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Adrienne Dellwo

Supplements for Relieving Pain With Fibromyalgia & Chronic Fatigue Syndrome

By September 21, 2009

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Pain management is a big problem for anyone with chronic pain -- medical science just hasn't figured out good was to relieve pain. For those of us with the unique pain types of fibromyalgia (FMS) and chronic fatigue syndrome (CFS or ME/CFS), it's an even bigger problem. That's because many of us are highly prone to side effects, and because some pain killers don't do a lot for us. For those who do have success with pain medications, some days we need more help than they can provide.

These are just some of the reasons many of us turn to nutritional supplements for pain management. If we're lucky, supplements will help us avoid some medications or make us rely less on pain killers. Supplements that can help with pain include:

  • Magnesium and/or Malic Acid: These substances, alone or together as magnesium malate, help reduce muscle pain in some people. They can also boost your energy. More information: Magnesium Malate
  • Vitamin D: Low vitamin D can cause muscle pain and weakness, along with a lot of other symptoms similar to those of FMS and ME/CFS. A lot of us are low in vitamin D, but even those of us with clinically normal levels may feel better when we get more. More information: Vitamin D
  • Serotonin Boosters: One of serotonin's jobs is to regulate pain signals in your brain. Many of us don't have enough of it, and boosting levels can help alleviate pain and other serotonin-related symptoms. (If you're on medication that raises serotonin, talk to your doctor before taking these.) Serotonin-boosting supplements include:

I'm among the lucky ones who've had tremendous success with supplements. The only ones from that list that I don't take are malic acid (because of side effects) and SAM-e (because of the cost.) Along with acupuncture and lifestyle changes, they've helped me avoid antidepressants and cut way back on narcotics.

Have you found supplements that help lower your pain levels? How much difference have they made? Have they replaced medications? Leave a comment below!

Learn more or join the conversation!


Suggested Reading:

Photo © Stockbyte/Getty Images

September 17, 2009 at 3:40 am
(1) Maija Haavisto says:

It’s quite unclear whether L-theanine actually boost serotonin, though it does boost GABA and dopamine. Of the “serotonin boosters” you list only 5-HTP is likely to work by a serotonergic mechanism (well, OK, rhodiola may be an SNRI, but still). This isn’t the first time, by the way, that you list something as a serotonin booster without real evidence of it – in fact you seem to do it pretty often.

The most important supplement for pain is surely DL-phenylalanine, which both increases dopamine levels and slows down the degradation of endogenous opioids, making it work somewhat like low dose naltrexone (and it can also be used to boost LDN).

Guide Note: Please see my reply to this below, which clarifies information given here.

September 21, 2009 at 2:21 pm
(2) Adrienne -- Your Guide to Fibromyalgia & ME/CFS says:


Actually, there’s evidence that all of those boost serotonin, although it’s true that the evidence is split on theanine. Some of those supplements work by a serotonergic mechanism while others work in other ways. The information for the articles linked above is from high-quality scientific sources and went through a rigorous medical review. Sources are listed at the end for your perusal.

DL-phenylalanine does boost the effects of pain killers; however, it’s a nervous system stimulant and most of us need to calm our nervous systems, not stimulate them.

September 17, 2009 at 7:33 am
(3) Michelle Jadaa says:

I take d-ribose for energy,its amazing and no side effects,

September 21, 2009 at 9:38 pm
(4) Vandamir says:

I’ve been taking supplements for just over two months and have seen a measurable decrease in pain (enough so that I could go back to work full-time last week). I’m taking Rhodiola & L-theanine in the morning and Melatonin, 5HTP and a Calcium & Magnesium supplement at night along with LDN and a Chinese herbal blend called Ziziphus 18 to promote sleep and increase Serotonin. I also couldn’t take Malic Acid due to side-effects. At this point the only prescription I’m taking for CFS & FMS is LDN, everything else is supplements or herbs. I did what my medical doctor didn’t think was possible: avoid taking antidepressants and narcotics.

September 25, 2009 at 4:31 pm
(5) wilted says:

If some of the supplements have the same effects (such as increasing the production of serotonin) as the prescribed snri’s do, why don’t they have your undesirable side affects as well? I ask these questions in sincere want of the truth. What is wrong with having the prescribed pain or low dose antidepressant if they help you function throughout the day? Are we not still ‘taking something’? Putting something in the body that is either replacing whats missing or an additive to assist what is broken down .I am not asking about some of the meds that put you in a groggy stupor all day. Does anyone find that the prescription meds taken are much fewer in number of a daily regiment than the supplements that are recommended? Just curious

September 28, 2009 at 3:55 pm
(6) Adrienne -- Your Guide to Fibromyalgia & ME/CFS says:


Very good question about why the supplements don’t have the same side effects as the medications, when they have a similar effect. The reasons are varied, but it can help to understand some basics of brain chemistry and how medications work.

