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Low Aerobic Energy Production and Pain in Fibromyalgia – Is Your Microcirculation to Blame?

  [ 128 votes ]   [ 13 Comments ]
By Cort Johnson • www.ProHealth.com • June 4, 2014


Low Aerobic Energy Production and Pain in Fibromyalgia – Is Your Microcirculation to Blame?. © Dirima | Dreamstime.com
© Dirima | Dreamstime.com
Reprinted with the kind permission of Cort Johnson and Health Rising.

Exercise is highly recommended as an adjunct therapy in Fibromyalgia. When we’re talking about exercise and FM, however, we’re not talking about pounding the pavement.

A 2010 review of exercise studies 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. Another review warning not to overdo stated that “the latest findings concerning the neurophysiology of nociception indicate the fundamental importance of assigning workloads 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 “something” in ME/CFS involves a damaged aerobic energy production process. We haven’t covered exercise in FM before but guess what – some FM studies suggest the same. Aerobic energy production – which relies on the consumption of oxygen by the muscles -is where we get most of our energy. In fact, when it comes to exercise the study results are very similar.

Déjà vu All Over Again – the Fibromyalgia Exercise Studies

A 2013 study found reduced oxygen consumption in FM patients both during a submaximal and a maximal exercise test. . 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), which may also be found in ME/CFS.

They also noted FM patients demonstrate ‘sustained sympathetic hyperactivity’ during rest (the stress response is on during rest) but 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 it 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) was behind 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. Now on to the present study…

The Study

Pain severity is associated with muscle strength and peak oxygen uptake in adults with fibromyalgia. 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.

These researchers wanted to know if reduced aerobic energy production (low VO2 max) was associated with reduced strength and increased pain, so they had their FM patients exercise to exhaustion while measuring their oxygen uptake and then did a separate muscle strength test.

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.
  • Simply the presence of pain could be reducing muscle contractions during exercise. It turns out that activated pain receptors in the joints tell the motor neurons in the brain not to turn on the muscles. Even the anticipation of pain can reduce the efficiency of motor neuron activity. Pain is designed to make us stop using/help heal the affected tissue, and the brain is happy to participate in having us exercise less efficiently if that will help achieve that goal. (An April 2014 study indicating that trigger point injections increased handgrip strength in women with FM and/or myofascial pain syndrome suggested pain may be reducing strength.)

  • 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 exercise. Reduced muscle recruitment, then, could contribute to the painful, contracted feeling of muscles found in FM. Neither of these possibilities tell us anything about the energy production-pain link. The next one does.

  • Blood flow is critical not just to meet the oxygen demands of exercising tissues but to remove the toxins created during exercise. Both reduced capillary density and blood flow have been found in FM. At least as early as 2006, researchers were suggesting that muscle ischemia (low blood flow) both during and after exercise was causing pain in FM and driving the central sensitization found. Problems with the microcirculation could, therefore, be contributing to the aerobic energy problems, pain, and weakness found in FM.

The authors argued that next step is to determine associations between VO2 max and capillary flow during exercise. Being able to associated reduced capillary blood flow with low VO2 would point an arrow at the capillaries and the microcirculation, particularly if flows in larger blood vessels are normal. 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.

This study also suggests finding an appropriate exercise regimen could be helpful. FM studies have suggested that greater muscle strength is associated with better mental and emotional well-being and reduced oxidative stress, but not improved heart rate variability.

ME/CFS and FM

What an interesting jumble of energy production and muscle studies have occurred in these two disorders. 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. Four repeat exercise studies have been done in ME/CFS but none in FM. Still, the FM exercise studies show similar abnormalities without the need to do that second exercise test. (Aerobic energy production (VO2 max) also takes a hit in several autoimmune disorders (lupus, rheumatoid arthritis and polymyositis)).

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.

