Low Energy Production and Pain in Fibromyalgia

Low Energy Production and Pain in Fibromyalgia – Is Your Microcirculation To Blame? – Health Rising – https://www.healthrising.org – by Cort Johnson | May 25, 2014

Exercise is highly recommended as an adjunct therapy in fibromyalgia. 

Those of us with fibromyalgia know how extremely difficult this becomes. Our bodies seem to resist us with all their might and this article offers a possible explanation.

A 2010 review of exercise studies found that ‘slight to moderate’ intensity aerobic exercise sessions done two to three times a week worked best, and that appropriate levels of exercise result in improved fitness but only modestly improved pain.  

Everyone seems to believe that exercising will “make us feel better”. While that may be true in a larger sense of overall well-being, we rarely hear about this pesky limitation: it usually doesn’t help our pain much and sometimes can make it even worse.

Another review that warned not to overdo on exercise stated that “the latest findings…. indicate the fundamental importance of assigning workloads (i.e. exercise) that do not exacerbate post-exercise pain.”  

Something is stopping many FM patients and almost all ME/CFS patients from participating in intense exercise. Four studies suggest that that “something” in ME/CFS involves a damaged aerobic energy production process.

As these two “syndromes” get more scrutiny, there seems to be increasing overlap. Both have symptoms of pain and fatigue but with ME/CFS the main issue is the fatigue and for fibromyalgia, the main issue is the pain.

Several FM studies have found problems with exercise.

A 2011 finding  of reduced oxygen consumption (VO2 max), reduced heart rates during exercise, and delayed heart rate recovery suggested a familiar pattern of autonomic nervous dysfunction (increased sympathetic nervous system activation/decreased parasympathetic nervous system activity) was responsible.

The authors pointed out that 57% of FM patients met the criteria for chronotropic incompetence (an inability to get the heart up to speed during exercise). The same problem may be found in ME/CFS.

This finally gives a name to my experience. I’ve long been aware that I have to push my body quite a bit for quite a while before my heart rate finally rises up to the level necessary to transport enough oxygen to the muscles being used.

During this “lag time” I experience the intense burning in the muscles typical of anaerobic energy production. Then when I finally stop exerting myself, my heart rate increases for another few minutes before descending again.

They also noted FM patients demonstrate ‘sustained sympathetic hyperactivity’ during rest (the stress response is on during rest), and a hypoactive or poor response to stress.

This suggests that the stress response in FM is “on” when it should be “off”(at rest), and then tends to poop out when faced with work (such as intense exercise). (People with lupus have a similar response to exercise.)

A 2002 study finding of reduced oxygen uptake (VO2 max), ventilatory anaerobic threshold,  and heart rate during a maximal exercise test in FM again suggested problems with aerobic energy production were present.

These authors proposed that dysregulation of the autonomic nervous system (dysautonomia) causing the exercise issues in FM.

They also noted that resistance training was able to improve some aspects of autonomic nervous system functioning.

These findings suggest that, whatever the differences in their ability to exercise, FM and ME/CFS patients have very similar problems with aerobic energy production and autonomic dysfunction.

The Study

Pain severity is associated with muscle strength and peak oxygen uptake in adults with fibromyalgia. – free full-text /PMC4014369/ – Hooten WM, Smith JM, Eldrige JS, Olsen DA, Mauck WD, Moeschler SM. J Pain Res. 2014 May 3;7:237-42. doi: 10.2147/JPR.S61312. eCollection 2014.

It turned out that the FM patients with reduced aerobic energy production were significantly weaker and in more pain than FM patients with higher aerobic energy production.

The Triad: Energy Production, Strength and Pain

What’s causing this energy production-pain association? Studies have illuminated a number of possibilities.

1. Simply the presence of pain could be reducing the muscle contraction needed to exercise properly

That’s exactly what happens to me while bicycling: the physical pain of using a muscle seems to override my will and I feel myself weakening.

2. Indeed, some research suggests the normal muscle recruitment is not occurring in FM.

Because stimulating the same muscle unit again and again puts it into a contracted painful state, more and more muscle units need to become activated as we continue to exercise.

This is exactly what I feel during bike rides. While turning pedals, the big muscles of the thigh, hamstrings at the back and quadriceps at the front, are alternately contracting or relaxing over and over.

After a while, the series of signals to tighten and then release each muscle seem to get out of synchronization and my muscles get stuck in tightening mode: they can neither contract nor relax completely anymore. My whole leg gets stiff because the muscles get stuck in a semi-contracted state.

Then I have to dismount and use my leg muscles in a different way, like walking, in order for the signals and muscles to get resynchronized to the normal contract/relax sequence.

3. Blood flows are critical not just to meet the oxygen demands of exercising tissues but to remove the toxins created during exercise.

The reduced capillary density and blood flows been found in FM could cause problems removing those toxins. — At least as early as 2006, researchers suggested that muscle ischemia (low blood flows) both during and after exercise could be causing pain in FM and driving the central sensitization found.

The authors argued that next step is to determine what happens to capillary blood flows during during exercise. Given the overlap in both exercise and muscle study results in ME/CFS and FM, those results could very well apply to ME/CFS as well.

ME/CFS and FM

An interesting jumble of energy production and muscle problems have showed up in ME/CFS and FM.

Low blood volume – obviously potentially a critical factor in getting blood to the tissues – is acknowledged in ME/CFS but is hardly considered in FM but perhaps should be given the issues shown in the this study.

• Increased levels of oxidative stress,
• mitochondrial problems,
• muscle fiber issues,
• increased muscle levels of the toxins pyruvate and lactate, and
• reduced microcirculation in the muscles

have all been found in FM.

Studies suggest the muscles in both ME/CFS and FM patients suffer from reduced oxygen uptake.

A 2014 study finding normal blood flows but increased muscle and blood glutamate and lactic acid levels in the people with chronic widespread muscle pain suggested normal blood flows may not be enough to remove the toxic byproducts produced.

The energy production and muscle study results appear to be strikingly similar, however, in both diseases, and findings from either disease could end up informing the other.