Relapse or flair - confused

Hi everyone,

Hoping you may be able to help a confused newby.

Throughout most of last year I was getting sharp stabbing pains. Always in the same place (along my c-scar where I figure the nerves are also damaged) and lasting only seconds, but strong enough to take my breath away. This started shortley after what turned out to be my first major relapse (although I had had a few odd things hapening before) and which was dx as TM. They followed a distinct pattern, starting with a few a day and building up to around 30 in a day and then droppping away until they stopped. This would last for about 2 weeks and then I’d get about 2 weeks respite before it all started again. I did think it might be following my cycle, but as I don’t have a cycle as such due to a mirena coil I couldn’t prove this out. The pains finally stopped at the back end of the year and I hoped that was the last of them.

They started up again with avengance last week. Again starting with a couple a day, but very rapidly climbing into the mid twenties. They are also longer lasting than they were. I emailed my MS nurse who said that unless the symptom was constant then it was a flair due to stress/infection etc rather than a relapse. I’m confused. Surely the very nature of a stabbing pain is that they are not constant?

I’ve only been dx 5 weeks so I’m still new to all the terminology. How do I tell the difference between a relapse and a flair?



I don’t know if I really understand the difference that well myself, but as an example - I get tingling on my face sometimes, generally when particularly tired - happens for about an hour then goes.

I am currently having a relapse and my right leg has parasthesia and weakness all the time without stopping, since last Friday.

From what I’ve read, a relapse has to last 24hours to be a relapse.

I think what the nurse means is that your pains would have to be occuring throughout the day rather than only at certain times, although I can see the problem in telling the difference whether stabbing type pain is frequent enough to be considered constant.

I sometimes wonder if anyone really knows for sure tbh.

Hope the pain eases soon in any case.

My understanding is that if you fall ill experiencing new symptons, it is a relapse. Whereas if you fall ill experiencing symptons that you have had before. That is how it was explained to me. I have to say that I am not sure that I fully believe it.

I think you can have a relapse of something you have had previously, but it has to be at least 30 days since the last relapse. You have me thinking now though as my current symptoms are a partial repeat of my last relapse, which I thought ended 6 weeks ago (started about 3/4 weeks prior to that). Maybe it’s a worsening of that same relapse then rather than strictly speaking new.

In a way, I don’t suppose it much matters. I am off work with it whether it’s new or old, and I can’t get through to the ms nurse for love nor money (been trying since Monday). Might try neuro’s PA next, although I do hate making a fuss.

Thanks for the replies folks.

Glad I’m not the only confused one! :slight_smile:

Pains have been going on for about 10 days now, although they seem to be decreasing in numbers per day so hopefully I’m through the worst for this batch. Weather they come back next month will be the next question. I’ll probably run it past my MS nurse again when I see her for further clarification. I’m due to see her soon to start on DMDs so will ask then.


I’ve suffered from sharp stabbing pains in my right hand side just under my ribs. I’ve had this on and off since my 2nd relapse. It has shown it’s self in other relapses but not on it’s own. I also get it inbetween relapses, quite randomly and with nothing else that would make me think that it’s a relapse.

My neuro said that often when you’ve had something as part of a relapse it can happen again when you’re not relapsing just because there is a little bit of damage to the nerve so it can play up every now and again. I was offered tablets to deal with the pain, which I tried for a bit but they made me feel a bit strange and didn’t make any difference to the pain. I decided that it was easier to put up with the pain than the side effects of the tablets.

Here is the link to the definition of a relapse on here. It might help a bit, although in my experience you find out pretty quickly what is or isn’t a relapse.

If you’re unsure give your MS nurse a call.



I thought I would copy the MS Society definition of a relapse (reference given above), just so we can all have a little smile about the confusion around this important topic

After reading that i am more confused now lol .

I wonder if your stabbing pains are going to be one of your “warning signs”? By this I mean a symptom that you’ve had a long time that gets worse / comes back before a relapse is about to start. For me, it’s a numb big toe and thumb as well as appalling fatigue. When I get these I know I have to slow down or my MS is about to get its own way :frowning: (And I know this because, when I haven’t, I have a relapse.)

The 24 hours thing is daft when applied to some things because, eg and as you say, shooting pains are by their very nature not going to be constant. The way to get round it is to say that you have had a 24 hour period of new, frequent, shooting pains.

However, once you’re diagnosed, stuff like that doesn’t really matter. Neuros are only interested in relapses if they are “clinically significant” (ie serious / disabling / debilitating) and you are on DMDs or this attack may be counted towards you getting DMDs. I know this sounds very cynical, but it’s consistent with my experience at least.

If I were you, I would rest as much as possible. If other symptoms begin, then there’s no doubt that you are either having a relapse or something is causing a pseudo-relapse (eg a UTI).

Fingers crossed resting works and you’re feeling better soon.

Karen x

Thanks for the replies all.

@ Sewingchick - I feel so much better about being confused now. Having read that it’s a wonder anyone understands it! No hope for us mere mortals if the experts can’t make up their minds.

@ Karen - Ooh I hope not! The pains have almost gone now, down to 2 so far today, from mid 20’s earlier in the week. I have been struggling with tiredness and light headedness the last 2 days though. I will have to make sure I don’t over do things as I’m the worlds worst for trying to carry on regardless.

I thought about this a bit more. The truth is that you only know you’ve had a relapse when it’s gone. If you have some symptoms that you don’t normally have and then they go away again, at least partially, then you’ve had a relapse. If you’ve got some new symptom(s) that is(are) bothering you, you can go and get steroids and if the symptoms are gone a couple of weeks after you had the steroids, it was a relapse.

If you get some new symptoms and you still have them a year later or you still have them a few weeks after having steroids, then that’s deterioration associated with MS and not a relapse.


I have a cold at the moment and infection of the sinuses. I have had it for two weeks and it is really annoying me now, as it doesn’t seem to want to go away. It is definitely making my symptoms worse but I don’t think that it is a relapse. I think that it is just the cold. I have made things worse by going cycling and overdoing things. I am not going to continue to overdo things as it is a very stupid thing to do.

I was in a similar situation last year where I had a cold for a couple of weeks which brought on a full relapse that lasted about three months.