They say time changes everything

We all know that nights are the worst, but what is it about 3:00 pm? I do okay in the morning (except after a cup of coffee) then fair after noon, but then I can almost tell the time by my 3 o’clock flare. I know it’s not just me, I’ve seen others comment on it. Is there a chemical, medical, or other reason for it?

OMG I am so glad you posted this!!! I thought I was going crazy thinking I had these afternoon flares (not as intense as the evening flare). I thought it was rebound from the caffeine in the morning, but they persisted after I gave that up.

For me, it seems like my heart beats a bit faster, and I can see my chest start to get red/blotchy … then it carries throughout my body (legs, arms) ending with burning extremities … but maybe that’s just me.

For me, it’s just a sudden intense burst of heat that I can’t escape. My hands and feet are on fire and my normally cool body temperature rises. It subsides after a bit but it is so predictable…like clockwork! Lol

What time do you eat lunch?

The autonomic nervous system regulates functions of internal organs and mainly has two components, sympathetic and parasympathetic. The sympathetic nervous system main function is to stimulate the body’s “fight or flight response.” The parasympathetic nervous system main function is to “digest and rest.”

The sympathetic nervous system predominates during the day. At night the sympathetic nervous system relaxes; blood pressure falls, muscles relax and skin vessels dilate. The parasympathetic nervous system predominates at night.

This is why your erythromelalgia symptoms are inherently worse at night. In preparing to sleep, the sympathetic nervous system is suppressed and blood vessels dilate.

So, why did I ask when you eat lunch?

After a meal, the parasympathetic is activated due to the distension of the gastrointestinal tract and sympathetic activity is suppressed. Much like nighttime, this causes blood vessels to dilate and your body to warm.

You’re probably digesting lunch around 3:00 pm.

Erythromelalgia, at a very basic level, is autonomic nervous system dysfunction .


That explains it! Thanks for your insight.

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Has anyone tried varying their eating schedule to see if the 3pm flare/burning changes at all?

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sure have.
i don’t think it is as much connected to that as it is to outside temps and seasonal changes. just with it being warmer now i wake up warmer and my entire day of flaring has changed to a new sched.

eating … or fasting… didn’t make any difference however

It’s how you vascular system is responding to various agents that either constrict or blow your veins wide open to allow the blood to flow. I had to do a lot of research on this. For most people who have nerve damage especially in the hands and feet with so many smaller peripheral nerves and tiny veins, the last thing that you want is to take food, medication or supplements that cause vascular construction. At the same time, if you have high blood pressure and are taking a prescription medication for it, you’ll notice shortly after (like with drinking coffee) that you can see all your veins pushed up, which can be just as painful!

It’s a balancing act depending on your other health needs and your diet. You should discuss this with your doctor so they can take a look at what you might be talking at the wrong time or not together. I had to separate some of my medications because two of them were constructors or they would be fighting each other and my pain would skyrocket.

There’s no magic formula sadly, everyone is different. Even me, from day to day. I can use a magnesium oil that usually helps a great deal, but then out of nowhere a few days ago it left a horrible red burn on both arms. I’ll try to put a list on the best sites I’ve stored and check with the administrator here to see if I can share them with you guys.

Be well…

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I’ve been thinking about the 3 pm flare for a while (which is independent of how hot/cool it is, or when/what I’ve eaten, or what I’m doing). I think it might be a sympathetic nervous system spike / sympathetically mediated symptoms. Why I think this:

-I’m told the sympathetic nervous system can be recruited in cases of chronic pain, and can become the “amplifier”

-It is blocked by propranolol 60 mg ER taken in the morning (I couldn’t take this long term though, as it increased my reactive flaring for me … but glad I tried it and have that data point)

-SNRI’s taken in morning (effexor or cymbalta) make it worse. If i switch to night, afternoon symptoms are about 50% less (but I wake up at night!).

I’m hoping a sympathetic block will ameliorate the afternoon flaring specifically. One pain doctor made the comment that sometimes he sees very good results when the sympathetic nervous system and small fiber neuropathy components are treated simultaneously, and that makes sense to me.


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