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Fibromyalgia Pain Toolkit: The Topicals

Fibromyalgia can throw a lot of different types of pain at us—aching joints and muscles, burning nerves, trigger points, and more. We need different tools to combat each type of pain. Oral medications have a role in managing fibromyalgia pain, but certain types of pain need a different approach. In particular, tight muscle knots or trigger points need to be released physically and localized hot spots of muscle or nerve pain often need targeted treatment with topical medications. Topical pain-relievers are one of my favorite ways to manage pain because they can provide targeted relief with little to no systemic side effects.

Although fibromyalgia pain is usually widespread, we all have a few localized “hot spots” of muscle pain, usually in the neck, upper back, and low back. Fibromyalgia muscle pain stems from irritated nerves in the fascia, the connective tissue surrounding muscles, which gets tight and inflamed especially in certain areas. Applying topical pain relievers can really ease the pain in these hot spots, along with calming muscle spasms. Many people with fibromyalgia have other pain conditions such as joint pain from wear-and-tear arthritis or nerve pain from neuropathy, and topical treatments can help here, too.

One of the best things about topical treatments is that they go straight to the source of pain and are much less likely to cause side effects since only trace amounts will end up in the bloodstream. This doesn’t mean they are completely risk-free, of course, and I have outlined the best uses and things to watch out for on each topical listed below. Keep in mind that we all respond differently to various treatments so it may take a little trial and error as you build your personalized pain toolkit.

Magnesium oil or lotion

Magnesium has calming effects on the brain, nerves, and muscles and can ease muscle spasms and cramps. Applying magnesium topically to your feet and legs before bed can allow the body to go into deeper sleep, and calm restless legs. Magnesium can relax muscle tightness, ease muscle spasms and reduce muscle and nerve pain. A Mayo Clinic study found topical magnesium improved fibromyalgia symptoms. Be careful, though, as magnesium is a salt, and can be a bit abrasive to the skin. If you have an open cut don’t use it on that area, as it will sting. Magnesium creams and lotions are milder and gentler on the skin than the oils, but contain less magnesium. Frida Botanicals makes a lightweight smooth moisturizing magnesium cream, another good option is this lotion from Ancient Minerals.

USE FOR: - Tight muscles, muscle cramps, restless legs - Generalized relaxation and to ease anxiety and insomnia


- High dosages of both oral and topical magnesium can cause loose stools - Magnesium oils can be irritating to the skin, lotions are usually better tolerated.

- Do not apply over areas of broken skin.

Diclofenac 1% gel

This is a non-steroidal anti-inflammatory (NSAID) medication, similar to ibuprofen. It used to be avaialble only by prescription in the US but is now available over the counter. This type of medication when taken orally is usually mildly effective for fibromyalgia pain, but it is a whole different story when applied to the skin over painful muscle hot spots. The fascia really soaks this stuff up, and it will work locally to calm inflammation. It is especially helpful for muscle pain caused by overuse. If typing causes my arms to flare, or walking has made my feet ache, I grab the diclofenac gel from my toolkit. Diclofenac also really helps joint pain due to arthritis. While oral NSAIDS can irritate the stomach lining and have other side effects, very little of the topical versions reach the bloodstream. So topical versions carry less risks, but are not risk-free, so make sure to review potential side effects with your health care provider.


- Localized hot spots of muscle or joint pain - Any “-itis” pain such arthritis, plantar fasciitis, tendonitis

- Areas of overuse or after repetitive movement

- Apply over temples for a headache


- Can be toxic to pets so do not let them lick your skin after application

Medical marijuana/CBD salves:

If you live in a state where medical marijuana (cannabis) is legal, you can find a plethora of locally made balms and salves sold in dispensaries. Cannabis contains two primary pain-relieving chemicals, THC and CBD (cannabidiol). THC is a strong pain reliever but also causes the psychoactive effects of feeling “high.” However, topical usage allows the pain-relieving effects of THC without the brain effects, as very little is absorbed into the bloodstream. CBD gives mild pain relief along with anti-inflammatory and muscle relaxation effects. If you live in a state where medical marijuana use is legal, dispensaries are the best option to get high quality cannabis balms.

For those who live in states where cannabis is illegal or who don't wish to use anything containing THC, another option is a topical that contains CBD only. Although CBD has no mind-altering or psychoactive properties, it can lower pain and inflammation and ease muscle spasms. Frida Botanicals CBD muscle balm combines CBD with other herbal pain-relieving extracts.

USE FOR: - Muscle and joint pain - Pain from neuropathy (nerve damage) - Muscle spasms

CAUTIONS: - THC-containing products used topically does not cause a “high” feeling, but may be detectable in urine drug screening. - Many CBD topicals are of poor quality and may not contain much CBD.

Look into adding topical agents to your personal fibromyalgia pain toolkit, so you will never be left trying to hammer in a nail with a screwdriver! In this video learn more about how to combine topical pain relievers for the ultimate toolkit.


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