Each neurotransmitter has a variety of roles, and they can work differently in different areas of the brain. Generally, people with neurotransmitter-related illness have low levels only in certain areas of the brain. A good example of this is dopamine — in Parkinson’s, dopamine is low in the movement areas, while in ADD it’s low in attention areas. It’s bad to have either too little or too much of neurotransmitters as well. Sticking with dopamine, extremely high levels are associated with schizophrenia.

So when you take something that raises neurotransmitter levels, it might correct a deficiency in one area, but give you too much in another area. That’s where a lot of side effects likely come from.

Medications raise neurotransmitter levels and change the way your brain works more aggressively than supplements do. The simplest way to think about it is that medications force a change while supplements help your body change. Some supplements directly stimulate neurotransmitter activity (rhodiola rosea), some provide the building blocks of neurotransmitters (SAM-e, 5-HTP), and some help correct the balance of neurotransmitters (theanine, for norepinephrine & dopamine, possibly for serotonin as well), so taking several in conjunction is usually OK (as long as you can tolerate each one.) We all have to experiment to find which ones work best for us, which ones we can tolerate, and also what combinations are best. Personally, I take rhodiola, theanine & 5-HTP every day to get the right balance.

There’s absolutely nothing wrong with prescription pain killers or antidepressants, as long as they work well for you and you can tolerate them. Many of us don’t tolerate them well, don’t have success with them, or need something in addition to them. No matter what we take, yes — they ARE considered drugs in that they change the way our bodies function.

September 25, 2009 at 5:11 pm
(7) Gretchen says:

Thank you for your article on pain & supplements. I have tried so many, and cannot take them. This is very frustrating. Anything with magnesium aggravates my IBS and gives me a tummyache, and my bp meds do a good enough job of that, so I have to avoid everything else that bothers. I did not test low on Vit. D with a 10-vial test Dr. Shaw, my rheumatologist, ran recently. Anything that alters my seratonin increases my headaches, which are my #1 problem – I’ve had frequent migraines since I was 17 (I’m 68 now so that’s long enough!). I take Elavil (only 10 mg., that is all I can tolerate) and I have taken it for 15 yrs. I had good luck with Prozac about 20 yrs. ago, it was the only thing that ever helped my headaches other than narcotic pain relievers, but now when I try to take it, it GIVES me headaches. I guess it is the added effect of the Elavil & 4 bp meds, which I wasn’t taking when I first tried it. I even asked the dr. for the pediatric liquid form so I could take only 2-3 drops/day, and I could notice it. There are many other supplements, but I’ve tried them all. There is a headache dr. in Raleigh N.C. who describes his headache patients, many of them with FM, as canaries in a coal mine — super sensitive. He has it right. (But he was the 1st one to give me Lyrica, before it was even popular or OK’d by the FDA, and my hands & feet swelled.) I always appreciate a dr. who TRIES to help me, but I’m weary of trying. I’m almost ready to give up and settle into my rocking chair. I treasure the times spent with my grandchildren, and my 75 yr. old husband, who has had major surgery 4X including prostate CA, shingles, six stress FX’s in his foot and numerous other ailments in the last 5 yrs., needs me to stay UP — so I try. Our 46 yr. old son-in-law, father of our granddaughters, has been diagnosed with Stage IV colon cancer, so helping out with their family has given me renewed purpose (but NO extra energy!) and I LOVE my Bible Study. I won’t give up on these things, but my 100 African Violets are suffering. Thank you for your good publication, I always read it all hoping to find something helpful. God bless … Gretchen

September 25, 2009 at 10:10 pm
(8) Annie says:

To Gretchen : I’m with you on every thing you said. God Bless you. PTL

September 27, 2009 at 4:56 am
(9) Andrea says:

I’m wondering what BAD Side Effects have any of you Experienced with Malic Acid ????? That’s one I haven’t tried ???

Just wondering~~~ Thanks, Andrea

September 28, 2009 at 4:07 pm
(10) Adrienne -- Your Guide to Fibromyalgia & ME/CFS says:


I don’t do well with malic acid — it upsets my entire GI system and makes things very unpleasant! For those who can tolerate it, though, it work well.

September 28, 2009 at 5:55 pm
(11) Andrea says:

Thanks for the reply & info Adrienne !!
I read up a little more on it last night…… I was getting ready to place my order for the supplements that I take.

