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Adrienne Dellwo

Fibromyalgia Pain Type: Hyperalgesia

By September 3, 2009

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The term "fibromyalgia pain" is really a gross oversimplification; we have many different types of pain, and it's my opinion that we won't ever have effective pain treatments unless researchers start treating different types of pain as, well, different.

The most common kind of fibromyalgia pain, and the best researched, is hyperalgesia. "Hyper" means excess and "algesia" means pain. Hyperalgesia is the medical term for pain amplification in FMS. Our brains appear to take normal pain signals and "turn up the volume," making them more severe than they would normally be. That appears to happen through a complex process involving high levels of brain activity in the pain centers, not enough serotonin, and too much glutamate.

The important thing to remember about hyperalgesia is that it doesn't directly cause pain, it makes existing pain worse. If you have arthritis, myofascial pain syndrome, or other sources of chronic pain, it's important to treat those conditions aggressively. That gives your brain less to amplify, and can often quiet down your other symptoms as well.

This is just my opinion, but I think this is why some of us get relief from opiates/narcotics and anti-inflammatories. If those drugs work on your underlying pain condition, they help lower your fibro pain. If fibromyalgia is your only source of chronic pain, those drugs are less likely to work for you. This could help explain why studies show opiates and NSAIDS are ineffective for us -- they only do research on people without other pain conditions.

What fuels your hyperalgesia? Have you been able to treat it? What has helped, and what hasn't? Leave your comments below!

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Photo © Adam Crowley/Getty Images

September 3, 2009 at 12:35 pm
(1) Jenn says:

Very interesting post, particularly about how the research works. I never thought about how they only use those of us without underlying conditions. This post gave me a new outlook! Thanks =)


September 3, 2009 at 12:56 pm
(2) Jessica says:

I’m glad you brought this subject to everyone’s attention. A lot of people with Fibromyalgia tend to take opioids to relieve the pain, and end up with opioid-induced hyperalgesia. I wrote about in my own blog here.

September 3, 2009 at 2:02 pm
(3) Elizabeth Paine says:

Interesting article. I have had FM/CMFP/CFS for more than 20 years and have never found anything that helps. I have often wondered if fibromyalgics experience pain differently, perhaps we “experience” pain meds differently, too! I was prescribed way too many NSAIDS for a number of years, and they damaged my kidneys, to I can no longer look there for any relief. And now I’ve had no insurance for almost 3 years so can get virtually no health care at all.

September 3, 2009 at 6:08 pm
(4) Nancy A. says:

I’ve had fibromyalgia for 23 years. I take Lyrica and Tylenol every day. I’m also on Topamax which helps prevent migraines, since I’ve also had that problem for many years too. My pain is under control most of the time. I find that the only thing that will cause a severe flareup of my pain and fatigue is just overdoing things and not getting enough sleep. I rarely let this happen to me anymore since the suffering is just not worth it. I’m on Social Security Disability now, so I am able to rest during the day when I need to. I do miss having a life, though. I do miss being able to have a normal social life and being able to keep up with my family and former friends. But taking care of myself has to come first now. I just can’t let myself suffer those horrible fibro flareups anymore. No more guilt (especially with the holiday season not too far away).

September 6, 2009 at 6:42 pm
(5) Kimberly .N. says:

I find this an interesting post also. I also take lyrica, cannot take NSAIDS any more due to an adverse reaction. My underlying condition being Complex Regional Pain Syndrome, I find the Lyrica realy helps withthe nerve pain, i also wear a durogesic patch for the FM which helps when i also have enough rest and sleep, the pain definately flairs up more when i overdo things, which is often (because i am a single mum of 3 kids), until i rest and take it easy. Some days i wonder if the patch is evenw orth wearing, as it seems ineffective at times and leaves me little control of dosage and side effects. If im having a good day and resting i dont feel i need the patch, if im doing anything or am stressed the patch doesnt seem to work. I wish there was more research done on patients with multiple problems as im sure the differences in pain would be easily recognised and treated with much more precision.
I too am on a disability pension, which helps me manage my time, but i find it nearly impossible to stay financially on top of things, which probably also flairs up pain due to stress.

