Fibromyalgia flares are associated with intense pain, flulike aches and exhaustion, and other phenomena such as “brain fog,” as confirmed by the first-ever qualitative analysis of these periods of symptom exacerbation. Furthermore, according to the 44 people who responded to the investigators’ survey, the patients tried many coping techniques, from medications to massage and from meditation to humor.
One of the most common coping strategies described by the respondents is to avoid all forms of activity, which surprised the investigators.
“Avoiding everything may indicate a lack of knowledge of or ability to use healthy coping strategies, and therefore, future research could evaluate the potential effects of teaching patients healthy coping strategies as one method to deal with symptom flare,” wrote Ann Vincent, MD, and her 2 coauthors.
Vincent, Associate Professor of Medicine, Mayo Clinic, Rochester, Minnesota, said her team administered the survey to Mayo Clinic fibromyalgia patients at a ratio of 4:1 of females:males to reflect the gender proportion of the illness; 77% of the respondents were female, and 93% were non-Hispanic white.
When queried by Value-Based Care in Rheumatology about what the specific clinical implications are with respect to optimizing coping strategies, Vincent responded, “This is a qualitative study and this [the survey results] is what patients reported they do.” She and her coauthors suggest that future research could include a larger, more diverse patient population to assess the characteristics of fibromyalgia flares quantitatively.
The 7 items in the qualitative questionnaire were designed to probe the unique characteristics of flares. The questions included, “Do you experience any new symptoms during a fibromyalgia flare that are not typical of your everyday fibromyalgia symptoms?” and “How do you cope with a fibromyalgia flare?”
In the respondents’ descriptions of flare triggers, the most common theme was “stress, stress, stress” related to work and life in general. They also said “overdoing it” can cause flares; this included physical exercise and variations in normal activity such as attending social events. Inadequate or poor-quality sleep and weather changes were the other most common triggers. Sleep is particularly problematic for patients because flare-ups reduce sleep quality, causing a continuing feedback loop.
A key characteristic of flares is an intensification of symptoms to the point of being disabling. Many survey respondents described full-body aching and exhaustion, similar to having a flu, and also severe pain, which can be so intense that, as one patient described, it “makes me not want to move or be touched.” Respondents also described severe and disabling fatigue and other symptoms such as “fogginess in my head,” severe headaches or migraines, and difficulty with emotional regulation.
Among respondents, 77% turned to medications as treatment—principally acetaminophen and ibuprofen—and 22.7% reported using massage. Many also reported using meditation, breathing exercises, and hot or cold therapy. Three other major coping strategies were getting more rest or staying home, avoiding all activities including social interactions, and “waiting it out.”
Vincent A, Whipple MO, Rhudy LM. Fibromyalgia flares: a qualitative analysis [published online January 13, 2015]. Pain Med.