Shoulder, neck and head pain in FM and ME/CFS

Shoulder, neck and head pain are common in fibromyalgia and chronic fatigue syndrome. Could the autonomic nervous system be to blame?

I’ve suffered from upper body pain since I came down with ME/CFS/FM decades ago. I can draw a fairly distinct line from about the middle of my sternum upwards;  press a point anywhere above that line and there’s a good chance it’s going to cause pain.

Shoulder, neck and head  pain are common in both fibromyalgia  (FM) and chronic fatigue syndrome (ME/CFS); in fact, the pain in FM often first shows up in the shoulder, neck and head areas. Dr. Lapp has found that ‘pain, spasms and shortening of the muscles’ in these areas often leads to poor posture, rounded shoulder and shallow breathing in chronic fatigue syndrome and tension headaches may occur in as many  80% of ME/CFS patients.

Myofascial trigger points which trigger local and referred pain are  most common in the back, shoulder and neck areas of people with fibromyalgia.  If you’re going to try and find a cause of pain in FM and ME/CFS, it’s a good place to start.

The Study

In this study muscle activity, heart rate and heart rate variability were measured during a relaxation period, during isometric stretching, during several mental stress tests (including counting backwards) and when inhaling and then holding ones breath (a sympathetic nervous system enhancer) and eating (another SNS enhancer)  in people with fibromyalgia.

Trapezius Muscle

Stretching from the neck to midspine to the shoulder the trapezius muscle is well situated to contribute to the upper body pain in FM and ME/CFS.

They wanted to see if the trapezius, a nice big muscle stretching from the tip of the shoulder to the middle of the spine all the way up to the bottom of the skull, would ‘act up’ when FM patients were exposed to mental stress. The theory was that a dysregulated autonomic nervous system would, in a stressful situation, trigger painful muscle activity in fibromyalgia (no exercise or trauma required..).

There’s no reason it should; a mental stress test after all shouldn’t involve that muscle at all – but there is all this upper body pain in both FM and chronic fatigue syndrome to account for.

Just looking at that muscle with its ability to tighten the screws  everywhere from the spine to the shoulder to the neck set me, with my history of pain in that area, a little a quiver.  Interestingly this muscle, of all the muscles of the body, is one of  the most responsive to stress in FM.


Electromyograph readings indicated the FM patients had significantly more trapezius muscle activity during mental stress tests,  breath holding  and even during eating (two SNS activators) and instructed rest’ than health controls.  There was no difference in muscle activity  while watching TV.  Pain levels  that rose during the mental stress exercises in the shoulder/neck area but not in the lower back indicated  the upper body was particularly susceptible to stress induced pain.

A System Primed for Activation

This results displayed a sympathetic nervous system primed to become activated  in fibromyalgia.  How the  muscle activation caused pain is still unclear but the authors suggest one source may be activated trigger points. This is an interesting suggestion given Rowe’s finding that  small misalignments in the nerve/muscle interface in ME/CFS adolescents can trigger significant pain. Rowe finds certain types of  massage and  physical therapy  (myofascial release, etc.) that help to put the  nerves/muscles back into their proper alignment  can reduce pain significantly in his patients.  He states  they love this kind of body work.

Muscle Problems

To the researchers  surprise, muscle activity during isometric exercise was reduced in the FM patients relative to controls.  This could be due to problems with muscle metabolism or  with poor ‘motor unit’ recruitment. They did suggest that elevated potassium levels -also found in trapezius myalgia – which is similar to FM – could play a role reducing muscle fiber recruitment during exercise.  In any case it was remarkable to  see muscle activity increased in fibromyalgia when it shouldn’t be (during stressful situations) and then reduced  when it should be (during exercise) (!).

Little evidence of muscle issues was present in FM for years and the focus shifted to central nervous system issues but recent studies are beginning to find evidence of muscle problems both in fibromyalgia and chronic fatigue syndrome.

The Catecholamine/Sympathetic Nervous System Paradox Shows Up Again

Just as we saw in an earlier ME/CFS blog, the levels of  main drivers of the sympathetic nervous system in the blood, the catecholamines did not correlate with the sympathetic nervous activation that occurred. In fact, catecholamine levels were significantly reduced in the FM  patients.  In later blogs we’ll be looking in the role the vagus and other nerves may play in the enhanced fight/flight activity in both these disorders.

First, though, a look at yet another disorder that may have ties to both FM and ME/CFS.

Trapezius Myalgia – a Sister Disorder to Fibromyalgia and Chronic Fatigue Syndrome?

Characterized by chronic neck and shoulder pain,  people with ‘trapezius myalgia’ (TM), display the same autonomic nervous system signature (low heart rate variability) found in fibromyalgia, chronic fatigue syndrome, irritable bowel syndrome and other so-called allied disorders.  Interestingly, given the low HRV findings during sleep in ME/CFS, people with trapezius myalgia experienced their lowest HRV readings during sleep and may experience the same type of ‘micro-arousals’ speculated to occur in ME/CFS.

neck pain in Trapezius myalgia

Trapezius myalgia – a neck and shoulder pain disorder with higher incidences of femailes, shares some similarities with FM and ME/CFS

Dr. Newton’s and others works have suggested circulation may be a huge issue in ME/CFS and this study found ‘micro-circulation’ issues in TM.  Micro-circulation tests indicated reduced  trapezius blood flows and oxygenation saturation and higher lactate and pyruvate  in TM patients during a hour of computer work.  (One study found high rates of ‘hypertrophied muscles fibers and low rates of capillarization which sounds like a recipe for low blood flows.)

I’m not clear if micro-circulation tests have been done in ME/CFS but  the low blood volume, reduced blood flows and  the paradoxically high rates of pain after exercise in that disorder suggest they may be possible.

Reduced blood flows can cause pain through a  inflammatory process called ischemia which results in an explosion of free radicals. Maximum free radical and inflammation production in ischemia, occurs, interestingly enough, when normal blood flows are resumed, not during the period of low blood flows.

Given the advice of exercise physiologists that short bursts of anerobic activity are the most effective way to exercise in chronic fatigue syndrome, it was interesting to find that ‘specific strength training ‘, not aerobic exercise, is the most effective way to decrease pain in TM.  (Anerobic strength training also appears to  increase immune functioning (macrophage content) in TM.)

Wrap Up

In  past blogs we’ve seen the autonomic nervous system issues linked with fatigue and sleep issues in ME/CFS; now we see it  linked to stress, increased muscle activity and upper body pain in fibromyalgia and that muscle metabolism or other issues may come into play as well.

Fibromyalgia is going to be an interesting guide for us as we  dig deeper into the more extensive muscle/ANS research done in that disorder.




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