Could Fibromyalgia Be A Low-Endorphin Disease?

Could Fibromyalgia Be A Low-Endorphin Disease? – Health Rising – by Cort Johnson | Nov 7, 2016

Exercise studies indicate that exercise is generally helpful for people with fibromyalgia but that’s not the end of the story.

Most FM exercise studies focus on either mild or short duration exercise protocols.  Sustained, high-intensity exercise, on the other hand, is often poorly tolerated. A recent study may suggest why that might be so.

The Study: The acute effect of maximal exercise on plasma beta-endorphin levels in fibromyalgia patients. Korean Journal of Pain, 2016. Ali Bidari, Banafsheh Ghavidel-Parsa, […], and Mehrangiz Toutounchi. Oct 29 (4): 249-54

This study examined the effect of 30 minutes of strenuous exercise (70% of predicted maximal heart rate) on 30 FM patients and 15 healthy controls.

They measured levels of beta-endorphin, a neuropeptide that fits onto opioid receptors like a key into a lock, triggering the release of endogenous opioids called beta -endorphins that play a critical role in reducing pain.

Beta -endorphins are very effective at reducing pain; they’re 18 to 33 times stronger than morphine.  

They also play a major role in stimulating the ascending pain inhibition pathways. The poor performance of these pathways, which originate in the spinal cord, may account for much of the pain in FM.

During exercise beta -endorphins should kick in not just to damp down feelings of pain but also to provide feelings of well-being and even exhilaration.

They’re believed likely to be responsible for a “runner’s high” – something which is surely a distant memory for many people with FM.  


This study found lower levels of baseline beta-endorphins and a reduced increase during exercise in FM patients relative to healthy controls.

The authors suggested that reduced baseline beta -endorphin levels and their lackluster rise during exercise could help explain the pain and stiffness found in FM after extensive exercise.

Though I have a diagnosis of EDS, my doctors insist I also have Fibromyalgia. I wasn’t so sure, but this study describes exactly the problems I have had with exercise for decades:

pain and stiffness after extensive exercise.

reached their maximum heart rate at an earlier stage and having to push very hard to keep up with others


The study also found that the FM patients reached their maximum heart rate at an earlier stage of exercise than the healthy controls

Most of the FM patients rapidly reached their maximal heart rates at stages 2 and 3 while almost all the healthy controls reached their maximal heart rates at stages 4 or later. This suggested that FM patients had to push really hard to keep up with even the early stages of the exercise test.

The authors chalked that exercise intolerance up to autonomic nervous system dysfunction and cardiovascular problems.

Interestingly they suggested that the reduced exercise capacity found could be responsible for the low beta-endorphin levels. It apparently takes a certain exercise capacity to get the beta endorphins really flowing.

They also suggested that the lower beta -endorphin levels could be causing or contributing to the allodynia many people with FM experience.

This study, unfortunately, has one howling problem; because FM participants were significantly older than the healthy controls the lowered beta-endorphin levels could reflect that age difference. The authors argued, though, that there was no evidence that the age difference would affect the rise in beta-endorphins during exercise


“A promising approach in the treatment of chronic pain is to mobilize the endogenous opioid system..” Bonnard et. Al.

On the new drug front drugs that inhibit the breakdown of beta -endorphins – allowing endorphins to hang around longer show potential. These drugs, called Enkephalinase inhibitors, are being tested in laboratory animals.

On the more alternative front Self-hacked provides 30 ways to increase endogenous opioid levels, one of which includes taking a cold shower!

Other possibilities include things like

  • massage,
  • social interactions,
  • acupuncture,
  • butyrate (gut studies indicate butyrate is probably low in ME/CFS),
  • capsaicin,
  • marijuana,
  • pregnenolone,
  • kratom,
  • transcranial magnetic stimulation,
  • alcohol (in moderation),
  • eating chocolate,
  • magnesium,
  • oxytocin (be in love / have sex), and
  • others. (See the entire list here with recommendations on treatment options from Self-hacked).


The unfortunate inability of this study to involve age and sex matched controls  casts a pall over its results. Still, it appears to make perfect sense that low endorphin levels could be both reducing the activity of the pain inhibition pathways in FM and be responsible for the pain that intense exercise can bring

In the meantime people with FM could use this studies results as a reason to pamper and enjoy themselves as much as possible – and hopefully perk up those endorphin levels a bit.  


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