Pain Management

Pain is a very common symptom with ME.  Below are portions of the IC Primer that deal with the types of pain that many experience.  There is also a list of ways listed that might help with these pain conditions.  We also include a list of ways that patients have suggested. Please feel free to email us with any additional suggestions.
A hand-drawing of the muscles of the human back, from the pelvic region to the base of the skull.

"Pain" (IC Primer p. 7)

  • “Headaches: e.g. chronic, generalized headaches often involve aching of the eyes, behind the eyes or back of the head that may be associated with cervical muscle tension; migraine; tension headaches.”
  • “Significant pain can be experienced in muscles, muscle-tendon junctions, joints, abdomen or chest. It is noninflammatory in nature and often migrates. e.g. generalized hyperalgesia, widespread pain (may meet fibromyalgia criteria), myofascial or radiating pain.”

"Pain" (IC Primer p. 17)

Possible pathological types/components:

  • altered sensory information and pain processing in the brain that is perceived as pain
  • peripheral neuropathies
  • decreased pain threshold
  • dysregulation of sodium channels & ion transport
  • magnesium deficiency
  • inflammatory conditions
  • muscle pain generated by movement: paretic (decrease in muscle bulk/tone), spastic – (increase in muscle bulk/tone)
  • structural pain: failure of supportive structures

Differential pain diagram and descriptive words help determine type of pain:

  • aching
  • stabbing
  • shooting
  • pins & needles; (visual analogue scale: estimate severity)

Treat localized pain because it can intensify general pain


  • avoid pain exacerbators
  • pacing
  • local heat or cold
  • gentle stretching; manipulative body therapy
    • massage
    • physiotherapy
    • chiropractic
    • myofascial release techniques
  • relaxation techniques
    • biofeedback
    • ultrasound
    • meditation
  • TENS (Transcutaneous Electrical Nerve Stimulation)
  • acupuncture
  • magnesium sulfate (for muscle spasm)
  • hydrotherapy
  • Synaptic® Electronic Activation


  • topical ointments
  • anti-inflammatory/degenerate/neuropathies
    • NSAIDs
    • ibuprofen
    • naproxen
  • COX-2 inhibitors
    • Celecoxib
  • anticonvulsants
    • Gabapentin
    • Pregabalin
  • TCA [tricyclic antidepressants] – low dose for short time
    • Amitriptyline
    • Nortriptyline
    • Doxepin
  • muscle relaxants
    • Baclofen
    • Cyclobenzaprine
  • migraines
    • Sumatriptan Succinate
  • narcotic/opiates: only if severe – requires rationale & documentation

Suggestions from our members:

  • Acupuncture from one trained in traditional Chinese medicine
  • Distraction is a powerful coping technique
  • Epsom salt bath
  • Magnesium spray
  • Lavender oil
  • Peppermint oil
  • Foods with salicylate (almonds)
  • Antioxidants
  • Lots of fluids to flush out toxins
  • Food symptom diary to find pain triggers (beef triples my pain levels)

Can Food Fight Pain?

How to Use Ginger for Pain Relief

Pain From Vitamin D Deficiency – And What To Do

How to Use Fish Oil for Pain Relief

How to Use Coconut Oil for Pain Relief

How to Use Tart Cherries for Pain Relief

Almonds for the pain

Homemade Muscle Rub Recipe with Cayenne Pepper for Quick Pain Relief

Apple Cider Vinegar for Pain Relief (video)  (8:39)

And, of course, activity level that avoids PENE (rest as much as needed to avoid exacerbation of symptoms)

Caffeine – My favorite way to start each day is with a great cup of coffee! I also will enjoy a cup of tea or perhaps a drink with caffeine in it. If you take it early enough, you could really ease your headache pain. It also will help acetaminophen (Tylenol) to work better. Drinking too much could be a problem and cause caffeine withdrawal. It is my favorite way to help with a headache!

A Cold Pack can work wonders. – If you have a migraine headache, place a cold pack on your forehead. Ice cubes wrapped in a towel, a bag of frozen peas, or even a cold shower may lessen the pain. Keep the compress on your head for 15 minutes, then take a break for 15 minutes.

A Hot Compress or a Heating Pad – If you have a tension headache, place a heating pad on your neck or the back of your head. If you have a sinus headache, hold a warm cloth to the area that hurts. A warm shower might also do the trick.


Stanford Hospital's Dr. Ian Carroll on Nerve Pain (1:39:10) 28 Oct 2013

An informative presentation by Dr. Ian Carroll of Stanford (California, US) explaining what nerve pain is, as well as information about how various medications work. Posted in 2013, this presentation does not include the more recent information about the effectiveness of low dose naltrexone.


Unraveling the Complexity of Chronic Pain and Fatigue (Part 1 of 3) (53:05) 06 Sept 2020

Part 1: Dr. Lucinda Bateman, internist and Medical Director at the Bateman Horne Center, teaches about strategies and tools for systematically approaching complex chronic illness presentations. This presentation contains the following: • Case presentations • Tools for measuring and tracking severity of pain and fatigue • Tools for efficiently measuring and tracking impaired function

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