Pain Variability in Fibromyalgia Is Related to Activity and Rest: Role of Peripheral Tissue Impulse Input


      Because fibromyalgia (FM) patients frequently report activity-dependent deep tissue pains, impulse input from painful body regions may be relevant for their musculoskeletal complaints. In addition, peripheral impulse input may induce and maintain thermal and mechanical hyperalgesia of FM patients. If so, activity and rest may alternately enhance and diminish intensity of FM pain. However, the effects of exercise on pain are ambiguous in studies of FM. Whereas exercise-only studies demonstrated increased pain and hyperalgesia during and after physical activity, some exercise studies that included rest periods resulted in decreased FM pain and increased function. To further clarify these effects, we examined the effects of alternating exercise with rest on clinical pain and thermal/mechanical hyperalgesia of 34 FM patients and 36 age-matched healthy controls (NC). Using an ergometer, all subjects performed arm exercise to exhaustion twice alternating with 15-minute rest periods. Although strenuous muscle activity was reported as painful by most FM subjects, overall clinical pain consistently decreased during the rest periods. Additionally, FM subjects' pain sensitivity to mechanical pressure decreased after each exercise and rest session. Conclusion: Alternating strenuous exercise with brief rest periods not only decreased overall clinical pain of FM subjects but also their mechanical hyperalgesia. No prolonged worsening of overall FM pain and hyperalgesia occurred despite vigorous muscle activity. Our findings contribute further evidence that FM pain and hyperalgesia are at least partially maintained by muscle impulse input, and that some types of exercises may be beneficial for FM.


      FM is a pain-amplification syndrome that depends at least in part on peripheral tissue impulse input. Whereas muscle activity increased overall pain, short rest periods produced analgesic effects.

      Key words

      To read this article in full you will need to make a payment

      Purchase one-time access:

      Academic & Personal: 24 hour online accessCorporate R&D Professionals: 24 hour online access
      One-time access price info
      • For academic or personal research use, select 'Academic and Personal'
      • For corporate R&D use, select 'Corporate R&D Professionals'


      Subscribe to The Journal of Pain
      Already a print subscriber? Claim online access
      Already an online subscriber? Sign in
      Institutional Access: Sign in to ScienceDirect


