Muscle ache

What do we mean by muscle ache?

Muscles get sore for lots of reasons. It’s normal to feel aches after working hard.  Muscles that have been over-stretched or over-strained will feel stiff and painful for a time, while these minor injuries heal. This is normal and should not take too long for the pain to ease.

Muscle ache that does not go away points to other problems that need attention. Some medicines can make muscles ache, particularly the ones prescribed for lowering cholesterol. If you are on this type of medication and you start getting muscle pain, tenderness or weakness, check with your GP or pharmacist as soon as possible.

There are other diagnosable inflammatory causes of muscle ache like rheumatoid arthritis. Polymyalgia rheumatica is a form of painful muscle inflammation affecting the shoulders and upper body, usually in middle age. It requires medical treatment.

You can also get the painful muscles when you have a cold, flu or some other virus. Virus infections often cause muscle pain. These usually pass within a week or so. Sometimes it is when these viral pains do not go quickly that a ‘fibromyalgia’ pattern can start. Most of this section is devoted to this sort of chronic muscle ache.

What do we mean by fibromyalgia syndrome (FMS)?

Fibromyalgia makes you feel tired and causes widespread muscle pain and ‘tender points’. These tender points are places on the neck, shoulders, back, hips, arms or legs that hurt when touched. People with fibromyalgia may have other symptoms, such as trouble sleeping, morning stiffness, headaches, sensitivity to temperature, bright lights and loud noises, numbness or tingling in fingers and toes, and problems with thinking and memory, sometimes called ‘fibro fog’. There is widespread agreement among doctors that people with FMS have typical ‘tender points’ in particular areas of the limbs, chest, back and neck, where even slight pressure feels very painful. There are no laboratory tests for FMS, so doctors have to rule out other potential causes before deciding you have it. FMS isn’t caused by inflammation or nerve damage, but that doesn’t mean FMS pain is ‘all in the mind’. And even though doctors don’t yet fully understand why FMS happens, there is a lot you can do to reduce the pain it causes.

As many as three out of every four people who have FMS, also have chronic fatigue syndrome (CFS). Other common conditions that often occur along with FMS and CFS include irritable bowel syndrome (lBS), migraine, restless legs syndrome (RLS), and painful menstrual periods. In all these health problems, blood tests and scans may give perfectly normal results. Yet, from time to time, the body doesn’t properly regulate blood circulation or muscle tension. This regulation depends on nerves, hormones and brain chemicals that pass messages between the brain and the body.

What causes FMS?

If you have FMS, your muscles (even though they aren’t really damaged) keep sending pain signals to your brain. When they reach your brain, these pain signals have an exaggerated impact. It’s as if your brain is ‘turning up the volume’ on incoming signals. This can turn mild pressure, or even an itch, into pain. One explanation could be that people with FMS don’t have enough of a brain chemical called serotonin, which is needed to process pain signals. This over-sensitivity can affect other senses too – such as vision, hearing and even smell. Different things can set off this central sensitisation. Some experts think it can be triggered by an abnormal response to stress. The stress could be emotional (such as ongoing anger, anxiety or depression) or it could be physical stress caused by an infection or an injury.

FMS and central sensitisation are not psychological problems. But psychological treatments can reduce the sensitisation, because the way you think and feel can make central sensitisation better or worse. For instance, many people with FMS are hyper-vigilant. This means their senses are always on the lookout for trouble. Hyper-vigilance can be triggered by a trauma or by an anxiety disorder, and perhaps some people are born with nervous systems that are more hyper-vigilant than others. Another thing that seems to make FMS worse is catastrophising. This means you tend to imagine that things will go disastrously wrong, and that small disturbances must have awful causes and will have terrible consequences.

Psychological treatments can be especially helpful if you are an anxious person, or if you tend to be hyper-vigilant or to catastrophise, or if you are depressed.

FMS, CFS and ‘brain fog’

Many people with FMS or CFS complain of brain fog. Some say brain fog is worse than their pain or fatigue. They have no concentration or focus, they mix up words, have problems with memory recall and numbers, don’t recognise places they know, have trouble finding things, and find themselves unable to multi-task.

What causes brain fog? Perhaps it occurs partly because people with FMS and CFS don’t sleep well, or because blood flow to the thinking parts of the brain is reduced. It can also be due to the side-effects of pain medication, or just the distraction of pain itself. People with FMS say that the worse their pain is, the foggier they feel. Stress, anxiety and overloaded senses seem to make brain fog worse too.

FMS pain and depression

Depression can be painful. According to Harvard Health Newsletter, more than 50% of depressed patients who visit a GP complain only of physical symptoms, usually involving pain of some sort. Long-term pain is of course depressing in itself. It can change how you think and feel and what you do. Many people with persistent pain become more isolated, immobile and dependent on medication.

But depression is no more common in FMS than in painful conditions that have an obvious physical cause, such as rheumatoid arthritis. Research also shows that the brain chemistry of FMS isn’t the same as in depression. Depression also causes something like brain fog, but research shows that it’s slightly different from the brain fog experienced by people with FMS.

Sleep is also usually poor with FMS but this is different from the sleep disturbance found in depression. Another difference is that, although people with FMS respond to anti-depressants such as amitryptiline, the doses needed are much smaller than those used to treat depression. Yet although FMS isn’t a form of depression, all types of antidepressants have some sort of positive effect on FMS pain. In addition, some types of antidepressants may also help the sleep disturbances, fatigue and depressed mood.

For example researchers have found that SSRI’s (such as Prozac) reduced pain and depression, but don’t relieve fatigue or sleep disturbance.

FMS and sleep problems

FMS and sleep disorders go hand in hand. Pain disturbs sleep and poor sleep makes pain feel worse, so it can be a vicious circle. Up to 80% of people with FMS have some type of sleep problem. Many people with FMS have restless leg syndrome (RLS) too, and this can cause even more sleep problems. Amitriptyline in low doses can help FMS but may make RLS worse. Be aware of this if you get RLS as part of your FMS.

Treating FMS

Three approaches are likely to be useful in all kinds of regulatory disorders, including FMS. They are: supporting more restful sleep, getting appropriate exercise, and cognitive behavioural therapy (CBT).

What other information might be helpful?

• If the pain is mainly in your lower back, you might find our section on BACK PAIN helpful.
• If you think that you might be suffering from anxiety (feeling nervous or having worrying thoughts that are making you feel very tense), you might find our section on STRESS AND ANXIETY helpful.
• If you are feeling low or depressed, particularly when you wake and this seems to make the pain worse, you might find our section on DEPRESSION helpful.

For more information visit:

• NHS Website information on fibromyalgia
• NHS Website information on pain