Not first-line — use only when established therapies have failed
Patient Discharge Instructions
copy discharge instructions
Fibromyalgia flare home care
Your flare is a temporary worsening of your fibromyalgia — it is real and it will improve
Most flares resolve within days to a few weeks with appropriate management
Avoid complete bed rest — gentle activity helps recovery
Medications
Take your fibromyalgia medications as prescribed — do not stop them suddenly
If a new short-term medication was prescribed tonight, take it as directed
Avoid over-the-counter pain medications not discussed with your doctor
Gentle activity
Short gentle walks, stretching, or warm water exercise as tolerated
Avoid pushing through severe pain — pace yourself
Gradually increase activity as flare improves
Sleep
Consistent bedtime and wake time even during the flare
Limit screens 1 hour before bed
Cool, dark, quiet room
Warm bath or shower before bed may help
Heat and comfort measures
Warm packs or heat pad to painful areas
Gentle massage if tolerated
Relaxation breathing or guided imagery for acute pain episodes
Trigger management
Identify and reduce your specific flare trigger if known — stress, overexertion, poor sleep
Pacing — alternate activity with rest; avoid overdoing then crashing pattern
Warning signs to return to the emergency department
Return immediately if you develop
Fever above 38 C or chills
New joint swelling, redness, or warmth
New weakness in arms or legs
New numbness or tingling in a defined area
Unintentional weight loss
Thoughts of harming yourself — call 988 (Suicide and Crisis Lifeline) or go to the nearest emergency department
Symptoms dramatically different from your usual fibromyalgia
Follow-up
See your primary care doctor or rheumatologist within 1 to 2 weeks
Review your current medications — dose adjustments may help
Discuss referrals for physiotherapy, CBT, or sleep medicine if not already arranged
Psychiatry or mental health
If your mood is low or you are feeling hopeless, please mention this at your follow-up
Treatment for depression directly improves fibromyalgia symptoms
References
Guidelines and key sources
Diagnostic criteria and classification
Wolfe F et al — 2016 Revisions to the 2010 Fibromyalgia Diagnostic Criteria; Seminars in Arthritis and Rheumatism 2016
Current ACR diagnostic criteria with WPI and SSS scoring
Arnold LM et al — AAPT Diagnostic Criteria for Fibromyalgia; Journal of Pain 2019
American Academy of Pain Medicine Task Force criteria
Fitzcharles MA et al — Nociplastic Pain: Towards an Understanding of Prevalent Pain Conditions; Lancet 2021
Mechanism classification and treatment implications
Clinical management guidelines
Vincent A, Whipple MO, Rhudy LM — Fibromyalgia Flares: A Qualitative Analysis; Pain Medicine 2016
Primary evidence source on flare characterization and triggers
Winslow BT, Vandal C, Dang L — Fibromyalgia: Diagnosis and Management; American Family Physician 2023
Comprehensive current management review
Goldenberg DL, Burckhardt C, Crofford L — Management of Fibromyalgia Syndrome; JAMA 2004
Foundational multimodal management framework
Dowell D et al — CDC Clinical Practice Guideline for Prescribing Opioids for Pain; MMWR 2022
Opioid avoidance recommendation applicable to fibromyalgia
Evidence for specific interventions
Bidonde J et al — Mixed Exercise Training for Adults with Fibromyalgia; Cochrane Database 2019
Exercise as primary evidence-based nonpharmacologic intervention
Kundakci B et al — Efficacy of Nonpharmacological Interventions for Individual Features of Fibromyalgia; Pain 2022
Meta-analysis supporting CBT, exercise, and mind-body therapies
Kundakci B et al — International Multidisciplinary Delphi Consensus Recommendations on Non-Pharmacological Interventions; Seminars in Arthritis and Rheumatism 2022
Consensus support for multimodal nonpharmacologic approach
Pathophysiology and special topics
Falco P et al — Autonomic Dysfunction in Fibromyalgia Syndrome: The Role of Small Fiber Damage; Clinical Neurophysiology 2026
Small fiber neuropathy and autonomic dysfunction evidence
Bailly F — The Challenge of Differentiating Fibromyalgia from Small-Fiber Neuropathy; Joint Bone Spine 2021
Differential diagnosis of fibromyalgia versus small fiber neuropathy
Robbins R et al — Management of Chronic Multisymptom Illness; Mayo Clinic Proceedings 2022
VA/DoD Clinical Practice Guideline synopsis applicable to fibromyalgia
SymptomDx is an educational tool for medical professionals. It does not replace clinical judgment. Verify all clinical data and drug dosages with authoritative sources.