Pain in Chronic Fatigue Syndrome can come in the form of burning muscle pain after exertion or chronic burning pain and skin sensitivity known as fibromyalgia. Many people have both CFS and its “sister,” FM.
Chronic Fatigue Syndrome: A Treatment Guide theorizes that this pain is generated mostly in the brain and spinal cord. In addition, experts like Dr. Martin Pall believe that the inflammatory process in CFS causes proteins called cytokines to bind to opioid receptors, reducing the ability of endorphins to keep pain in check. (R)
This (still very long) post isn’t an attempt to cover every common treatment for pain, but only those that have some support for use specifically in CFS/FM.
This article is now a video series on Youtube:
Table of Contents
Over-the-Counter (OTC) Painkillers
Acetaminophen
Branded as Tylenol in the US, acetaminophen is the best over-the-counter painkiller I’ve found for treating my post-exertional malaise.
Acetaminophen is not safe to use at the upper dose limit for long periods of time; read more here.
NSAIDs
NSAIDs, or non-steroidal anti-inflammatory drugs, include aspirin, ibuprofen and naproxen, and their general anti-inflammatory mechanisms (R) should be useful in treating CFS pain.
The downside of NSAIDs is that they cause leaky gut (R1, R2), a condition which allows food particles and toxins to pass from the intestines to the bloodstream, where they trigger inflammation. (R)
They can also cause ulcers, bleeding, and heart problems. (R)
Gabinergics
Gabinergics are substances that raise GABA, your nervous system’s primary calming neurotransmitter. Essentially, GABA reduces transmission in the brain and nerves, which has a calming effect.
Gabinergics, in my experience, are soothing, blunt pain, and can cause (different degrees of) giddyness. They’re a great complement to OTC painkillers.
Gabapentin and Pregabalin
Gabapentin and pregabalin are the primary drugs used to treat chronic fibromyalgia.
They took me from nearly crying from the pain at being lightly touched to, well, pretty much normal.
You only need to be on one drug or the other. In my experience they are frequently/easily prescribed by doctors.
Lithium Oratate
Lithium oratate is a mineral available in supplement form related to the pharmaceutical lithium.
Daily doses can range from 1-8 caps. As with all gabinergics, too high a dose will produce a state similar to drunkenness, including giddyness and some generally mild discoordination. Start low and go slow, seeing what dose works best to blunt the pain without impairing you.
I’ve found that lithium oratate plus acetaminophen is a very effective cocktail in reducing pain from post-exertional malaise.
Theanine, Scullcap, and Kava-Kava
The amino acid theanine and the herbs scullcap and kava-kava also increase GABA, though I’ve not found them to be as effective in treating pain as lithium oratate.
Kava-kava can be effective at high doses (3-4 bags of this tea), but because it carries mold many are sensitive to it and should not be using it on a regular basis. Mold sensitivity can also be paradoxically stimulating, rather than relaxing.
Theanine is part of my sleep stack and has wide ranges in dosing, so experimenting with it may show it to be effective in treating pain for you. Doses range from 50-800mg/day and it is very cheap when bought as powder in bulk.
Benzodiazepenes
Benzos like Xanax (alprazolam), Klonopin (clonazepam) and Valium (diazepam) also work with GABA and are effective in blunting pain, in my experience.
If you’re working with a doctor sympathetic to CFSers they may be open to prescribing a slower-acting benzo like Klonopin or Valium either to try to increase energy or for insomnia. Even if you take a dose at night, slower-acting benzos will stay in your system at least partly into the next day.
If you’re interested in learning more about the complex ways in which benzos benefit CFSers, here’s my post on the subject.
