Managing Fibromyalgia Pain
& Reducing Symptom Flares
When tensing your upper body muscles to scrub the outdoor grill, you expect your neck and shoulders will soon start to ache. But why do your leg muscles begin hurting when they aren’t getting a workout? The answer has to do with your fibromyalgia and understanding what’s going on makes managing your pain easier. Fortunately, a study by Hong-You Ge, M.D., Ph.D., explains why your pain spreads to unexpected areas.1
Ge asked a group of fibromyalgia patients and healthy pain-free controls to hold their arms straight out like a T while comfortably sitting in a chair. This simple test triggers the release of pain-relievers into the spinal cord to reduce muscle aches and fatigue. It soothes pain like the runner’s high, but not so in people with fibromyalgia.
Fibro Muscles Fatigue Faster
Study participants contracted the large shoulder muscles in the upper back on each side (the trapezius) until it gave away to fatigue. Healthy subjects kept the contraction for almost five minutes, but patients only sustained it for two minutes. The amount of effort exerted by both groups was the same, so why do fibromyalgia muscles give out faster?
The answer has to do with those rock-like knots in your muscles, called myofascial trigger points (MTPs). Most fibromyalgia patients have five MTPs in their trapezius – it’s the muscle that contracts when your arms are extended outward.2 MTPs hurt all the time and worse yet, they interfere with normal muscle function.
Muscles are made up of a multitude of fibers or individual motor units. When a muscle is contracted, the fibers operate like shift workers to share the load. Some fibers work for a while, then others take their place. This trade-off of activity is a healthy way to prevent burnout within a muscle. However, MTPs in a muscle prevents it from successfully sharing the workload. Pain also interferes with this process.3
“When one or more MTPs are in a muscle,” says Ge, “the motor units are firing all the time; they never stop. The normal shifting mechanism is lost, leading to premature development of muscle fatigue.” In the case of fibromyalgia, Ge adds: “Patients are quickly getting tired due to the existence of a large amount of MTPs.” You must keep this defective shift-work system in mind when managing your fibromyalgia pain.
Migrating Pains Are Real
Moving past the hurdles of accelerated muscle fatigue, Ge assessed pain levels at the trapezius and a distant muscle in the leg. Remember, subjects were sitting so the legs were relaxed during the procedure.
The brief muscle contraction in the healthy group led to less pain in the shoulder area right after the exercise and 20 minutes later. This is what should happen when taxing one’s muscles. Otherwise, people would avoid exercising at all costs. And when Ge checked for pain in the lower leg, the healthy group didn’t experience any discomfort but the patients did.
In the fibromyalgia group, the spinal cord and brain did not kick in to relieve post-exercise soreness in the shoulders. Worse yet, pain increased significantly in the leg muscles that were relaxed throughout the study. This increase in leg discomfort persisted for at least 20 minutes after the shoulder contractions.
What does this mean? The system in the spinal cord and brain that people rely upon to ease post-exercise achiness is doing the opposite in people with fibromyalgia. Instead of soothing your discomfort, muscle contractions make it worse. So, managing your fibromyalgia pain becomes a perplexing challenge because muscles you don’t use start hurting for no apparent reason.
Why Your Pain Spreads
When a persistent barrage of painful signals enters your spinal cord, your central nervous system changes how it functions. Ordinarily, these alterations are just temporary until the painful situation resolves (such as an injury). But in fibromyalgia patients, these changes appear to be permanent.
Pain is supposed to be a short-lived danger signal. However, if your brain doesn’t put a lid on your pain, you have special sensors in your spinal cord that magnify the signals. They are like a fail-safe mechanism to make sure your brain is aware of the situation. As soon as the brain gets your pain under control, these sensors stop making a fuss. But in fibromyalgia, they are chronically turned on and your brain is overwhelmed.
The pain signals entering the cord get amplified, then redirected to other body regions to make them ache. So, if you are on your feet all day, they will become sore and cause the muscles in your arms to hurt too. And pain that migrates is tough to control.
Minimizing Symptom Flares
Exercise is an essential part of staying fit and healthy, but it is hard to do if it increases your pain. The trick to managing fibromyalgia pain is to avoid overworking any of your muscles. You need frequent breaks and must change positions to avoid muscle strain. Of course, this is easier said than done. So, to minimize the impact of using your muscles, try different self-help techniques and medication strategies.
