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Adrienne Dellwo

Exercise Pain in Chronic Fatigue Syndrome/Fibromyalgia vs. Rheumatoid Arthritis

By February 19, 2014

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Research Brief

New research demonstrates the negative pain-related impact of exercise on some people with chronic fatigue syndrome (ME/CFS) and comorbid fibromyalgia (FMS) and suggests that drug treatments may help lessen the effects in some cases.

Please note: this study looked at the pain response to exercise, not the full breadth of exercise-induced symptoms that are common in ME/CFS. Myriad studies have examined post-exertional malaise, which is the symptom flare following activity, and have demonstrated multiple abnormal physiological reactions to exercise. The intent of this study was to compare two chronic pain populations to see how they differ.

Researchers had a group of women with ME/CFS/FMS, a group of women with rheumatoid arthritis (RA,) and a group of healthy women exercise on a bicycle and looked at several measures of pain before and after the sessions. Half of them received a placebo while the others were given the pain drug paracetamol.

Exertion levels were below maximums and exercise sessions were a full week apart.

Their analysis showed:

  • The RA group had reductions in pain after exercise, both with the drug and with the placebo;
  • In the ME/CFS/FMS placebo group, some measures showed worsening pain while other measures were in conclusive but seemed to indicate worsening;
  • In the ME/CFS/FMS paracetamol group, some people had a decrease in pain measurements, but the decrease was not significant.

By comparing two chronic pain populations, researchers are able to show that the different response between the ME/CFS/FMS group and healthy controls are not merely due to the presence of chronic pain.

This was a fairly small study, but it and any further research it spawns could add to our understanding of this hallmark symptom of ME/CFS. (My assumption is that they included people who also had FMS because not all cases of ME/CFS involve significant pain.)

Also, it shows that medication may be able to help alleviate exercise-induced pain, at least in some. (However, paracetamol results in this study were not terribly impressive.)

What does exercise do to your pain levels? Do you have ME/CFS alone or with FMS? Does anything help your post-exertion pain? Leave your comments below!


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February 20, 2014 at 2:16 am
(1) Lorraine says:

It’s true…in my 30s I did a lot of aerobic exercising…I was always very fatigued after… This was in the 90′s..doctors had no idea why.. Over the years I’ve stayed active..played tennis and now do yoga and Pilates. I’m not so fatigued after yoga and Pilates but my muscles are very sore and painful. If I do too much I DO get fatigued. Last year I was diagnosed with fibromyalgia . I try to take things easier now and listen to my body.

February 20, 2014 at 9:18 am
(2) Colleen says:

I am still in a diagnostic process…. for among other things various autoimmune diseases one of which is RA. Ironically, I went to a lumbar spine physical therapy class this morning before I read this. I had noted pain, (not normal, post exercise pain – but PAIN) after the class. No one has mentioned FMS, so I wonder if that is a possibility.

February 20, 2014 at 11:22 am
(3) shakota says:

After 15 years of fibro and getting older, my exercise capability had become almost nil. Doing a few ballet leg lifts resulted in a level 9 (out of a possible 10) pain.

But for some reason, don’t know why, I’ve been able to withstand 30-40 minutes of almost daily brisk walking with intermittent jogging, ice skating and ballet leg lifts.

My trapezius and neck muscles have always been super sensitive to any weight or lifting. But now when they are sore I tell myself that I’ve been de-conditioned and that they will become stronger.

For daily pain, I take hot baths, very small doses of a combination of methadone and baclofen, self-massage with a bengay-type cream mixed with a lotion, hot packs, ice packs.

I’m determined to get more fit.

February 20, 2014 at 12:36 pm
(4) leorising says:

Paracetamol = British name for Tylenol, FYI. No, not an impressive treatment for our pain! :D

February 21, 2014 at 3:18 pm
(5) Elize says:

I have FMS/CFS/RA and Polyneuropathy in sytemic connective tissue. I am just really having a hard time with any excercise. Somedays even sitting on a chair is a big problem. Walking would be nice but then my ankles just gives way.

February 21, 2014 at 3:22 pm
(6) catherine says:

I practice a martial art called Iaido. It’s swinging a sword basically I have had to adjust my practice because of FM by using a lighter sword and taking breaks. Too much over the head lifting means I suffer for about two days after a 2 hour class. Really, brisk walking is the best for me and with the least flareup afterwards. What is odd is if I limit my Iaido practice it actually seems to help! Knowing that time is the problem……I do the usual. I take magnesium citrate before exercise and Tylenol.

