Fibromyalgia (Acute Flares)

Acute fibromyalgia flares, also known as exacerbations or crises, are periods when symptoms of the disease significantly intensify. These flares can vary in duration, from a few days to several weeks, and are often unpredictable, adding an additional layer of difficulty for those suffering from this condition. During an acute flare, patients experience increased intensity of musculoskeletal pain, which can be debilitating and affect their ability to carry out daily activities. In addition to pain, other symptoms such as extreme fatigue, insomnia, cognitive problems, and gastrointestinal symptoms may also worsen.

Acute flare-ups not only have a physical impact, but also an emotional and psychological one. The unpredictability and severity of the pain can lead to feelings of hopelessness, anxiety, and depression. Patients’ quality of life may decline during these periods, affecting their social and work relationships.

Common Triggers of Outbreaks

Identifying and managing triggers is crucial to minimizing the frequency and severity of acute flares. Some of the most common triggers include:

  1. Stress and Anxiety: Emotional stress is one of the main triggers of fibromyalgia flare-ups. High-pressure situations, personal or work-related problems, can precipitate a flare-up.
  2. Climate Changes: Variations in climate, especially cold and humidity, have been reported by many patients as factors that worsen their symptoms.
  3. Lack of sleep: Unrefreshing sleep is a common feature of fibromyalgia, and lack of sleep can trigger a flare.
  4. Strenuous Physical Activity: Although moderate exercise can be beneficial, excessive or inappropriate physical activity can lead to an exacerbation of symptoms.
  5. Infecciones: Enfermedades infecciosas como la gripe o el resfriado común pueden desencadenar brotes de fibromialgia.
  6. Hormonal Changes: Hormonal fluctuations, especially in women, can influence the appearance of outbreaks.

Management Strategies during Acute Outbreaks

Managing acute fibromyalgia flares requires a multifaceted approach that combines pharmacological and non-pharmacological treatments. Some effective strategies are described below:

  1. Medicines :
    • Pain relievers: Drugs such as acetaminophen or nonsteroidal anti-inflammatory drugs (NSAIDs) may be helpful in relieving pain during a flare-up.
    • Antidepressants: Medications such as duloxetine and amitriptyline, which act on the central nervous system, can help manage pain and improve sleep.
    • Anticonvulsants: Drugs such as pregabalin and gabapentin have been shown to be effective in treating neuropathic pain associated with fibromyalgia.
  1. Non-Pharmacological Therapies:
    • Physical Therapy: Low-impact exercises, such as yoga, swimming, and tai chi, can be beneficial for maintaining mobility and reducing pain.
    • Relaxation Techniques: Practices such as meditation, deep breathing, and cognitive behavioral therapy can help reduce stress and anxiety, which are common triggers.
    • Acupuncture: Some research suggests that acupuncture may be effective in reducing pain and improving overall well-being.
    • Diets and Supplements: Maintaining a balanced diet and, in some cases, using supplements such as vitamin D and magnesium may be beneficial for some patients.
  2. Lifestyle Modifications:
    • Sleep Hygiene: Establishing a regular sleep routine and creating a restful environment can improve sleep quality and reduce the frequency of flare-ups.
    • Stress Management: Identifying sources of stress and learning effective stress management techniques can prevent acute stress flares.
    • Symptom Monitoring: Keeping track of symptoms and possible triggers can help patients identify patterns and take preventive measures.

Bibliographic References

  • Castaldo, M., Giordano, A., Valente, D., Citera, G., & Ingraham, G. (2021). “Evaluation and management of fibromyalgia flares in clinical practice”. Clinical Rheumatology, 40(4), 1157–1167. DOI:10.1007/s10067-020-05413-3.
  • García-Campayo, J., & Andrés, E. (2022). “Cognitive-behavioral therapy for the management of fibromyalgia flares”. Journal of Clinical Psychology, 78(3), 345-358. DOI:10.1002/jclp.23299.
  • O’Mahony, R., Coughlan, RJ, & O’Mahony, B. (2023). “The role of physiotherapy in the treatment of fibromyalgia flares”. Journal of Bodywork and Movement Therapies, 27(2), 50–57. DOI:10.1016/j.jbmt.2023.02.007.
  • Perrot, S., & Russell, I.J. (2022). “The effect of stress reduction interventions on fibromyalgia symptoms: a systematic review.” Journal of Psychosomatic Research, 142, 110367. DOI:10.1016/j.jpsychores.2022.110367.
  • Vincent, A., & Whipple, M.O. (2023). “Impact of Seasonal Changes on Symptom Severity in Patients with Fibromyalgia: A Cohort Study.” Pain Research and Management, 2023, 8469482. DOI:10.1155/2023/8469482.