5 ways to ease a fibromyalgia flare-up

Written by: Dr Vijay Hajela
Edited by: Laura Burgess

One of the most important things someone with fibromyalgia can do is to recognise that they have the condition as early as possible and to treat it seriously. Unfortunately, many people struggle on until they hit a wall and the consequences can be devastating on their work, relationships and physical and psychological well-being.

Fortunately, fibromyalgia is now a well-recognised condition that can be managed effectively. We’ve asked consultant rheumatologist Dr Vijay Hajela to share his five-step strategy on handling a flare-up.

How can I prepare for a flare-up of fibromyalgia?

The first stage of management of fibromyalgia has to be a full exploration of an individual’s personal situation: their symptoms and the impact these have on work, hobbies and relationships.

Potential triggers then need to be considered. Education is the key to success. I believe that once someone fully understands the nature of the condition, what causes flare-ups and how these affect them it is only then that an individualised management plan can be made.

This usually consists of five main strategies:

1. Graduated exercise
Starting to move gently, regularly, with tiny increments is key to recovery in fibromyalgia. But not overdoing it is vital. Pushing yourself too much and suffering for the next few days is a common mistake. Accepting that you will have good and bad days on which your targets will need to be different is something that needs careful attention.

Choosing an exercise that you can do regularly, in varying amounts, increasing by small increments, is a key start. An exercise bike is often helpful, starting off even with five minutes a day on bad days or a little longer on better days but still keeping well within a comfortable level. Then increasing by perhaps only a minute a week. But after just 10 weeks that’s 15 minutes a day even on the bad days.

2. Pacing
Not overdoing it even on the better days is a key principle that extends to other aspects of life too when you are recovering from fibromyalgia flares. I often hear of people dreading or even avoiding social events in the evening, since getting back late after three to four hours would leave them drained for days.

Instead, the principle of pacing would suggest going but for only one hour. People will be pleased to see you; you will feel good that you made it and yet limited the ‘damage’ from being overtired.

Similarly, working hours might need adjustment temporarily or tasks such as gardening need breaking down into more manageable 30-minute sessions.

3. Anticipation of triggers
Many people with fibromyalgia find that it takes them longer to recover from other illnesses, injuries or other routinely draining episodes. For example, it might take twice as long to get over flu or to rehabilitate following a surgical procedure. Christmas can be draining for most of us but it is a frequent trigger for a flare of fibromyalgia. This can be anticipated. Allowing sufficient time to recover, putting into place a few extra days of leave, for example, might be the difference between January being miserable and being tolerable. Following planned surgery, expect to need twice as long off work.

4. Pain relief
Sometimes the pain reaches a level that is intolerable and we need to use medication to temporarily dampen down the pain. The pain in fibromyalgia is ‘nerve pain’ or ‘neurogenic’. Hence routine pain killers often don’t work. Pain killers that wind down the sensitivity of nerves by working on neurotransmitters are required. These are often effective at getting someone out of a hole and allowing them to start moving, to sleep better and to at least begin the process of rehabilitation.

Admittedly there can be side effects and these often worry people so much that they deprive themselves of the chance of pain relief that could be the key to recovery. In my experience, about 1 in 5 people get a side effect from the first medication we try. These are not usually dangerous, just unpleasant, and not sufficient enough to warrant stopping the medication.

But that does mean 4 out of 5 people or 80% do tolerate it. And that’s not bad odds considering that 100% of those people are suffering terrible pain, sleeping poorly and their daily functioning is severely affected. However, medication is not for everyone and is not the whole answer and this needs careful discussion in each case.

5. Exclusion and/or management of co-existing illnesses
Fibromyalgia is more frequent in the context of certain other illnesses. For example, approximately 20% of patients with rheumatoid arthritis have fibromyalgia. It also occurs more commonly in the context of anxiety or depression. These underlying illnesses may also need attention so that they don’t impact on an individual’s ability to recover from their fibromyalgia flare.

In summary, fibromyalgia can be a debilitating condition affecting all aspects of a person’s life, however, once recognised it can be managed effectively. This will take specialist-care, time and persistence but the rewards can be immense.


If you would like to discuss your experience with fibromyalgia with a specialist, do not hesitate to book an appointment with Dr Hajela now. 

By Dr Vijay Hajela

Dr Vijay Hajela is an expert consultant rheumatologist with more than 20 years of experience. He is based across the southeast in London, Brighton, and Hayward's Heath. Dr Hajela specialises in musculoskeletal pain, arthritis, fibromyalgia, gout, polymyalgia and SLE (lupus).

Dr Hajela qualified in 1990 from medical school at the University of Newcastle upon Tyne. Following this, he worked in hospitals across the United Kingdom and spent some time working in Auckland, New Zealand. He most recently worked as a consultant rheumatologist at University Hospitals Sussex before leaving to work in the private sector.

He has held various positions such as clinical lead for rheumatology in two hospitals, chair of a primary care musculoskeletal panel and director of medical education. In addition to his work as a consultant, he has been an examiner for the Royal College of Physicians since 2005.

In 2007, he was named the National Association of Clinical Tutors Travelling Fellow and was able to travel to North Carolina, working closely with senior medical staff at several US teaching hospitals. Furthermore, Dr Hajela spent three years as a regional chair of the British Society for Rheumatology from 2014 to 2017. He continues to teach at both an undergraduate and postgraduate level.

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