What I’ve also noticed is my “startle reflex” becomes exaggerated when I have a flair up after too much exercise. Almost like PTSD……Adreneline surges.

February 21, 2014 at 3:59 pm
(7) Sandy says:

For me a gentle yoga class offered by my local Iyengar teacher has been the best thing. If I try to advance to other levels, I usually get too sore and wiped out. On hour several times a week works the best.

They do a very low level of yoga that focuses on the back and hips to help with strength and balance. It made a world of difference with falling problems.

I will be having a fusion of 4 vertebrae soon. I am not looking forward to the long and painful recovery but plan to do those parts of yoga that won’t stress my surgical area. It will hopefully speed the recovery process.

February 21, 2014 at 4:31 pm
(8) Jo Anna says:

I’ve just begun an 8 – form Tai Chi class especially for helping increase balance in the elderly and disabled, It can be done standing, sitting or using the chair for balance. After my first class, I was notedly better balanced, for the rest of the day! I’ll let you know how I am after the 6 weeks are up.

February 21, 2014 at 4:35 pm
(9) Lynn Staples says:

I take paracetamol and tramadol on a regular basis, and I’m still in pain all the time. If I do more than I normally do (not a great deal these days) my pain totally goes out of control. I do armchair exercises and I do still walk around shops etc, however I am purchasing a scooter soon so I can go for days out, at the moment if I do travel anywhere I don’t enjoy it as I know I cannot walk very far when I get there.

February 21, 2014 at 4:39 pm
(10) lee says:

regular gentle yoga is killing me…just started recently and might have to stop….;(
in some ways feels good but for the most part, body totally inflamed

February 21, 2014 at 4:44 pm
(11) Rose says:

I have a question and don’t know where else to ask it. I want to know if Yoga and Tai Chi, etc. use Middle Eastern Meditation? I won’t say why I’m asking, because it might not be acceptable for this site. Anyway, Is there such a thing as those practices being done free from any type of meditation…just for physical benefits? I sure would like to know the answers to these questions. Also, do they really help fibroites?
Thank you.

February 21, 2014 at 5:11 pm
(12) Sandy says:

All the professionals say you have to exercise. I know that isn’t going to be bad. While I am exercising I don’t feel too bad. But I know in 2 days it is going to bad. PAIN everywhere. Lucky me I have FMS, rheumatoid, and osteoarthritis. My flare will last from 2-5 days. Sometimes it just hurts to breathe and the pain is all the way down to the bone. Other times it might be sore muscle pain that just doesn’t seem to ease up. And the fatigue. I am to worn out to take a shower or get up in the morning. Days like that I try to get up around noon. I have something to eat try to straighten up and then back to bed until it is time to fix dinner. Was the med before exercise and increase in regular med or something different”

February 21, 2014 at 5:28 pm
(13) anne says:

does anyone use vicodin for cfids pain?

February 21, 2014 at 5:42 pm
(14) MELANIE Coffey says:

I went to water aerobics for arthritis and fibro patients 5 yrs. I always kept up sith teacher. 2 yrs ago I started noticing that when I dressed after class very fatique. Then it got to where I would leave class early. I had to stop last year because I hurt si joint. I go and just walk in pool now.But no matter what protien I eat before and after I am very fatique. I am down rest of day. I read it was post exsertion.i also cannot walk over a walmart or big store. I was looking for a friend a b day present and went from store to store looking plus had pt that day. I way over did it.

February 21, 2014 at 7:00 pm
(15) Adele Tyhurst says:

I have much less pain and sleep better if I do mild aerobic exercise at least 4 to 5 times a week. The important thing is to start with a short time like 10 minutes and gradually increase your time. Don’t try to keep up with people don’t have FM. I suggest starting out walking. Don’t try to use heavy weights. I use only 1 and 2 pound weights and never exercise hard enough to get sore muscles. No pain no gain is not good for us. I would never try to take an exercise class with “normal” people or with a trainer or class leader who does not have training working with people who have FM. I think we need to keep it gentle and not tire youself out but do it frequently.