I decided to just stick with a Magnesium No Malic Acid…..
Money is tight right now, & I KNOW that the Regular Mag. was helping me out !! Didn’t want to risk it making me ill, I too have GI issues ! Thanks again, Andrea

September 30, 2009 at 1:33 pm
(12) Roisin says:

I’m about to go coo coo I went to see my dr last week and I might as well have went to this web site i would have got more information about my illness than what my dr has for me ,,,,,like he says,,,,, you have severe pain and your on the highest dose of mediacation and there is nothing more we can do no mention of see a artritis specialist , or seeing a neurlogist ( that is probably spelt wrong) I have had severe pain for too many years
I do have irritable bowel, and depression which i take st.johns wort I too myself off the anti depresants as I was a zombie
lifting a mug of tea the kettle all these things make my pain worse it the movement of my arms makes the pain worse
Then when I sleep and this is only with a sleeping tablet my hands are so swollen in the morning its so painful to get my tablets out of that packaging which anyone with pains finds so terrable painful
But I was keeping going i’m looking after a elderly relative who is 89yrs and doesnt have pain or ake and i’m coming 60yr and every thing i do for her is in agony I cant keep this up but no one else is going to do for her the way i look after her and her home I have my own to do also yes i have children but they are useless they cant see my pain and dont understand at all for i look great though i say it myself i still have my dark hair well a noad grey one here and there i oftern say where is my gray hair i have EARNED IT WITH ALL THE PAIN I HAVE HAD OVER THE YEARS
God my back is crippling me after all this typing
the dr has me on Lyrica and tramidol 2 three times day oh then there is the gout, and disyness and the rest
anyway i have probably bored whoever is reading this but thanks for being their you know people in wheel chairs get so much sympithy , and yet we have a hidden disablity and people think we are pulling fast one i wish they could be in my shoes for one day i would like to hear what they had to say then oh my god i’m so dun inn

October 28, 2009 at 12:54 pm
(13) Dan says:

I have tried everything for the head pain associated with CFS. Nothing works 100%, except with time it goes away (usually after 3 months when a flare up occurs). Eating right and exercise helps raise serotonin levels and helps somewhat temporarily, as does Vicodin or Darvocet, but don’t abuse them. Wasting money on all those additional supplements does not help, I know from years of experience. Eat a good diet with lots of fruits and vegetables, and a lot less sugar and junk foods, and avoid alcohol. Excercise as much as you can. When my CFS flares up the type of headaches are awful, horrible, but with time they do go away for a long time, until the unfortunate next relapse.

November 8, 2009 at 9:47 pm
(14) Laura says:

Would anyone take dl phenylalanine for Chronic pain (fibromyalgia and arthritis)?

November 12, 2009 at 7:19 am
(15) Dahlia says:

I recently saw a chiropractor for low back problems. He suggested I start taking bromelain/turmeric for inflammation and glucosamine sulfate to help with my bones.

I’d been taking glucosamine/chondroitin for years and really didn’t notice anything. We’ll see if the sulfate kind helps.

As for the bromelain/turmeric combination, if I took it 3 times a day, I did notice a lessening of my pain. It worked almost as much as my pain meds (Ultracet & Ibuprofen).

March 17, 2010 at 5:45 pm
(16) Bryce says:

-D,L-phenylalanine is actually a mix of D-phenylalanine, a chemical that blocks an enzyme (enkephalinase) that breaks down a certain endorphin, and L-phenylalanine, which is an early precursor to norepinepherine and dopamine (it has to be converted to L-tyrosine first).

The reason it’s sold like this is because when it’s chemically manufactured, both are made at the same time — it’s harder and probably more expensive to separate the two chemicals out. It can have some stimulant effect in certain people, BUT it is unique as being the only readily available chemical that boosts your own endogenous opiate (endorphin) system. It’s also dirt cheap if you get it from the right supplier or as bulk powder and I would argue that it’s worth trying for most FM patients.

Other interesting chemicals include D-ribose, COQ10, creatine and some vitamin B derivatives (e.g. B1 –> sulbutiamine, B6 –> pyritinol, B12 –> methylcobalamin). 5-LOXin is an interesting antiinflammatory supplement that may serve as a good replacement for Advil, etc. for those who have difficulty tolerating NSAIDS; circumin has interesting antiinlammatory properties as well.

TENS units are technically medical devices but are often grouped into complementary/alternative medicine. Same with myofascial trigger point injections, where a trained physician puts a needle directly into trigger points to release them, then injects a small amount of lidocaine to reduce residual pain and somewhat speed recovery.

@Migraine sufferers in particular (such as the earlier commenter): try high dose riboflavin (B2). Dirt cheap even in capsule form from iHerb (probably other sites, that’s just where I get mine from). 400 mg/day has a demonstrable positive prophylactic effect against migraine. Not useful for acute treatment though.

There are plenty others, but I thought it was important to mention these since this result comes up so high on Google. Good luck!

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