        • Angelopoulos T.J.
        • Denys B.G.
        • Weikart C.
        • Dasilva S.G.
        • Michael T.J.
        • Robertson R.J.
        Endogenous opioids may modulate catecholamine secretion during high intensity exercise.
        Eur J Appl Physiol. 1995; 70: 195-199
        • Baker A.K.
        • Hoffmann V.L.
        • Meert T.F.
        Interactions of NMDA antagonists and an alpha 2 agonist with mu, delta and kappa opioids in an acute nociception assay.
        Acta Anaesthesiol Belg. 2002; 53: 203-212
        • Barlow D.H.
        • Blanchard E.B.
        • Hayes S.C.
        • Epstein L.H.
        Single-case designs and clinical biofeedback experimentation.
        Biofeedback Self Regul. 1977; 2: 221-239
        • Barlow D.H.
        • Hersen M.
        Single-case experimental designs. Uses in applied clinical research.
        Arch Gen Psychiatry. 1973; 29: 319-325
        • Bennett R.M.
        • Clark S.R.
        • Goldberg L.
        • Nelson D.
        • Bonafede R.P.
        • Porter J.
        • Specht D.
        Aerobic fitness in patients with fibrositis. A controlled study of respiratory gas exchange and 133xenon clearance from exercising muscle.
        Arthritis Rheum. 1989; 32: 454-460
        • Borg G.
        Borg's perceived exertion and pain scales, 1st ed.
        Human Kinetics, Champaign, IL1998
        • Burckhardt C.S.
        • Clark S.R.
        • Padrick K.P.
        Use of the modified Balke treadmill protocol for determining the aerobic capacity of women with fibromyalgia.
        Arthritis Care Res. 1989; 2: 165-167
        • Busch A.
        • Barber K.A.R.
        • Overend T.J.
        • Peloso P.M.J.
        • Schachter C.L.
        Exercise for treating fibromyalgia syndrome.
        Cochrane Database Syst Rev. 2007; 4
        • Busch A.J.
        • Schachter C.L.
        • Overend T.J.
        • Peloso P.M.J.
        • Barber K.A.R.
        Exercise for treating fibromyalgia: A systematic review.
        J Rheumatol. 2008; 35: 1130-1144
        • Clark S.R.
        Prescribing exercise for fibromyalgia patients.
        Arthritis Care Res. 1994; 7: 221-225
        • Clark S.R.
        • Burckhardt C.S.
        • O'Reilly C.A.
        • Bennett R.M.
        Fitness characteristics and perceived exertion in women with fibromyalgia.
        J Musculoske Pain. 1993; 1: 191-197
        • Cooper B.Y.
        • Vierck C.J.
        • Yeomans D.C.
        Selective reduction of second pain sensations by systemic morphine in humans.
        Pain. 1986; 24: 93-116
        • De Kock M.
        • Meert T.F.
        Alpha 2-adrenoceptor agonists and stress-induced analgesia in rats: Influence of stressors and methods of analysis.
        Pharmacol Biochem Behav. 1997; 58: 109-117
        • Desmeules J.A.
        • Cedraschi C.
        • Rapiti E.
        • Baumgartner E.
        • Finckh A.
        • Cohen P.
        • Dayer P.
        • Vischer T.L.
        Neurophysiologic evidence for a central sensitization in patients with fibromyalgia.
        Arthritis Rheum. 2003; 48: 1420-1429
        • Gowans S.E.
        • deHueck A.
        • Voss S.
        • Silaj A.
        • Abbey S.E.
        • Reynolds W.J.
        Effect of a randomized, controlled trial of exercise on mood and physical function in individuals with fibromyalgia.
        Arthritis Care Res. 2001; 45: 519-529
        • Gracely R.H.
        • Lynch S.A.
        • Bennett G.J.
        Painful neuropathy: altered central processing maintained dynamically by peripheral input.
        Pain. 1992; 51: 175-194
        • Hadhazy V.
        Mind and body therapy for fibromyalgia.
        Cochrane Database Syst Rev. 2003; 1
        • Hakkinen A.
        • Hakkinen K.
        • Hannonen P.
        • Alen M.
        Strength training induced adaptations in neuromuscular function of premenopausal women with fibromyalgia: Comparison with healthy women.
        Ann Rheum Dis. 2001; 60: 21-26
        • Hayes S.C.
        Single case experimental design and empirical clinical practice.
        J Consult Clin Psychol. 1981; 49: 193-211
        • Isomeri R.
        • Mikkelsson M.
        • Latikka P.
        • Kammonen K.