Newton’s studies finding poor pH handling and increased muscle acidosis suggest something similar is happening in ME/CFS. Reduced muscle ATP production has also been found in ME/CFS. Studies have suggested both ME/CFS and FM have reduced oxygen uptake at the level of the muscles.

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 toxic byproducts from dysfunctional muscles.

The ME/CFS and FM fields remain stubbornly separate with few studies incorporating both types of patients. For most part FM researchers research FM and ME/CFS researchers research ME/CFS. Rarely, do the twain meet. The energy production and muscle study results appear to be strikingly similar, however, and findings from either disease could end up informing the other. With neither disorder getting much in the way of federal funding working together might be a good idea.
_______________

About the Author:  Cort Johnson has had ME/CFS for over 30 years. The founder of Phoenix Rising and Health Rising, Cort has contributed hundreds of blogs on chronic fatigue syndrome, fibromyalgia and their allied disorders over the past 10 years. Find more of Cort's and other bloggers' work at Health Rising.
 



Please Discuss This Article:   Post a Comment 

Resistance Training and Improved Muscle Strength
Posted by: MykieC
Jun 5, 2014
I have a dual diagnosis of ME and FMS. I was severely disabled for some time and in a state of almost perpetual flare up until I eliminated the drugs my old rheumatologist had me on and began using a combination of several different antioxidants, muscle relaxers, and heavy doses of melatonin and valarian root for my sleep regimen. I also went through a very effective head and neck therapy that significantly improved my symptoms, and I don't feel pain or fatigue to nearly the level I once did, yet I still struggle with exercise. My goal was to walk daily, but in order to clean house, mow my lawn, etc, I tend to only walk a few times a week--with little to no change in how I feel or build up in my endurance, and some days I can't even make my usual route. No matter how hard I try, I cannot seem to walk longer nor do I see any health benefits from it. I wonder if I attempt to build my muscles through some form of resistance training, might this help and does the author or others have suggestions on where I might get started? It seems this article hints at this as a possibility. I have a very tight budget, so a gym membership is out the question, but I do have a few free weights at home and could possibly purchase more second hand. Would starting to lift at home possibly help? Where should I begin? Any suggestions would be greatly appreciated!
Reply Reply

 
to MykieC
Posted by: winningwithfibro
Jun 14, 2014
Hi, MykieC, you mentioned that you went through a very effective head and neck therapy - what type of treatment was this? I have heard of a treatment called "meningeal decompression," and wondered if it was this, as I have considered it, it sounds very promising. ALSO: regarding weight-lifting or resistance training, you asked for suggestions. I am NOT a physical therapist, personal trainer or doctor, but I can tell you what helped me. I have had FM for nearly 30 years. Two and a half years ago, I began a process during which I quit smoking, lost 60 pounds (through a popular program), began riding my bicycle regularly (it is something I CAN do, walking is too hard on my ruptured discs) and after two summers of hard biking and eating clean (very little sugar, no dairy, no soy, no processed foods, only coconut oil and butter, no artificial additives, etc.)I began lifting weights through another popular program. Within TWO months, I had built biceps that were pain-free - the only muscles I have that can tolerate pressure without pain. I am 54 years old, by the way - none of this was easy, believe me, but for the first time in 30 years, I have some hope that I can rise above this thing and try to get my life back. The article above is excellent information to add to my arsenal - I have a list of "things" that may help, from magnesium to iodine to acupuncture to the decompression treatment. I am on a very tight budget, too, as the FM ruined my career and it is very hard to make ends meet, but I have found that if something makes me FEEL better with this illness, it is worth it to prioritize. I am grateful for your comment, and I wish you well. Please let me know what the treatment is if you don't mind. And if you'd like to hear more about how I began to lift weights, let me know. Thanks!