February 21, 2014 at 9:12 pm
(16) Pained says:

Have done Tai Chi for more than five years and find it has helped, as has warm water exercise. Tai Chi is called “moving meditation.” Unsure why anyone would find basic meditation in and of itself offputting since it has no religious content, instead it’s a calming and centering of the mind which has been proven to help relax the body and help alleviate pain. Multiple studies have shown benefit from both meditation and Tai Chi and the Arthritis Association has a Tai Chi program available on its website. No matter how poorly I feel before Tai Chi, always improved after an hour. I feel tired after the warm water workout and achey that night but the longer I go without exercising, the worse my overall pain levels are. (Diagnosed with fibro and arthritis.)

February 22, 2014 at 10:52 am
(17) Ed Corrin says:

I have had what I thought to be Fibromyalgia for 4 1/2 years and take 100mg Tramadol and 1,000 Acetaminophen 3 x/d, which keeps the pain down pretty well. However, I recently had an MRI which showed an enlarged Thyroid. I then had an ultrasound which showed that I have bilateral nodules on my thyroid which I am to have aspirated next week. In the meantime, I have been researching all the thyroid diseases and found that Hypothyroidism has many of the same symptoms as Fibromyalgia. Has anyone ever been misdiagnosed of one for the other?

February 22, 2014 at 11:12 am
(18) Rose Venosa says:

In the last 4 years since I started with severe Fibromyalgia after some sort of virus, I have gained 20 lbs due to lack of exercise. I have become a different person and lead a totally different life now. I was a person who was always moving and dancing and ready for anything. Now, I try walking with my neighbor and it’s not too bad while I’m walking but then right after showering and the rest of the night and for about 2 days afterward, I am done. Useless. I could not believe this was like a punishment for exercising! After several Doctors and well-meaning friends telling me how I just need to “get over the hump” and after a few weeks I should be better. Well, there is no guarantee of that and I can not afford to be knocked back to the point of hardly getting out of bed for days at a time. I have enough trouble just trying to get through the day. It’s a shame some must see my weight gain as my being lazy but the truth is I just don’t move very much and the metabolism is shot. I wish I could go back to who I was but at this point I’m just trying to accept what has happened to me and make the best of it.

February 22, 2014 at 12:51 pm
(19) CT Yankee in the UK says:

I have ME and FM. Paracetamol does not work for me but ibuprofen does. I also find arnica cream or wintergreen oil mixed with a massage oil very effective after exercise.

I do exercise regularly but at my own pace: walking and Pilates are best for me. When the weather is milder and drier I cycle very short distances but not more than twice a week and never two days in a row as it wipes me out. I am thinking of trying swimming again (start with 10-15 mins) and seeing how strenuous it feels. Has anyone else had success with swimming as a form of exercise for ME / FM?

Re Rose’s question: Pilates is similar to yoga but without meditation.

February 22, 2014 at 1:19 pm
(20) barb quester says:

i’ve had cfs/fm for 20 years now. i notice a lot of pain and fatigue when i do the laundry every week. i am exhausted the next day.
i have OA in many places — neck, lower back, both wrists, right knee, ankles — and doing a lot of stairs (i have a two story house) does me in.
i take hydro and tylenol and they seem to keep my pain abated. but the exhaustion doesn’t seem to go away.
also i think the sun has some effect in the summer because some of my meds are sun sensitive.

so much to keep track of!

February 22, 2014 at 1:51 pm
(21) Dianne Bunn says:

I could not do any exercise at all for years without sending myself into a flare. My doctor recommended getting into warm water exercise but I live in a small town and our pool is kept for competitive swimming and definitely too cold for me! So. this fall I took up Tai Chi. It’s the best thing I could ever have done and my doctor at the pain clinic agrees. It’s slow and quite complicated ( I can’t remember the moves on my own) So I downloaded 3 videos from You tube. It’s great for circulation and stretching. Once you pay the membership to the International Tai Chi Organization you attend class for free anywhere in the world! I love it! It gets me out and moving and I have made some new friends. It’s not just for old folks and you can do it in a chair if you have to which is what I will have to do for a while since I just had knee surgery. I also have arthritis and sjogren’s syndrome. It has also helped me stay more positive because I am finally moving and doing something for me!

February 23, 2014 at 2:57 am
(22) JulieB says:

Thank God, at last some research to show to all those people who insist I’ll have less pain after exercise.

