Fibromyalgia Basics

Muscle Pain Relief for Fibro

Almost all fibromyalgia patients are aware of knot-like areas of exquisite tenderness in their tight, ropy muscles. Pressing on these knots hurts and radiates pain elsewhere. Most of these areas were the tender points used for diagnosing fibromyalgia until 2011. Today, these nodules are known to be myofascial trigger points (MTPs) and they can drive your pain through the roof. This section offers advice on treating muscle MTPs to get relief from your fibromyalgia pain.

MTPs Overlooked

Wonder why your doctor never mentioned you have MTPs that need treatment? A physical exam is not required to diagnosis fibromyalgia. As a result, most doctors are not trained to look for MTPs, nor do they know how to treat them. But just because your painful muscle knots are frequently ignored, it doesn’t mean they don’t exist.

Understanding how MTPs contribute to your pain is an essential first step. It provides ample motivation to get these muscle-pain generators located and treated. Otherwise, your MTPs will be overlooked. 

Understanding MTPs

The average fibromyalgia patient has about a dozen MTPs, and each one represents a treatment opportunity.¹ Curious about what goes on inside these painful nodules to make them hurt? … learn more.

Researchers can image MTPs, so they are every bit as real as they are painful. MTPs are abnormal areas of densely compacted muscle fibers in a contracted state. They  make your muscles feel tight and restrict blood flow to the area. In addition, MTPs are reservoirs of nasty chemicals that irritate nearby nerve endings to cause pain. When the MTP is treated, the muscle relaxes and releases the chemical contents.

MTPs continuously feed your central nervous system with noxious “pain alarms” and activate your peripheral nervous system. It’s a vicious cycle and medications often fail to shut down these neurological signals that sustain this cycle. So, the best treatment approach is to directly target your MTPs. To achieve success, you need to understand why MTPs develop and learn ways to minimize their occurrence. For an article addressing these issues, read more.

The most popular theory on what causes fibromyalgia relates to your central nervous system, not your muscles. A dysfunctional brain and spinal cord cause an amplification of pain signals, making your whole body hurt. Yet, the presence of MTPs in your muscles is also a contributing factor and there’s research to prove this. Treating just one shoulder muscle MTP in fibromyalgia patients leads to reduced body-wide pain relief.²

Fibromyalgia patients have lots of MTPs, so where do you begin? Start with your most bothersome MTPs first, which are often in the upper shoulders, back of the neck, and lower back region. A variety of techniques can be used. Several common methods are described below along with a box on the pros and cons of each.

Manual Therapies

Trigger-point focused therapies are often done by a physical therapist (PT) with special training in this area. Many therapists use a tiny needle to poke the area above trigger points to break them up (it’s dry needling). PTs perform dry needling in all states except California, Oregon, New York, and Hawaii. In these four states, you need to find an acupuncturist who specifically treats MTPs. Studies show drying needling MTPs in fibromyalgia provides more muscle pain relief than simply massaging the areas.³  In fact, it may also improve the function of the peripheral nervous system involved in sustaining the MTPs.⁴

Physical therapists use a variety manual therapies in addition to dry needling to relieve MTP pain. The approaches used often depend upon how many MTPs you have and where they are located. For example, the therapist may apply pressure to the MTP nodule while very carefully stretching the muscle. Or they may use a coolant spray that numbs the painful area before stretching. Techniques focusing on reducing the MTPs in fibromyalgia are most effective.⁵ In fact, one session per week for four weeks produces significant symptom relief.

Other providers who offer MTP-focused manual therapies are massage therapists, osteopaths, and chiropractors. A medical doctor whose focus is treating myofascial pain is also a great option, but they are hard to find. Regardless of the type of provider, ask them to teach you a home program to help between visits.

Stretch with Heat/Coolant

Muscles with trigger points cannot just be stretched because they will recoil and produce more trigger points. Application of heat relaxes the muscle so it can be gently stretched (never stretch to the point of pain). Coolant topicals work as an anesthetic to enable a light stretch of the muscle as well. Both treatment techniques ease fibromyalgia muscle tightness and provide pain relief.

Ideally, you want to seek the care of a physical therapist to perform this technique. If you respond favorably, ask the therapist to teach you how to do some of the stretches at home. Follow-up appointments with a trained specialist are still required for hard-to-reach areas and stubborn MTPs.

Trigger Point Injections

A needle with anesthetic (such as lidocaine) is injected into the eye of the trigger point, forcing it to release the knotted contraction. The procedure is followed by a gentle massage of the area and then on/off application of a cold pack to reduce initial pain. This technique is reserved for stubborn trigger points (i.e., maybe one or two) and is done by a physician.