 


Walking exercise.
Posted by: shanemann
Jun 5, 2014
I believe that this article is right on! I never had the ability to recover quickly from strenuous exercise. I can no longer lift weights or walk long distances. I only walk about a mile several times per week, but I am increasing my rate of speed gradually. I walk fast for a bit and then walk more slowly. I alternate fast and slower walking. I believe that this is the best strategy for me. I
Reply Reply

FMS and exercise
Posted by: elvis321
Jun 5, 2014
I have had severe FMS, CFS and Osteoarthritis (both knees replaced); I'm now 53 and have been on permanent disability, from a career I worked hard to obtain, since age 42. I had been a very active person my entire life: athletic awards, certified scuba-diver, golf, I ran and was an avid gardener. By the time I was into my 30s I knew something was very wrong as my life took a slide. I kept doing what I could and pushed myself..but..here I am now. Overweight by 100+lbs. in agony on a regular basis, frustrated at not being able to do as I did. Pacing - done it; even wore a time and took rest breaks on regular intervals to build up strength. Nope!! We get there are problems with us, but I am no longer going to be a SUCKER FOR A CURE...not until there is one. Please let us if that is even possible?
Reply Reply

 
Reply to elvis321
Posted by: winningwithfibro
Jun 14, 2014
I am SO sorry for how this has all happened in your life. Your frustration is completely understandable, I think most of us have become anxious for a cure. As severe as your case is, I would think you might be skeptical about anything that could make you well. I don't know for sure what led me to this article or to your comment, or prompted me to reply to it, but I feel a need to tell you that, even after all you've been through, there can be hope. For me, the depression that went with weighing nearly 200 pounds just made me eat more poorly. The inability to exercise made me do even less, as I was in constant pain. But I was lucky - my kids had some things going on in their lives that caused me to feel 100% devoted to losing weight and feeling more agile or flexible or strong - whatever I could do. So I got committed - I lost over 60 pounds in eight months (basically portion control and journaling) and did what I COULD do - I rode my bike. I rode for 5 minutes the first day, as it hurt and I had VERY little stamina. Then the next day I rode 10 minutes. Then I worked up to half an hour. It was very difficult, but I kept track on a calendar of how long I biked, and just seeing the tiniest improvements made me feel like I'd done something - kind of like when I accomplished things in my long-ago-lost-to-fibro career. Within a couple of months, I could ride an hour! By the next summer (riding is impossible in winter where I live), I was able to ride for two hours - sometimes even three! - at a time, three or four times a week! Did the fibro go away? Heck, no! I still have it, it still hurts, I still have fibro fog, I still can't sleep well, but oddly enough, I FEEL about 50% better than I did when I was over-weight and sitting on the couch eating Oreos (my awful, awful addiction!)and pasta. BUT...here's the key for me: I figured I was going to hurt anyway, whether I did anything or not, so why not at least be smaller, have an easier time getting around, less work on my joints, look better, be more comfortable in clothing (which as you know, can just plain hurt with fibro)and I do have to say, I don't feel as SICK as I did before. So, even though I have nothing to sell, no 'magic cure' to try and pawn off on anyone, I do have what I'm hoping is a little inspiration for you, and for others who see this: as disheartened as you may be, as tired and frustrated as these illness can make you, if you can find the will to take even the smallest step - and keep at it, even though you don't feel well - there is hope that you can improve your quality of life, until there IS a cure for these illnesses. peace&comfort to you

 

