Exercise and Broken Pain Controls in Fibromyalgia

How It May Help, Even Thought it Can Hurt

A woman rests on the handlebars of an exercise bicycle.
Exercise is a controversial topic among those with fibromyalgia..

Exercise is always a touchy subject to bring up where fibromyalgia is concerned. Most of us with the condition know that over-exertion leads to symptom flares, yet doctors keep telling us we need to exercise. It can feel like they just don't understand – or care about – the toll that exercise can take on us.

At the same time, most of us understand that our doctors are not out to cause us increased pain, fatigue, cognitive dysfunction, etc.

They want us to feel better and be more functional, and they're relying on a growing body of scientific evidence when they recommend exercise.

It's also confusing to think about exercise as a way to improve fibromyalgia. This isn't an illness of the muscles or joints; it involves the nerves and brain. It's not clear, on the face of it, to see how exercising the muscles and joints can improve central nervous system function.

Exercise and Pain Modulation in Fibromyalgia

Even though multiple studies show that we can benefit from exercise, not even doctors and researchers could tell us precisely why exercise seems to be effective. However, that's changing.

An early 2016 study published in Brain Sciences (Ellingson) appears to shed light on what exercise is doing for us, thanks to an advanced brain imaging technique called functional magnetic resonance imaging, or fMRI.

First, though, it's important to understand the term "pain modulation." You may not know it, but your brain actually can influence much pain you perceive at any given moment.

For example, think of times when you've been surprised by pain. It seems to hurt worse than when you brace yourself for it, right? (Or, at least, it did before you had fibromyalgia.)

The reason for that is something called pain inhibition. Your brain, when it anticipates pain, takes certain physiological steps that help you feel it less than you would otherwise.

We have evidence that this process doesn't function properly in fibromyalgia. We have an inadequate pain modulation system.

In the Brain Sciences study, researchers built their work on earlier studies that told us:

  • The pain modulation system is important because on one hand, we need to recognize when things cause pain so we can protect ourselves, and on the other hand, we don't want our systems constantly flooded with pain signals (which is what happens in fibromyalgia.)
  • Exercise stimulates the pain modulatory system, which helps it function better.
  • Regular aerobic exercise training has, in research, been demonstrated to be consistently helpful for us.

It stands to reason, then, that exercise can help us by improving our central nervous system's ability to modulate pain. However, looking at the total body of exercise research is inconclusive. In some studies, it appeared to make us less sensitive to pain while in others, it made us more sensitive pain or made no difference at all.

The Study's Results

Nine women with fibromyalgia and a control group of nine pain-free women had fMRIs done after exercise and after resting quietly.

During the scans, they applied pain to gauge the different responses. The participants bicycled for a short amount of time at a moderate intensity.

After exercise, both groups showed less pain sensitivity than before, supporting the theory that exercise increases pain modulation. They also noted several significant differences in brain activity patterns between the illness group and controls, especially in two regions of the brain that are involved in pain modulation – the anterior insula and the left dorsolateral prefrontal cortex.

Researchers concluded that moderate exercise does lead to a short-term (20-30 minute) improvement in pain. They further hypothesize that regular exercise may make the effects longer lasting.

Because aerobic exercise training has shown more consistent benefits compared to other forms of exercise, they call for trials to test whether exercise training can improve pain modulation.

Applying the Research

So can we say without a doubt that we'll hurt less if we exercise? No. But you already knew that because of the times you've done too much and landed yourself in bed for a week.

What we can say is that moderate exercise appears to make positive changes in a system that's dysfunctional in us. However, this was a small study. It included only women, which makes sense because 90% of fibromyalgia diagnoses are in women, but it means we may not be able to apply the results to everyone.

And this next bit of information is extremely important: they excluded people diagnosed with mental health conditions as well as those who were taking medications that could impact their pain or brain scans. Think about how many of us would be rejected by that study: everyone who's clinically depressed as well as those who are on brain-altering medications to control their pain.

This isn't mentioned in the study, but it seems likely that the more severely ill someone, the less likely they are to volunteer for an exercise study. How many of us would see a requirement of 20-30 minutes of moderate exercise and hobble slowly but determinedly in the other direction?

It's also important to note that the exertion in the study was moderate. In fact, researchers point out that their control group participants didn't work anywhere near hard enough to see benefits to their pain modulation system. No one is suggesting that we go out and exercise really hard for a long time.

So where does this leave us? It's increasingly clear that exercise can help us, in spite of the possible negative effects. What we need to do is figure out how much exertion we can tolerate and stay within our limits, or gradually work to increase our limits. It's tough, but it can be done. Here's help:


Bidonde J, et al. Current rheumatology reviews. 2014;10(1):45-79. Exercise for adults with fibromyalgia: an umbrella systematic review with synthesis of best evidence.

Ellingson LD, et al. Brain sciences. 2016 Feb 26;6(1). pii: E8. Exercise strengthens central nervous system modulation of pain in fibromyalgia.

Koltyn KF. Sports medicine. 2000 Feb;29(2):85-98. Analgesia following exercise: a review.

Newcomb LW, et al. Medicine and science in sports and exercise. 2011 Jun;43(6):1106-13. Influence of preferred versus prescribed exercise on pain in fibromyalgia.

Nijs J, et al. Pain physician. 2012 Jul;15(3 Suppl):ES205-13. Dysfunctional endogenous analgesia during exercise in patients with chronic pain: to exercise or not to exercise.

Ossipov MH, Morimura K, Porreca F. Current opinion in supportive and palliative care. 2014 Jun;8(2):143-51. Descending pain modulation and chronification of pain.

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