Self-Help Techniques
Stack Your Skeleton – Keep your head over your shoulders and your shoulders over your hips. Also, work with your arms close to the body or have them supported by pillows. This minimizes neck and shoulder strain. Remember this throughout your day; it will prevent you from leaning forward for prolonged periods. It also reduces the odds of developing more MTPs in your shoulder muscles.
Alternate Muscle Use – Don’t make the mistake of scrubbing or doing repetitive movements with your dominant arm. Alternate to avoid muscle fatigue and minimize the spread of your fibromyalgia pain. Also, consider using different directions of movement. Don’t just scrub back and forth or in a circular fashion. Try up and down, and diagonal movements. Keep in mind that any one muscle will hit the wall of fatigue within two minutes. Take lots of breaks and don’t let anyone make you feel guilty about it.
Heat – Make use of heat wraps and warm water because your soft tissues have heat sensors that relieve pain. “Likewise, warm water or a hot shower increases blood flow, reducing MTP pain and stiffness,” says Ge.
Deep Breathing – Fibromyalgia muscles do not get enough oxygen during exercise. Try deep, relaxation breathing throughout the day to help counter this problem.
Sleep – If you anticipate a heavy workload, get extra sleep the night before as a preemptive strike. Increasing the quality and quantity of sleep improves the ability of your central nervous system to inhibit pain.4
Reduce Dietary Glutamate – Glutamate is a food-additive that also activates the sensors in your spinal cord that magnify pain.
Medical Management
Magnesium – The body uses magnesium to block the activation of the special sensors in your spinal cord that increase pain. One study shows magnesium supplementation is associated with less muscle stiffness and discomfort in fibromyalgia.5 The typical dose is 500 mg/day and chelated forms are easier on the stomach.
Reduce Pain Inputs – The efficiency of your body’s pain-relieving system is made worse by too many inputs from your peripheral tissues.6 For example, one study shows that irritated skin (itchy or burning) is linked to greater fibromyalgia pain.7 Soothing gels/topicals may help with the skin, while lidocaine patches may reduce MTP pain. The patches can be purchased over the counter and cut into fourths (place them over your trapezius muscles).
Medication Adjustments – Prescription medications that bolster your pain-relieving system may minimize the spread of pain. Examples include the three FDA-approved drugs and tricyclic antidepressants. Muscle relaxants and sleep medications may also help you manage your fibromyalgia pain. Unfortunately, symptom flares and special situations known to exacerbate your pain can’t be avoided. Talk to your doctor about adjusting the dose for certain predicaments, such as holiday events and word deadlines.
Helpful Resources
The above measures will help you manage your fibromyalgia pain. Depending upon the situations you face, certain methods may be more appropriate. In addition, if you can increase your fitness level, the more tolerant your muscles will become to bouts of exertion. But starting and maintaining a fitness program is a difficult task. See our suggestions in Fibro Friendly Exercises.
Check the following articles and website sections:
Muscle Pain Relief – this section contains several articles on MTPs and how to treat them (including the use of lidocaine patches and topicals)
Finding Medical Help – know the pros and cons of each medical specialist and learn which questions to ask when selecting a good fibromyalgia doctor
Alternative Therapies – this section contains several articles on nondrug approaches to manage your fibromyalgia pain and other symptoms, such as massage, spa therapy, TENS units and acupuncture
Fibromyalgia Headache Treatments – learn what you can do to tame your head pain because it makes fibromyalgia more difficult to manage
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References for Managing Fibromyalgia Pain
- Ge HY, et al. Eur J Pain 16(2):196-203, 2012. Abstract
- Ge HY, et al. PAIN 147(1-3):233-40, 2009. Abstract
- Ge HY, et al. Pain Med 13:957-64, 2012. Journal Report
- Soldatelli M, Caumo W, et al. Korean J Pain 36(1):113-127, 2023. Journal Report
- Tarsitano MG, et al. Eur Rev Med Pharmacol Sci 28:4038-4045, 2024. Journal Report
- Brietzke AP, Caumo W, et al. Medicine 98:3(e13477), 2019. Journal Report
- Donghia M, et al. J Clin Med 13:4404, 2024. Journal Report