Build the Ultimate Fibromyalgia Pain Toolkit: Part 1 of 2

By Ginevra Liptan, MD.

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. For Pain Awareness Month, I want to help you build your own personal fibromyalgia toolkit, so you can always have the right tool on hand, since you can’t take out a screw with a hammer!

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. In part 2 of this article, I will review all the devices that can go into your toolbox to relieve painful muscle knots.

Ginevra Liptan, MD

But first I want to talk about topical pain-relievers, which are one of my favorite ways to manage pain because they can provide targeted relief, based on the specific type of pain, 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 is the relaxation mineral: It 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 and ease muscle spasms. 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. The creams and lotions are milder and gentler on the skin than the oils, but contain less magnesium.


  • 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 prescription non-steroidal anti-inflammatory (NSAID) medication, similar to ibuprofen. This type of medication when taken orally is usually not very effective for fibromyalgia, 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 or standing has made my feet ache, I grab the diclofenac gel from my toolkit.

Diclofenac also really helps joint pain due to arthritis, and is FDA-approved for that usage.  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
  • A prescription medication, so talk to your health care provider about whether this is an option for you

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. Fibromyalgia patients often report that cannabis used topically is very helpful for pain relief from arthritic joints and from sore muscles of fibromyalgia without making them feel “high.”

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. The most effective medical cannabis salves contain roughly equal amounts of THC and CBD.

Cannabis used topically does not cause a “high” feeling, but can be detectable in urine drug screening. 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, another option is a hemp extract that contains CBD only, as these are currently legal to be sold in all 50 states. Topical balms and salves that contain CBD derived from hemp plants have no mind-altering or psychoactive properties, but still can lower pain and inflammation and ease muscle spasms.


  • Muscle and joint pain
  • Pain from neuropathy (nerve damage)
  • Muscle spasms


  • Learn whether medical marijuana is legal in your state at or Marijuana Policy Project at
  • Many online CBD topicals are poor quality may not contain much CBD. One reliable source is

My Pain AwayTM Fibro Cream

An herbal homeopathic cream that is very gentle but still helpful for muscle and nerve pain. This cream is based on the principles of homeopathy, that very dilute amounts of natural substances can trigger a healing response in the body. It contains very small amounts of several herbs known to be useful for pain relief, including Arnica and Echinacea. Arnica has been used for hundreds of years to treat bruises, muscle pain, and inflammation. This formulation is very gentle and tolerated by even my most chemically sensitive patients.


  • Muscle pain hot spots
  • Neuropathy


  • Avoid if sensitive to any of the ingredients

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. Stay tuned for Part 2, to learn about the tools you need to treat trigger points, and check out my book The FibroManual to learn more about effective fibromyalgia treatment options.

Ginevra Liptan, MD is a graduate of Tufts University School of Medicine who developed fibromyalgia during medical school. She is now the medical director of The Frida Center for Fibromyalgia [] and the author of The FibroManual: A Complete Fibromyalgia Treatment Guide for You and Your Doctor [].

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