February 23, 2014 at 3:21 pm
(23) Budie says:

In reply to Ed Corrin, I have both hypothyroidism and Fibro and yes the symptoms are very similar. Mary Shomon (from About) has a good book on hypothyroidism called “Living Well With Hypothyroidism”. Most of the time I don’t know what I am dealing with. Mine is from thyroid cancer. I don’t feel I have ever been on the right meds for it; but the “doctors always know best”? Right!!

February 24, 2014 at 7:33 am
(24) KR says:

I have RA. I’ve cycled for over twenty years and raced for fifteen. Last year when I was diagnosed I could barely walk. Now I’m on Embrel and methotrexate. Went away in January for a month to Thailand and cycled hard 50-80 miles a day, about five times a week. Felt FANTASTIC. most of my pain vanished. Now I’m back home and less active, starting to feel it again. The answer for me isn’t just exercise, it’s hard exercise.

February 24, 2014 at 12:43 pm
(25) Krissy says:

Yes, exercise is good to keep in shape, but not to do it so that it hurts you. I have RA, FM, CFS/ME and have for 30 years. At my age a lot of problems have occurred and I am now on 8 oxy’s per day just go walk. One has to just do what feels best for exercise — whatever works, do it! Another subject: I’d like to see these pain clinics go away as doctors make their money “re-diagnosing” people in a 10-minute interview with NO testing. I have quit 3 pain clinics and will never go to one again. I have degenerative disc disease and a completely worn out back and just found this out after complaining of back pain for YEARS! Someone actually sent me to have an MRI and looked at it. I wonder how long I’ve been living with this, when docs wouldn’t listen. I am in the midst of trying to accept this new diagnosis and it’s hard. What I can do will remain to be seen after I have joint replacement on my toes this week. I hope I can walk because that is the best exercise for me and good for weight loss. Take care, everyone. This isn’t easy, is it?

February 24, 2014 at 3:38 pm
(26) Ed Corrin says:

Thank you for your response Budie. I will have my nodules aspirated tomorrow and will find out next Tuesday whether I have thyroid cancer and/or hypothyroidism. If so, I will seek out the book that you referred to. Thanks again.

February 28, 2014 at 3:40 pm
(27) Laura says:

I’ve had fibro for 2 yrs since an auto accident( I’m only 42 and have 3 small kids). Exercise is really difficult. I washed the kitchen floor and dusted a few days ago and that sent me into a flare. Lately even a short session of very gentle yoga sends me into a flare. Just started going to a pain clinic BC cymbalta/ lyrics/ acupuncture/chiro not helping enough and they are trying to get me into pool PT which I think would be great. I want to be able to do yoga and pilates again. My biggest pain area is my hips, so even walking too much causes severe pain. Also, thinking about trying tramadol and a muscle relaxant, although I had a severe reaction( palpitations like you wouldn’t believe to Flexeril years ago for a back injury)

March 4, 2014 at 12:08 am
(28) Paula Simon says:

Fibro and RA often go hand in hand. I have both. Should I exercise one week and take the next off? We need more informative studies. Quit putting out the same old crap, please.

March 6, 2014 at 5:10 am
(29) Martin says:

I use cannabis have fibromyalgia complex PTSD look up GW pharm

March 16, 2014 at 9:50 am
(30) Maria says:

I have always complained to my doctor, physical therapist and occupational therapist that after I am done exercise my fibromyalgia and chronic fatigue symptoms put me in a flare up and also that my body stiffened even more. None of them believed me. I hope there are further studies to prove some chronic pain sufferers have worsened symptoms after exercise.

April 15, 2014 at 10:47 pm
(31) Rachel says:

I’ve had CFS & Fibro for over 20 years. I love to work out but exercise is my own worst enemy, I can do 20 minutes light on a treadmill and send myself into a five day relapse, buring shoulders and back, buring eyeballs, can’t think and feel like a Mack truck range over . Could sleep for a week. 3 years ago I tried Cymbolta. After a month on the drug, I tried the gym again. I worked up slow. It was almost a miracle, I was doing 45 mins of moderate exercise with no flare up. I couldn’t believe it and they should study this. Unfortunately I had to go off the meds to try and have another baby but I just went back on it last week so I am hopeful to be able to get back to the gym soon. So far I’m just exhausted for the meds.

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