September 7, 2009 at 10:16 am
(6) Tracy says:

I was diagnosed with fibromyalgia 4 years ago at the same time I found out that my thyroid had quit working (the two do seem to go together frequently). I take Cymbalta but at 40mgs rather than 60mg since 60 makes me shaky. But the 40 does seem to help. Started Topomax 6 months ago, seemed to help at first, now I’m not so sure. But more than anything, mild exercise does the most good! Of course, its incredibly hard some days to get up and move when you feel so tired and hurt, but it really makes more difference for me than anything else. I recently started walking dogs at our local animal shelter and I’m getting a lot out of that…the exercise and the pleasure of helping the dogs. I highly recommend it! Of course, not overdoing it is really important, and that can be just as hard. I also take flexeril as needed but I’ve used that for years because I have scoliosis. Anyway, walking the dogs has been a big help for me and the people at the shelter have been really good about not giving me an animal that will be too strong for me.

October 1, 2009 at 11:26 pm
(7) Sally says:

Thanks for this explanation about the pain caused by FM. I managed to get rid of my chronic fatigue by going gluten and dairy free and I have found that careful scrutiny of my diet keeps the pain at bay. Tomatoes and citrus fruits are an absolute no-no! To eat a tomato one day, is to spend the next day in bed with the pain. I take no medications at all. Food intolerances can play a big part in many conditions of the auto-immune system so it’s not a bad idea looking into the possibilities of those being behind FM and thyroid problems.

December 30, 2009 at 5:00 pm
(8) Carol says:

Any one who’s been diagnosed with fibromyalgia should look into chronic Lyme and also, more importantly, electromagnetic hypersensitivity (otherwise known as microwave sickness, electrical sensitivity, electrosensitivity). My fibro was caused by area cell phone and wifi towers.

February 5, 2010 at 4:45 pm
(9) Melissa says:

I am having a difficult time controlling my fibro pain lately. I usually have it under control with moderate activity, daily dose of Eleuthero (siberian ginseng) and occasional NSAIDS. But lately the widespread pain and pain on the top of my skull is unmanageable. I don’t like to take pharmaceuticals. I much prefer natural remedies first and if that fails then turn to my doctor. So does anyone have any natural remedies I can try for pain management or a website to check out?

February 8, 2010 at 5:01 pm
(10) Adrienne Dellwo says:


A couple of things — first, I’ve read that adaptogens (like Eleuthero) sometimes become less effective after awhile and that it can help to rotate through 2 or more similar ones now and then. If you’re interested in trying something in place of the ginseng, rhodiola rosea is similar and has worked wonders for me.

Also, about the pain on the top of your head: do you have really painful spots on the side of your neck? You might have myofascial trigger points there, as they can cause referred pain on the top of the skull. Try icing the sides of your neck and see if it helps. You might also try acupuncture, if you do have active trigger points there.

Hope this helps!

February 27, 2013 at 4:05 pm
(11) shelly says:

hyperalgesia: I just read about this after leaving a question about my diagnosis and pain. I would like to explain in better detail my situation and ask if hyperalgesia is what is occurring. About 7 years ago I was misdiagnosed with fibromyalgia. Months later I diagnosed other symptoms that led to Dystonia. After being treated for dystonia for years I was still having terrible pain that I knew was unrelated to the dystonia but could not get the neurologist to order an MRI because he insisted was the Dystonia. Years later after I was finally able to get private insurance I went out on my own and had an MRI done which showed a torn/compressed disc. I am on 30 mg of morphine twice a day and 15 mg of oxycodone up to 4 times a day. It keeps me relatively comfortable as long as I keep my activity light. However, if I forget to make a dr appt in time to refill my meds before they run out, within 5-6 hours of running out of morphine I’m in a delirious almost incoherent pain and usually end up in the ER. Any type of touch to any part of my body has me in even more agonizing pain. My Dr just said it goes with the torn disc but this just doesn’t sound right. Is a torn disc that damaging? He also said it was inoperable. Do I have any other options in dealing with this?

September 29, 2013 at 7:53 pm
(12) Alina Yoshimura says:

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