        Effects of amitrityline and cardiovascular fitness training on pain in patients with primary fibromyalgia.
        J Musculoskelet Pain. 1993; 2: 253-260
        • Janal M.N.
        • Colt E.W.
        • Clark W.C.
        • Glusman M.
        Pain sensitivity, mood and plasma endocrine levels in man following long-distance running: Effects of naloxone.
        Pain. 1984; 19: 13-25
        • Jones K.D.
        • Clark S.R.
        Individualizing the exercise prescription for persons with fibromyalgia.
        Rheum Dis Clin North Am. 2002; 28: 419-436
        • Kemppainen P.
        • Pertovaara A.
        • Huopaniemi T.
        • Johansson G.
        • Karonen S.L.
        Modification of dental pain and cutaneous thermal sensitivity by physical exercise in man.
        Brain Res. 1985; 360: 33-40
        • King C.D.
        • Devine D.P.
        • Vierck C.J.
        • Rodgers J.
        • Yezierski R.P.
        Differential effects of stress on escape and reflex responses to nociceptive thermal stimuli in the rat.
        Brain Res. 2003; 987: 214-222
        • King S.J.
        • Wessel J.
        • Bhambhani Y.
        • Sholter D.
        • Maksymowych W.
        The effects of exercise and education, individually or combined, in women with fibromyalgia.
        J Rheumatol. 2002; 29: 2620-2627
        • Koltyn K.F.
        Analgesia following exercise: A review.
        Sports Med. 2000; 29: 85-98
        • Maixner W.
        • Fillingim R.
        • Sigurdsson A.
        • Kincaid S.
        • Silva S.
        Sensitivity of patients with painful temporomandibular disorders to experimentally evoked pain: Evidence for altered temporal summation of pain.
        Pain. 1998; 76: 71-81
        • Maquet D.
        • Croisier J.L.
        • Renard C.
        • Crielaard J.M.
        Muscle performance in patients with fibromyalgia.
        Joint Bone Spine. 2002; 69: 293-299
        • Martin L.
        • Nutting A.
        • MacIntosh B.R.
        • Edworthy S.M.
        • Butterwick D.
        • Cook J.
        An exercise program in the treatment of fibromyalgia.
        J Rheumatol. 1996; 23: 1050-1053
        • McCain G.A.
        • Bell D.A.
        • Mai F.M.
        • Halliday P.D.
        A controlled study of the effects of a supervised cardiovascular fitness training program on the manifestations of primary fibromyalgia.
        Arthritis Rheum. 1988; 31: 1135-1141
        • Meiworm L.
        • Jakob E.
        • Walker U.A.
        • Peter H.H.
        • Keul J.
        Patients with fibromyalgia benefit from aerobic endurance exercise.
        Clin Rheumatol. 2000; 19: 253-257
        • Mengshoel A.M.
        • Vollestad N.K.
        • Forre O.
        Pain and fatigue induced by exercise in fibromyalgia patients and sedentary healthy subjects.
        Clin Exp Rheumatol. 1995; 13: 477-482
        • Miles M.P.
        • Clarkson P.M.
        Exercise-induced muscle pain, soreness, and cramps.
        J Sports Med Phys Fitness. 1994; 34: 203-216
        • Nørregaard J.
        • Lykkegaard J.J.
        • Mehlsen J.
        • Danneskiold-Samsøe B.
        Exercise training in treatment of fibromyalgia.
        J Musculoskelet Pain. 1997; 5: 71-79
        • Owens P.C.
        • Smith R.
        Opioid peptides in blood and cerebrospinal fluid during acute stress.
        Baillieres Clin Endocrinol Metab. 1987; 1: 415-437
        • Peng Y.B.
        • Lin Q.
        • Willis W.D.
        Involvement of alpha-2 adrenoceptors in the periaqueductal gray-induced inhibition of dorsal horn cell activity in rats.
        J Pharmacol Exp Ther. 1996; 278: 125-135
        • Price D.D.
        • Craggs J.G.
        • Zhou Q.Q.
        • Verne G.N.
        • Perlstein W.M.
        • Robinson M.E.
        Widespread hyperalgesia in irritable bowel syndrome is dynamically maintained by tonic visceral impulse input and placebo/nocebo factors: Evidence from human psychophysics, animal models, and neuroimaging.
        Neuroimage. 2009; 47: 995-1001
        • Price D.D.
        • Harkins S.W.
        Psychophysical approaches to pain measurement and assessment.
        in: Turk D.C. Melzack R. Handbook of Pain Assessment, 1st ed. Guilford Press, New York, NY1992: 114-134
        • Price D.D.
        • Vander-Gruen A.
