By Wendy Burnett
I’ve been seeing some questions online about what a “flare” is, and how you know when you’re having one. The simplest definition is “a time when your fibromyalgia symptoms get worse, then improve again.” (With the caveat that if they STAY worse permanently it’s not a flare, its a worsening of the illness.)
A “fibromyalgia flare” is actually more accurately described as a “symptom flare,” since it can involve ANY symptom or combination of symptoms related to the illness or to comorbid conditions. Most patients (and doctors) only look at pain and fatigue levels; but increased severity of IBS/other digestive issues, fibrofog, anxiety, depression, itching, skin sensitivity, or any other symptom related to your fibromyalgia is ALSO a flare.
Each patient tends to have their own specific definition, so if you ask 20 people, you’ll actually get 20 different definitions; but they’ll all have some things in common:
- First, pain levels. A flare involves higher pain than your “usual” levels. If your pain is mostly around a 4 or 5, and suddenly goes up to a 6 or 7, you may be starting a flare.
- Second, time. If your pain levels are higher than what you normally deal with for a few hours, then drop back down with your next dose of medication, it’s a “spike” or “breakthrough pain.” For your doctor to consider it a flare, it will have to last for at least 24 hours or more, and some flares have lasted for months.
- Third, fatigue. Although for shorter flares this may not be a huge issue, pain exhausts your body, and in a flare that lasts more than a few days, fatigue levels are going to be higher than normal as well. It’s also possible to have a flare where pain levels stay around your normal levels, but the fatigue is much worse.
- Finally, other symptoms. A flare will frequently involve other symptoms getting worse as well. FibroFog is one that tends to go along with flares, making them even harder to deal with (it’s always “fun” trying to figure out if you actually TOOK your pills or not . . .)
These are the basics, and many of us include “intensity” in our personal definitions as well. For some, it’s not a flare unless the intensity increases so much that they’re practically incapacitated or are bed-bound; for others any increase in symptoms is a flare. (My personal “benchmark” is that pain and/or fatigue levels have to go up by at least a full number, like from a 5 to a 6, and stay at the new level for at least a couple of days for me to call it a flare.)
Many times a patient will specify by saying, “I’m having a fatigue flare,” or “I’m having a pain flare,” when one symptom is much worse than the others, or it’s the only symptom that has intensified.
For more definitions of terms used in talking about fibromyalgia or myalgic encephalopathy (chronic fatigue syndrome), check out: Fibromyalgia & Chronic Fatigue Syndrome Glossary
Related articles
- Baffled by a Fibromyalgia Flare-up That Came Out of Nowhere? (ohmyachesandpains.info)
- Top 5 Posts: How to Prevent Holiday Flares
Thanks for this explanation Wendy! I’m one of those who thought that a flare would be incapacitating, and it’s an adjustment to think otherwise, lol. But perhaps categorizing flares by major symptoms and intensity will be a more realistic way of seeing things – it certainly makes more sense!
Thanks for the ‘Aha!” moment, and I’ll look forward to the updates
Thanks Cynthia.
Incapacitating flares are miserable experiences, but limiting the definition of a flare to incapacitating pain seems to me to also limit our ability to respond appropriately when our symptoms get worse. If I only allow a flare to “count” if I’m confined to bed, how can I allow myself to ask for help before I reach that point? If a flare is only incapacitating pain, maybe I don’t need to give myself a break when I’m “only” exhausted, foggy, or depressed. The problem I see is that if I don’t give myself a break when these other symptoms start to get worse, it pushes me INTO that state of incapacitating pain . . .(been there, done that, way more times than I’m willing to admit.)
Thanks Wendy, you covered the concept quite well, hitting the nail square on the head. Along with the pain and fatigue factor, however, one may also experience intestinal (IBS) issues, nausea, and my personal bugaboo, Fibro Fog and confusion, along with a hefty dose of anxiety. These latter are not a writer’s favorite part of this Fibro experience, but then neither is the pain or fatigue! I am fortunate in that I have discovered how to keep my flares down to a few hours instead of a few days. Everyone is different, as we all know, and It is my hope that everyone can find their own personal answers! *:) Thanks for all your efforts. Keep smiling! It’s important! *:)
Thanks Pati
Thank you for the comment, and the reminder . . . You’re exactly right about the IBS, nausea, and fogginess. A “fibromyalgia flare” is actually more accurately described as a “symptom flare,” since it can involve ANY symptom or combination of symptoms related to the illness or to comorbid conditions (and I’m about to update the post to clarify that point, thanks to your comment.) Even though the majority of fibromyalgia patients (and doctors) only relate “fibromyalgia flares” to the pain/fatigue symptoms, increases in the intensity of any of the other symptoms of fibro can lead to increased pain and fatigue if those increases aren’t treated early enough.
i like that there is a difference between a spike and a flare. i think i’m having a spike. let’s hope it is a spike. so tired.
Hey mags –
I’ve got my fingers crossed for “spike.” Now REST so it doesn’t turn into a flare. LOL (I know you, you’re as stubborn as I am, and will try to keep going until you CAN’T go any more . . .Don’t make me get S. after you.)
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I think the worst about the flare is figuring out how in the world it happened. You think you figured it out and wait for the tell tale signs of a flare coming and so you slow down… sometimes you don’t slow down fast enough to miss the flare.
I haven’t thought of the spikes though. I know there is a difference between a crash and a flare. A crash does not last as long but it is exhausting. Plus, if I do not take enough care after the crash then I could end up in a flare.
What a confusing thing to go through and try to figure out.
Amanda – Flares are indeed very confusing. It took me years to figure out that many of mine are actually weather related, and that if weather changes and other flare triggers got combined, it could lead to some pretty horrible days. I finally learned that I had to be especially careful about triggers I CAN control during the times of year when we get a lot of unpredictable weather changes so that I minimize the chances that I’ll over-do things, or miss meds, then get hit with a change in the weather that makes it even worse.