Keeping Aches Under Control
When tensing your upper body muscles to scrub the outdoor grill, you expect your neck and shoulders will soon start to ache. It’s life with fibromyalgia. But why would your leg muscles begin hurting if they didn’t get a workout? An AFSA-funded study by Hong-You Ge, M.D., Ph.D., of Denmark explains why your pain migrates to unexpected areas.1
Ge asked a group of fibromyalgia patients and healthy pain-free controls to perform a two-minute contraction of their shoulder muscles. Subjects just had to hold their arms straight out like a T while comfortably sitting in a chair. It’s certainly less intense than the workout you get from cleaning a grill, getting the house ready for company or everyday chores.
Sustained muscle contractions trigger the release of pain-relievers into the spinal cord to reduce muscle aches and fatigue. This is a natural process that soothes pain (like the runner’s high), at least in healthy subjects. Yet, this system that provides analgesia after exercise appears to be working the wrong way in fibromyalgia patients.
Fibro Muscles Fatigue Faster
Study participants were asked to contract the large shoulder muscles in the upper back until they gave away to fatigue. Healthy subjects kept the contraction for almost five minutes, but patients were only able to sustain it for two minutes.
The perceived level of exertion was the same for both groups, so why did the muscles give out faster in the patients? The answer has to do with those rock-like knots in your muscles, called myofascial trigger points (MTPs). They hurt when pressed and radiate pain everywhere. According to Ge, most fibromyalgia patients have five MTPs in their upper trapezius muscle. 2 This is the triangle-shaped shoulder muscle that usually gets a workout with upper body movements.
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 period of time, 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 and fatigued due to the existence of a large amount of MTPs. They are not faking their perceived exertion ratings.”
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. Keep in mind that the leg was relaxed during the entire procedure. Pain sensitivity was measured at three time points: before and immediately after contracting the shoulders, as well as 20 minutes later.
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. It’s the pain inhibits pain phenomenon. After all, if this did not happen, people would learn to avoid exercise whenever possible. Pain sensitivity in the lower leg was unaffected in the healthy group, but not so in the patients.
Pain levels started out much higher in the fibromyalgia group (as expected). But the spinal cord and brain did not kick in to relieve post-exercise soreness in the shoulders. Worse yet, pain sensitivity increased significantly in the leg muscle that was relaxed throughout the study. This increase in leg pain 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 discomfort is doing the opposite in people with fibromyalgia. There is a shift from pain inhibition to pain amplification in the patients. Also, patients starting out with lower pain thresholds (greater pain sensitivity), ended up with more pain in their legs at the end of the exercise. So, those that needed pain relief the most, received less of it!
What could be happening in your spinal cord and brain to make your pain migrate to other areas? When a persistent barrage of painful signals enter your spinal cord, it can undergo changes in the way the cord functions. Pain is supposed to be a danger signal, and you have NMDA receptors in your cord that can amplify pain. Ordinarily, the NMDA receptors get rowdy for a short period of time, just to get your brain’s attention. Then the brain gets your pain under control and the NMDA receptors shut up again. In fibromyalgia, the NMDA receptors are chronically turned on and the brain becomes 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. The unpredictable migration of pain in fibromyalgia makes living with this disease more challenging.
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 is to not overwork any of your muscles. You need frequent rest breaks and must change positions to avoid muscle strain. Of course, this is easier said than done. So, here is what you do to minimize the impact of using your muscles:
Stack Your Skeleton – Keep your head over your shoulders and your shoulders over your hips. Also avoid working with your arms extended. If you work with your arm close to the body or have them supported by pillows, this minimizes neck and shoulder strain. Remember this as you move through your day; it will prevent you from leaning forward for prolonged periods. Most importantly, it reduces the odds of developing MTPs in the 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 the spread of 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, so keep switching things up. If your muscles feel worn out, they likely are. 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 activates the parasympathetic activity,” says Ge. “This increases blood flow, reducing MTP pain and muscle stiffness.”
Deep Breathing – Muscles do not get enough oxygen during exercise due to an overly active sympathetic nervous system. This system clamps down on blood flow to exercising muscles, making matters worse. Deep, relaxation breathing throughout the day activates the “calming” parasympathetic system to counter the sympathetic dominance.
Sleep – If you are anticipating 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
Magnesium – The body uses magnesium to block the activation of the NMDA receptors in the spinal cord. While it is not known for sure if taking magnesium supplements will improve your body’s ability to temper these receptors, it’s worth a shot. A recent 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 reduced efficiency of your pain inhibitory system is made worse by sensory inputs from your peripheral tissues.6 A recent study shows that irritated skin (itchy or burning) is linked to greater overall 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 – Are you on a prescription medication that bolsters your pain inhibitory system? Example medications include the three FDA-approved drugs and tricyclic antidepressants. If you are on any of these, talk to your doctor about adjusting the dose for special situations. In other words, when you are preparing for holiday events, big work deadlines, or cleaning your house to entertain.
All of the above measures are attempts to reduce the impact of your body’s pain generators. Depending upon the situations you face, certain methods may be more appropriate. However, it is important to have a full arsenal to keep your body aches (and your fatigue levels) under control. 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 Movement Therapies.
- 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