 
Reply to elvis321
Posted by: MykieC
Jun 21, 2014
Hi elvis321, I appreciate your frank response to this post about your frustrations and lack of response to exercise. It's difficult not to lose hope. I feel compelled to share my story with you. What helped me may or may not help you, but maybe it will at least offer some hope. For a long time, I was stuck in a downward spiral and rock bottom was two years spent in a state of almost constant flare-up with little hope of getting better. I have been diagnosed with both CFS and FMS and given all my research, I believe I could have both. I also have extensive damage to my spine with 7 herniated discs and I am over 100 lbs overweight. For a while, I thought death would be the only thing that would save me from the hell I was living in. I lost my career, my family, my friends; I couldn't even go to the grocery store. My rheumatologist's answer was to drug me to death. At one time, I was on lyrica, topamax, cymbalta, xanaflex, tramadol and amitriptyline. Then I began doing my own research. Before I could begin to heal, I had to get off of all of that stuff. It turned out some of it was causing my symptoms to increase rather than decrease and causing others all together. I found other drugs, mostly supplements and nutrients that actually works to help my body function right, decreases inflammation, allows me to sleep right and dramatically reduces my fatigue; glutathione, curcumin, Co-Q-10, Magnesium, probiotics, valerian root, melatonin, DHA, NADH. I also discovered I was gluten and soy intolerant, which was causing me to gain weight, causes inflammation and is responsible for my IBS. Nutrition is incredibly important to this illness. I also had an excellent head and neck therapy that was very effective. Now, with my new rheumatologist, I only get D3, a mild muscle relaxer I take 3x a day and some tramadol for bad days. I also see a neurologist who helped me figure some of this out. It took me over a year to find the right things to treat me, but I kept trying things, changing and adding on until I found what works to make me feel my best. Now I can do a few of the things that make my life matter to me and I can keep a clean house and mow my lawn and I know to normal people this sounds like small stuff, but I'm sure you understand just how impossible it can be to do these things. Now my flare ups are further apart and minor in comparison, if still frustrating and painful and disruptive. My point is in all this blathering is to please not do yourself the disservice of giving up on yourself. There is help out there, even if it's not from modern medicine or your practitioner. And many of us are starting from different places. I had to find these medicinal solutions before I could get to a place where exercise was even an option and as you can see from my other posts, I'm struggling with it. Still, I'm grateful to have the wellness I've found and the freedom it's brought me. You just have to do the work of finding the information, trying things out and seeing what works for you, all in baby steps. I wish you the best of luck and hope that you too can find a solution, even if it's not a cure.

 


my experiences
Posted by: graced1
Jun 13, 2014
I have a diagnosis of osteoarthritis, severe chronic neutropenia and fibromyalgia with myofacial pain syndrome. My pain was once through the roof and nothing touched it. I began seeing a chiropractor and getting the spine aligned and then began to work out on a regular basis. That was hard because it wore me out more than perked me up and it hurt so much I could barely even try. But I began very slow and now I am up to working out about half hour or so a day. And the fatigue response to exercise has lessened greatly! It just took longer and I had to pace myself with the results. I do not run, I walk, and I bike indoors, and lift weights. Nothing too hard or difficult. But I am getting there after years of nightmare pain and being deathly sick, I feel like I am able to get through the day and even work out consistently.
Reply Reply

 
small steps
Posted by: winningwithfibro
Jun 14, 2014
Yay, you!!! It is so good to hear that someone else has found that taking the smallest step and pushing through it will eventually show you some improvement!!! I'm so happy for you, and I am right there with you, you have my support! peace~

 

 
Reply to graced1
Posted by: MykieC
Jun 21, 2014
Hi graced1, congratulations on your progress. I too have FMS with myofacial pain syndrome, but since I had therapy, I don't have any MPS symptoms and a serious decrease in other symptoms and my therapist said that this therapy works for many people with FMS, so I thought I'd mention it to you. It worked wonders for me. Here's a list of practitioners: http://www.americanbackpaincenter.com/ExperienceSOPractitionersList. The site is mostly geared toward practitioners, but there are some good testimonials that tell a little more about it. I did Chiro, too and it helped, but this seems to be a long-term permanent solution. Best of luck to you!