Nutritional Therapies
Malic acid, magnesium and omega-3 fatty acids are all recommended for treating pain in Chronic Fatigue Syndrome and Fibromyalgia. (R)
Magnesium
A supplement containing malic acid and magnesium reduced pain and tenderness in fibromyalgia patients at high enough doses (up to 1200mg of malic acid and 300mg of magnesium daily) over a period of six months. (R)
Some studies show that magnesium decreases the perception of pain by acting on NMDA receptors in the nervous system, (R1, R2, R3), while another found it was no different from placebo. (R)
Magnesium significantly relieved tender points and depression in fibromyalgia patients, especially when combined with the antidepressant amitriptyline. Interestingly, the lower the patients’ magnesium levels were, the worse their symptoms. (R1, R2)
A small study of CFS patients found that magnesium reduced their pain as well. (R)
IV magnesium aided in the reduction of stubborn nervous pain in cancer patients. (R)
If oxidative stress, including stimulation of NMDA receptors and release of nitric oxide (NO), are indeed behind CFS pain, as has been proposed, (R) then other treatments that should impede this mechanism include hydroxycobalamin (a form of vitamin B12) and 5-MTHF, a form of the B vitamin folate. (R)
Omega-3 Fatty Acids
In people with chronic pain, those with a higher Omega 6: Omega 3 ratio in their diet had more pain and were more impaired. (R)
CFSers have a higher Omega 6:Omega 3 ratio than the general population, and the higher the ratio, the more pain and fatigue they experience and the more impaired they are. (R)
One study concluded that the severity of illness in CFS is linked to oxidative stress pathways, and that omega-3s are one of a number of treatments that should help rout them. (R)
A study of delayed-onset muscle soreness found that omega-3s reduced pain 48 hours after exertion. (R)
High-dose omega-3s healed damaged nerves and reduced neuropathy in animals (R) and improved neuropathic pain in a small human trial that included an FM patient. (R)
Omega-3s may be as effective as NSAIDs in treating pain. (R)
A meta-study of inflammatory joint pain found omega-3s reduce NSAID use, joint pain, and morning stiffness. (R)
Studies generally use daily doses in the 1200mg-7200mg range. Animal sources (eg, fatty fish) may be superior to plant sources. (R1, R2)
Vitamin E
Vitamin E, an antioxidant which protects cell walls from oxidative damage (R), has been found to be low in those with CFS, (R) with one study finding that the lower vitamin E was, the more muscle pain. (R)
1600mg of vitamin E daily for six months was effective in reducing shingles pain, known as neuralgia. (R) As a fat-soluble nutrient (ie, that builds in the body), high doses like that generally aren’t advised; Chronic Fatigue Syndrome: A Treatment Guide suggests 200mg a day.
Etc.
Several studies have found that the antioxidant alpha lipoic acid improves neuropathic pain in diabetics; (R) one discovered that the same population has low vitamin B6 levels. (R)
There is also support for Acetyl-l carnitine (R) and N-acetylcysteine (R) in treating neuropathic pain.
Earthing
Earthing, AKA grouding, is the practice of having the skin in contact with the earth. You can also achieve benefits by walking on earth with leather-soled shoes (since they’re conductive) or using earthing/grounding pads, sheets, and other indoor products.
Grounding’s wide-ranging benefits are due to the earth’s electrical conductance. Grounding provides your body with electrons that bind to free radicals, or substances responsible for oxidative inflammation, to neutralize them. (R)
Several studies and case studies testing the effects of using grounding products while sleeping have reported reducing pain and improving sleep quality, (R1, R2, R3) while one study on the phenomenon of delayed-onset muscle soreness found that grounding overnight lowered both inflammation and pain and shortened recovery times. (R)
Heat and Cold
Heat and cold are both useful therapeutically for general muscle and joint pain.
There’s debate as to which is superior for muscle recovery, but ultimately this is an area where you should experiment.
Heat Therapy
It goes without saying that hot baths are very soothing; try adding some relaxing essential oil, like lavender or jasmine.
If you opt to use a sauna, an added bonus is that you’ll sweat out toxins, including those from mold or bacteria.