Unlike the tiny needles used for dry needling, syringes are larger and cause more trauma to the injected area. The resulting post-injection soreness limits this technique to one or two muscles. Conversely, lidocaine patches worn around-the-clock may be suitable alternative.

Wondering which is more effective for fibromyalgia, trigger point injections or lidocaine patches, and how accurate does the injection have to be for it to work? For answers, read Closing Down Your Pain.

Low-Level Laser Therapy (LLLT)

A focused beam of light in the infrared frequency range is emitted during LLLT to aid the cellular processes beneath the surface. Theoretically, it improves blood flow, increases energy distribution to the tissues, and reduces chemical waste products that irritate nerve endings. Most LLLT trials involve applying the hand-held probe for 1-3 minutes to each painful area, usually over MTPs.^6,7

The fibromyalgia studies vary in the number and frequency of treatments. Some trials performed LLLT daily (except weekends) for two weeks, while others gave treatments three times per week for 3-8 weeks. Overall pain levels, number of pain sites, fatigue, physical function, and morning stiffness often improved. But what are the odds that you will respond to this therapy? The answer is unknown. However, more intense sessions applied to the MTPs provided the best muscle pain relief in fibromyalgia patients.

The downside of LLLT is cost, but the upside is lack of side effects. Physical therapists and chiropractors are the two specialists who offer this therapy and insurance usually doesn’t cover it. One more point: the inexpensive devices advertised on the Internet are a waste of money. The truly effective machines cost $20,000 to $40,000.

Topical Ointments & Patches

Topicals containing lidocaine or aspirin often help soothe sore muscles. Menthol is another analgesic. Although you may not like the odor, it initially provides a cool feeling, followed by warmth to relax the muscles. The most cost-effective topical is Bengay Ultra Strength with 30% aspirin and 10% menthol at $1.30 per ounce.

Topicals containing lidocaine or aspirin often provide soothing pain relief to sore fibromyalgia muscles. Menthol is another analgesic. Although you may not like the odor, it initially provides a cool feeling, followed by warmth to relax the muscles. The most cost-effective topical is Bengay Ultra Strength with 30% aspirin and 10% menthol at $1.30 per ounce.

Fibro Muscle Pain Relief Tips

Heat wraps and warm water help relax muscles, improve circulation, and reduce the impact of MTPs. Use heat before and after therapy sessions. Alternate with ice after trigger point injections with a syringe. Gently massaging the area after treatment and drinking lots of water helps flush out the chemicals from the MTPs so they don’t irritate the nearby nerve endings. Minimize over-straining recently treated muscles; they need time to recover. For a comprehensive treatment program, see Managing Fibromyalgia Pain.

Do It Yourself MTP Help

Treating your MTPs is essential for getting your fibromyalgia muscle pain under control. Even if your town has skilled experts in this area, relying solely upon a therapist is costly and time-consuming. The best approach is to know how to treat most MTPs yourself and rely upon your healthcare providers to handle the stubborn ones.

Identifying & Treating MTPs is a must-read article for all fibromyalgia patients. It will teach you what to look for when you self-examine your muscles for MTPs and then how to apply self-help techniques to treat them.

Fibromyalgia Headaches … treatments to ease pain – This article illustrates the key MTPs that cause headaches and shows where to press to deactivate them.  It addresses research and treatments for both tension-type headaches and migraines.

Tender Points are Mostly MTPs – See the last section of the article, Spotlight on Back Pain.

Check back for links to the following articles offering “how-to” help with diagrams on treating MTPs in specific body regions:

• Painful MTPs in the Chest & Abdominal Regions
• Pelvic Pain & MTPs
• Pain Around the Hips & Buttocks
• Treating Heel & Calf Pain

A series of self-help articles have been prepared for fibromyalgia patients with the guidance of Ken Lamm, P.T., an experienced physical therapist in Tucson, Arizona. Check back for article postings.

References for Fibro Muscle Pain Relief

1. Ge HY, et al. J Pain 11(7):644-51, 2010.  Free Report
2. Affaitati G, at al. Eur J Pain 15:61-9, 2011. Abstract
3. Vakera-Calero JA, et al. Int J Environ Res Public Health 19:9904, 2022. Free Report
4. Castro-Sanchez AM, et al. Acupunct Med 38(3):140-149, 2020. Abstract
5. Audoux CR, et al., Int J Environ Res Public Health 20:1061, 2023. Free Report
6. Gur A, et al. Rheumatol Int 22(5):188-93, 2002. Abstract
7. Yeh SW, at al. Pain Physician 22:241-254, 2019. Free Report