 


I feel the same way.
Posted by: Wahela
Jun 14, 2014
A few summers ago, I decided that my fat old dog and I would work up gradually. We would walk to the park (two blocks), rest and walk home, Adding one more block every week during the summer. So by the end of the summer, we'd be walking probably ten blocks a night. At the end of the summer? I was still walking to the park, resting and walking back, exhausted by the time I got home. I told my rheumatologist that there is this brick wall that I just can't break through it. She said (she's young and gorgeous and built well), "you just have to force yourself to get through that brick wall." I didn't think she appreciated the difficulty I have. I bought a semi recumbent bicycle for the living room. I can ride that while watching TV for ten minutes. I just can't make it any farther, but at least I am feeling increased circulation in my lower legs and feet. So I guess that's what I will do. Sometimes I feel like I'm wading through 3' of water, I just can't lift my legs any higher. I can appreciate your problem.
Reply Reply

reply to MykieC
Posted by: winningwithfibro
Jun 14, 2014
Hi, MykieC, you mentioned that you went through a very effective head and neck therapy - what type of treatment was this? I have heard of a treatment called "meningeal decompression," and wondered if it was this, as I have considered it, it sounds very promising. ALSO: regarding weight-lifting or resistance training, you asked for suggestions. I am NOT a physical therapist, personal trainer or doctor, but I can tell you what helped me. I have had FM for nearly 30 years. Two and a half years ago, I began a process during which I quit smoking, lost 60 pounds (through a popular program), began riding my bicycle regularly (it is something I CAN do, walking is too hard on my ruptured discs) and after two summers of hard biking and eating clean (very little sugar, no dairy, no soy, no processed foods, only coconut oil and butter, no artificial additives, etc.)I began lifting weights through another popular program. Within TWO months, I had built biceps that were pain-free - the only muscles I have that can tolerate pressure without pain. I am 54 years old, by the way - none of this was easy, believe me, but for the first time in 30 years, I have some hope that I can rise above this thing and try to get my life back. The article above is excellent information to add to my arsenal - I have a list of "things" that may help, from magnesium to iodine to acupuncture to the decompression treatment. I am on a very tight budget, too, as the FM ruined my career and it is very hard to make ends meet, but I have found that if something makes me FEEL better with this illness, it is worth it to prioritize. I am grateful for your comment, and I wish you well. Please let me know what the treatment is if you don't mind. And if you'd like to hear more about how I began to lift weights, let me know. Thanks!
Reply Reply

To winnningwithfibro
Posted by: MykieC
Jun 21, 2014
Hi winningwithfibro, thanks so much for responding to me with all this information. We sound very much alike both in circumstance and in determination to overcome this illness to whatever degree that we may. I would love to hear about how you got started with lifting; any advice would be most welcome. I don't want to hurt myself and I am starting out pretty basic. I used to be a very active woman with lots of natural muscle; I didn't have to work hard at it, I just worked and played hard. Now, I'm so weak I have difficulty holding up a drill for very long with a steady hand, because I was near bed-ridden for almost two years between the CFS and spinal deterioration. I'm glad to hear biking has worked for you. I've been curious to try one myself. I asked my therapist for more information on the therapy technique we used, it's called Strategic Orthopedics and here's a list of practitioners: http://www.americanbackpaincenter.com/ExperienceSOPractitionersList.html. Since it's rather new, the list is small. If you don't find someone in your area, I suggest calling them, as the list might not be completely up-to-date (one of my two therapists isn't on there). There are also testimonials from practitioners on the site and I agree with most everything they have to say about it, having been on the receiving end of so many therapies myself. I'm not familiar with the one you mentioned, though. One last question for you or anyone else out there: Have you had any success with yoga or tai-chi? These are both things I've thought to try out and wondered if others have had any success. I thought it might improve my balance and be a good way to stretch and incorporate some movement.
Reply Reply

ATP - Using CoQ10
Posted by: kimbakat
Aug 13, 2014
I've had such an improvement in energy after using 100mg a day of CoQ10. Takes about 3 days to feel effects. Sometimes I forget to take it because I start feeling better.

It helps with the ATP into the mitocondria of the cells. Pub Med has some articles related to Fibromyalgia and CoQ10. The data is really promising.
Reply Reply


Post a Comment

 
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