        • Miller J.
        • Rafii A.
        • Price C.
        A psychophysical analysis of morphine analgesia.
        Pain. 1985; 22: 261-269
        • Rossy L.A.
        • Buckelew S.P.
        • Dorr N.
        • Hagglund K.J.
        • Thayer J.F.
        • McIntosh M.J.
        • Hewett J.E.
        • Johnson J.C.
        A meta-analysis of fibromyalgia treatment interventions.
        Ann Behav Med. 1999; 21: 180-191
        • Satoh M.
        • Kuraishi Y.
        • Kawamura M.
        Effects of intrathecal antibodies to substance P, calcitonin gene-related peptide and galanin on repeated cold stress-induced hyperalgesia: Comparison with carrageenan-induced hyperalgesia.
        Pain. 1992; 49: 273-278
        • Schwarz L.
        • Kindermann W.
        Changes in beta-endorphin levels in response to aerobic and anaerobic exercise.
        Sports Med. 1992; 13: 25-36
        • Sigurdsson A.
        • Maixner W.
        Effects of experimental and clinical noxious counterirritants on pain perception.
        Pain. 1994; 57: 265-275
        • Sorensen J.
        • Graven-Nielsen T.
        • Henriksson K.G.
        • Bengtsson M.
        • Arendt-Nielsen L.
        Hyperexcitability in fibromyalgia.
        J Rheumatol. 1998; 25: 152-155
        • Sparling P.B.
        • Giuffrida A.
        • Piomelli D.
        • Rosskopf L.
        • Dietrich A.
        Exercise activates the endocannabinoid system.
        Neuroreport. 2003; 14: 2209-2211
        • Staud R.
        • Craggs J.G.
        • Perlstein W.M.
        • Robinson M.E.
        • Price D.D.
        Brain activity associated with slow temporal summation of C-fiber evoked pain in fibromyalgia patients and healthy controls.
        Eur J Pain. 2008; 12: 1078-1089
        • Staud R.
        • Nagel S.
        • Robinson M.E.
        • Price D.D.
        Enhanced central pain processing of fibromyalgia patients is maintained by muscle afferent input: A randomized, double-blind, placebo controlled trial.
        Pain. 2009; 145: 96-104
        • Staud R.
        • Robinson M.E.
        • Price D.D.
        Temporal summation of second pain and its maintenance are useful for characterizing widespread central sensitization of fibromyalgia patients.
        J Pain. 2007; 8: 893-901
        • Staud R.
        • Spaeth M.
        Psychophysical and neurochemical abnormalities of pain processing in fibromyalgia.
        CNS Spectr. 2008; 13: 12-17
        • Valkeinen H.
        • Hakkinen A.
        • Hannonen P.
        • Hakkinen K.
        • Alen M.
        Acute heavy-resistance exercise-induced pain and neuromuscular fatigue in elderly women with fibromyalgia and in healthy controls - Effects of strength training.
        Arthritis Rheum. 2006; 54: 1334-1339
        • van Santen M.
        • Bolwijn P.
        • Landewe R.
        • Verstappen F.
        • Bakker C.
        • Hidding A.
        • van der Heijde D.
        • Houben H.
        • van der Linden S.
        High or low intensity aerobic fitness training in fibromyalgia: Does it matter?.
        J Rheumatol. 2002; 29: 582-587
        • Vidal C.
        • Jacob J.J.
        Stress hyperalgesia in rats: An experimental animal model of anxiogenic hyperalgesia in human.
        Life Sci. 1982; 31: 1241-1244
        • Wigers S.H.
        • Stiles T.C.
        • Vogel P.A.
        Effects of aerobic exercise versus stress management treatment in fibromyalgia. A 4.5 year prospective study.
        Scand J Rheumatol. 1996; 25: 77-86
        • Wolfe F.
        • Smythe H.A.
        • Yunus M.B.
        • Bennett R.M.
        • Bombardier C.
        • Goldenberg D.L.
        • Tugwell P.
        • Campbell S.M.
        • Abeles M.
        • Clark P.
        • Fam A.G.
        • Farber S.J.
        • Fiechtner J.J.
        • Franklin C.M.
        • Gatter R.A.
        • Hamaty D.
        • Lessard J.
        • Lichtbroun A.S.
        • Masi A.T.
        • McCain G.A.
        • Reynolds W.J.
        • Romano T.J.
        • Russell I.J.
        • Sheon R.P.
        The American College of Rheumatology 1990 Criteria for the Classification of Fibromyalgia. Report of the Multicenter Criteria Committee.
        Arthritis Rheum. 1990; 33: 160-172