If you’re open to trying a sauna, rent a session at a local sauna (ie, at a gym, spa or hotel) to see if you like it. Buying a home sauna can cost under $100 (look for ones that look like tents or sleeping bags; you don’t need a fancy wooden room).
I recommend spending slightly extra for a sauna with infrared, as you’ll sweat at lower temperatures and it’s actually anti-inflammatory.
Drink plenty of water before, during and after, adding salt if sweating makes you feel faint. Jump in the shower immediately after getting out so you don’t reabsorb the toxins.
Aim to use your sauna at least three times a week for toxin removal.
Cold Therapy
Cold therapy is more stressful than heat to people, (R) but it’s a crucial part of my health regimen.
Short bursts of cold -ie, a cold shower or bath, or letting yourself get cool from climate alone – calm the nervous system and are excellent for reducing pain.
During one summer of especially bad anxiety, soaking in cold baths helped me dramatically.
I like to jump in a cold shower straight from the sauna.
If you’re open to trying cold therapy, keep in mind that most of the discomfort comes from your reaction – ie, clenching muscles, chattering jaw, shrieking. You can consciously relax into it, and within a few seconds you’ll start to feel the benefits of it.
And remember, the aim of cold therapy is only to have goosebumps. You should not be going numb or losing circulation.
Read more about cold therapy here.
Boosting Endorphins
Endorphins are endogenous morphine-like chemicals – ie, your body’s natural painkillers. Increasing levels of them will reduce overall pain levels regardless of whether they were low to begin with.
Exercise
Exercise increases endorphins, and according to Chronic Fatigue Syndrome: A Treatment Guide, it can benefit those with Fibromyalgia, but not CFSers.
Laughter
Laughter – especially laughing with other people – reduces stress and releases endorphins, which increases pain tolerance. (R1, R2, R3, R4)
There are many ways to incorporate laughter into your life, but if you’re mostly stuck at home like me, creating a Youtube playlist of everything you find that makes you laugh is a gift that keeps giving.
Singing
Singing triggers endorphin release and is a great mood-booster. (R1, R2) It also stimulates the vagus nerve, which sends signals for your body to “rest and digest” from your brain down to your body.
I added my favorite songs to sing to a Youtube playlist and will sing for 30 minutes or so.
Acupuncture
Acupuncture has complex beneficial effects on the body’s endorphin system, (R1, R2) and in my experience it can be very useful in treating core CFS symptoms.
There are two caveats, however. First is that the amount of pain you’ll feel varies quite a bit from one practitioner to another, so it’s important to find someone whose technique doesn’t push you past your limits.
The second caveat is that if you’re highly pain-sensitive – ie, if a blood draw or injection is highly stressful or painful for you – acupuncture will likely feel similarly unpleasant.
In the second case, I suggest working with other therapies and trying acupuncture later on.
Qi Gong and Tai Chi, which work off the same energetic principles in Traditional Chinese Medicine, may be good alternatives.
Neural Retraining
Neural retraining program’s like ANS Rewire, The Gupta Program and Dynamic Neural Retraining System give you psychological techniques to desensitize your nervous system over time.
Over a period of weeks or months, you’ll find you’re more relaxed, sleeping better, experiencing less pain, and happier.
I’ve seen improvement in all these areas with Dynamic Neural Retraining System. Read more about my experience with it here.
Alternative Therapies
Meditation appears to improve the emotional response to pain generally and improves quality of life in fibromyalgia. (R)
Mindfulness meditation for patients with CFS, FM, chronic pain and chemical sensitivity results in “coping better with symptoms, improved overall well-being and quality of life, and enhanced health outcomes.” (R)
A study of yoga in fibromyalgia found that it improved stiffness and emotional issues, but not pain. (R)
Biofeedback (tool-assisted meditation) improves pain (R1, R2) and attention and fatigue (R) in fibromyalgia.
Regular massage improved pain, sleep, and quality of life in fibromyalgia in one study. (R)
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