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Fibromyalgia flare-ups — periods during which your symptoms drastically worsen — are easier to prevent than to treat. How can you learn to recognize your triggers, and what are some preventative steps that may help you?

What are fibromyalgia flare-ups?

Fibromyalgia might be characterized by widespread pain that generally never completely goes away, but the severity does change from period to period. Periods during which your fibromyalgia symptoms are particularly heavy are called flare-ups. They can strike fibromyalgia patients suddenly, though high stress levels generally give folks with fibro a good idea that they're likely to experience a flare-up, and they may last anywhere from a couple of days to a couple of weeks. 

Not all fibromyalgia flare-ups follow predictable triggers, but because some do, identifying your personal triggers can subsequently enable you to work on steering clear of things that will usually "set you off".

These things vary from patient to patient, but may include:

  • Seasonal and weather changes — many fibromyalgia patients find that their symptoms drastically worsen when it suddenly becomes much warmer or colder. 
  • Stress sets off flare-ups for many people with fibromyalgia. 
  • Being more physically active — whether because you've started a more intense workout program or because you're, say, moving house and carrying boxes — can also trigger flare-ups. Folks with fibromyalgia should ideally avoid sudden increases in their physical activity levels without previously consulting their treating doctors. 
  • Sleep deprivation is another thing that can trigger a fibromyalgia flare-up. You can become sleep-deprived after a few intense days at work or in your personal life that require you to get up earlier or go to bed later, but sleep deprivation may also be caused by insomnia or waking up several times a night. 
  • Illness and injury — whether you catch a cold or break a bone, any event that makes your immune system work overtime can lead to a fibromyalgia flare-up. 
  • Many patients find that traveling can worsen their symptoms as well. It may not be the travel itself that causes the flare-up in this case, but the fact that traveling often coincides with exposure to changes in temperature and climate, sleep patterns, and dietary changes. 
  • Any change in your treatment plan, whether concerning physical therapy or new medications, can also soon be followed by a flare-up. 

Can you avoid things that trigger fibromyalgia flare-ups?

Sometimes. It's not really necessary to note, for instance, that while actively working on stress relief can reduce stress levels, you're still going to get stressed at times. You can't control the weather either! Knowing that preventing a flare-up tends to be easier than fighting your way out of one, you will, however, want to see which triggers you can control. To be able to do that, you first need to know what your triggers are. 

Trigger journals

Because triggers aren't identical for all fibro patients and events and situations that correlate with flare-ups may slip your mind, keeping a trigger journal or log is a great way to start identifying what often triggers flare-ups for you. This doesn't need to take a lot of time.

Whether on the computer or in a nice notebook, jot down:

  • What you eat and how often you eat
  • In what ways you have been physically active, and for how long
  • Whether you feel relaxed or stressed
  • How much you've slept and how good your sleep quality was
  • What medications you've taken — write down any changes, including, for instance, whether you've used extra OTC pain killers
  • What your fibromyalgia symptoms were that day

By keeping this kind of journal, you'll be able to identify patterns you could miss if you didn't write everything down. That may not prevent the next flare-up, but it can arm you with a much better idea of what usually leads to fibromyalgia flare-ups, allowing you to prevent a nasty upswing in symptoms in future. 

What can you do to relieve and reduce stress?

It is well-known that stress exacerbates fibromyalgia symptoms and more extreme stress can trigger a serious flare-up. Considering the fact that stress, as well as depression and anxiety, are often unfortunately an integral part of fibromyalgia patients' daily lives, equipping yourself with new stress-relief techniques can work wonders. 

You've almost certainly experimented with some of these techniques already, but perhaps you'll also find new ones to try?

  • Meditation, deep breathing techniques, massage therapy, and acupuncture all help some people with fibromyalgia manage stress. 
  • Although strenuous exercise can make your fibromyalgia symptoms worse, near-total physical inactivity very much does the same. Patients who follow gentle but persistent workout regimes approved by their physicians generally have fewer fibromyalgia symptoms. One of the reasons is that working out can reduce your stress levels.
  • Do not discount talk therapy as a means to systematically reduce your stress levels over the longer-term. Cognitive behavioral therapy, especially, can help you work through stressors that are directly caused by your fibromyalgia and chronic pain as well as those that are totally unrelated but will still worsen your symptoms. 

Making your sleep work for you

With fatigue being a defining characteristic of fibromyalgia, it's really important to do whatever you can to improve your sleep quality as well as to actually get enough sleep in — contrary to popular belief, most adults require anything from seven to nine hours. So, we know that chronic pain makes it much harder to sleep as well as that sleep deprivation makes chronic pain worse; if attaining good-quality sleep consistently were easy, you'd have done it already!

Still, there are some things you can do to improve what's called your "sleep hygiene":

  • Consistently going to bed and getting up at the same time each day, including weekends
  • Either not napping during the day time, or making naps a regular part of your routine
  • Keeping electronics out of the bedroom
  • Making sure the temperature in your bedroom is good — this generally means slightly cooler than the temperature you'd prefer for the rest of your living space
  • Winding down with a relaxing routine — a shower or bath, some relaxing music, reading rather than using a TV or computer — an hour to 30 minutes before you actually go to bed

Some fibromyalgia patients are additionally affected by restless leg syndrome, which can make sleeping even harder. If you think you are one of them, treatment is available; ask your doctor. 

To exercise or not to exercise is not the question, but how to go about exercising is

Regular exercise that is tailored to your needs is extremely beneficial for fibromyalgia patients. If you haven't been working out recently, starting any new physical activity routine may initially increase your fibromyalgia symptoms, but they should subside over time as long as the exercise program is right for you.

Exercises that are most likely to help you include:

  • Walking
  • Swimming
  • Cycling
  • Aquarobics
  • Physical therapy exercises that will strengthen your muscles and improve your posture
Even exercising for as little as 15 to 30 minutes twice a week is likely to lead to an improvement in your symptoms. If a gentle exercise routine works well for you, you can then increase its intensity over time. Exercise generally improves your fitness and stamina, lessens depression, and leads to a better quality of life — but do consult your treating doctor before starting a new fitness regime!

How do you avoid over-exerting yourself?

Regular exercise is great — over-exertion is the bane of your existence. How do you strike the ideal balance and find that golden middle way? It is best if you discuss a "workout plan" (this doesn't have to involve the gym!) with your doctor or physical therapist, and then commit to sticking to it. This is the most straight-forward way to ensure that your activity levels will remain consistent, and keeps you out of the trap of doing too much while your fibromyalgia symptoms aren't that bad and then doing nothing at all when you have a flare-up. 

Nutrition

There's no one "fibromyalgia diet" that guarantees you reduced symptoms, but some foods do seem to exacerbate fibromyalgia symptoms in some patients. This is why a so-called elimination diet that has you avoid particular food groups for a period of time to see if this causes any change for you is sometimes recommended. In conjunction with a fibromyalgia trigger log, an elimination diet may help you uncover foods that tend to make your symptoms worse, as well as those you do well with. Regardless of whether you try this, however, keep in mind that a balanced diet rich in vegetables will generally keep you more energetic and less fatigued. 

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