan ahead and have systems in place to avert problems that may cause a pain flare. It also means you can make an informed judgement on whether you can actually say yes to attending an event or not.
ANTI-INFLAMMATORY DIET
Fibromyalgia has been shown in studies to have an inflammatory aspect with elevated cytokines such as IL-6 present. This inflammation plays a role in central sensitisation and development of pain. Hence it is recommended to follow an anti-inflammatory diet as much as possible. This means eliminating the inflammation culprits such as sugars, seed oils, alcohol, processed white flour products. Embrace diversity in the diet to nourish the gut microbiome, with the main focus being on eating plant-based foods such as different coloured vegetables and fruits, fresh herbs and spices, nuts, seeds and legumes. Include some fish in the diet and grass-fed organic meat and chicken.
There is a connection between fibromyalgia and non-coeliac wheat sensitivity and symptoms of both conditions overlap, particularly gastrointestinal ones. Therefore, I recommend a gluten free diet to some of my fibro patients. Avoidance of gluten is shown to reduce inflammatory markers. However, be aware of not falling into the trap of consuming a lot of crappy, gluten free packet foods. Keep the focus on fresh wholefoods and choose organic as much as possible.
SUNSHINE
Humans are part of nature and have a connection to the earth. I place a lot of importance on getting outside, connecting with the ground and spending time in the sunshine. It helps reduce stress levels and provides valuable vitamin D. Vitamin D deficiency is linked to chronic musculoskeletal pain and fibromyalgia. Some patients will require additional supplementation but sunshine should be the first consideration and consuming vitamin D rich foods such as organic eggs, liver and oily fish.
Finally, I do want to mention that it’s so important to not lose hope when you experience a fibro flare and feel as though you’re not going to come out of it or that all your hard work to manage your condition has gone down the drain. As you learn techniques and nutritional and lifestyle approaches to managing your condition, you will become more adept at getting things back on track quicker if a flare occurs. Life happens and we can’t always wrap ourselves in cotton wool or control circumstances around us as much as we like to. However, we can acquire knowledge and an arsenal of practices to help us deal with those times that arise and challenge us.
Sources:
Badaeva, A., Danilov, A., Kosareva, A. et al. (2024). Neuronutritional Approach to Fibromyalgia Management: A Narrative Review. Pain Ther 13, 1047–1061. https://doi.org/10.1007/s40122-024-00641-2
Bağlan Yentür S, Elbastı MŞ. (2024). Vitamin D Levels Are Associated With Pain and Pain Catastrophizing in Patients With Fibromyalgia Syndrome. J Clin Pract Res; 46(2): 171–177. https://jcpres.com/storage/upload/pdfs/1714402124-en.pdf
Maddox, Emma K., Shawn C. Massoni, Cara M. Hoffart, and Yumie Takata. (2023). “Dietary Effects on Pain Symptoms in Patients with Fibromyalgia Syndrome: Systematic Review and Future Directions” Nutrients 15, no. 3: 716. https://doi.org/10.3390/nu15030716
Niu, G., Zheng, X., Deng, B., Yang, Q., & Du, Y. (2024). Effects of exercise dosage on the treatment of fibromyalgia: A meta-analysis of randomised controlled trials. Musculoskeletal Care, e1918. https://doi.org/10.1002/msc.1918
Thomson E, Beer H, Ryan L, Philcox E, Kelly C. (2023). Food intolerance and sensitivity are associated with features of fibromyalgia in a self-selected community population. Food Health, 5(4):17. doi:10.53388/FH2023017
Yuva Venkata Raghava Neelapala, Domenico Mercuri, Luciana Macedo, Steven Hanna, Dylan Kobsar, and Lisa Carlesso. (2023). Mechanisms hypothesized for pain-relieving effects of exercise in fibromyalgia: a scoping review. Therapeutic Advances in Musculoskeletal Disease, 15. https://doi.org/10.1177/1759720X231182894
