Build the Ultimate Fibromyalgia Pain Toolkit: Part 2 of 2

Build the Ultimate Fibromyalgia Pain Toolkit: Part 2 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!

In Part 1 of this article (read here), I reviewed different topical pain-relievers that are great additions to your personal toolkit.

Ginevra Liptan, MD

In this article I will review some self-treatment tools to ease the pain of muscle trigger points, those painful knots that like to pop up in our upper back, neck, and lower back muscles. One study found an average of 12 trigger points in subjects with fibromyalgia, compared to one or less in healthy controls. Our muscles and their surrounding connective tissue, the fascia, is abnormally tense and tight, making it more inflamed and “sticky” and leading to the development of painful adhesions and tender knots.

But no medication, used topically or orally, can ease trigger point pain. Instead, they need to be physically treated to release the knot. They respond well to certain types of massage therapy, such as myofascial release, and to trigger point injections. However, you can address them yourself with some simple tools as well.

The best way to treat these knots is physically disrupt the tissue by gentle stretching or sustained pressure to allow the knot to soften. Think about a snag in a sweater, and the bunching or knot of fibers that it causes. The only way to unravel the knot is to pull the fibers away from each other and slide them back in place. A trigger point is essentially a snag in the fiber of the fascia, and these sticky fibers need to be physically released or broken up to allow the muscle to relax.

So tools that allow for gentle stretching of the fascia or that apply sustained pressure to loosen contraction knots are a must have in any fibromyalgia pain toolkit. Keep in mind with all these tools that breaking up fascial adhesions and knots requires sustained (meaning at least 3 minutes) and gentle constant pressure, not rubbing or rolling.

Thumbby Soft Massage Cone

This wonderful little tool sticks to the wall, allowing you to lean into it with your body weight to release tense, knotty areas. It feels like a thumb gently pressing into just the right spot. Great for use on trigger points in the upper and lower back. It is small, lightweight, and provides just the right amount of sustained pressure to allow trigger points to soften.

4″ Small Ball

Lie on the floor and place this small ball under any tight and painful areas. Allow yourself to sink onto the ball for a few minutes to provide the right amount of sustained pressure to gently release the fascia and break up trigger points. Really great for trigger points and tight areas in the buttocks and low back area. If you have a ball pump (like for a basketball or soccer ball) you can adjust the pressure in the ball to a level that is comfortable for you.

Half-Round Foam Roller

Lie on this foam roller (you can also use rolled up towel) with your head, neck, and spine supported by the roller, with arms out to the side in a T-position. This allows your body to relax the tightness held in our shoulders and neck and gives a gentle stretch to the chest wall, front of the shoulders, and neck. We spend so much of our time with our head and neck leaning forward as we look at computers or phones. This position generates significant neck and upper back tightness and trigger points in the upper trapezius muscles. Spending a few minutes a day in the opposite position, with the shoulders relaxed and soft around a half-foam roller or rolled up towel can ease this tension and allow trigger points in the upper back to soften.


This tool was designed to feel and function like skilled therapeutic hands under the body to gently relax tense muscles. It is a small soft foam cushion that can be place under your neck, upper back, or lower back for a nice fascial stretch of those areas. It can also be used as targeted treatment for trigger points, similar to how you use the small ball. But this jack-of-all-trades tool has a few more uses too! If you place the craniocradle at the base of your skull and lie on it for a few minutes, those tense muscles that so commonly trigger tension headaches will soften. If you are prone to tension headaches you will want to give this tool a try. And if that wasn’t enough, the pressure of the craniocradle at the base of your head also triggers the brain to generate a bodywide relaxation response that will ease anxiety and lessen overall muscle tension.

Visit for helpful instructional videos to learn the multiple ways you can use this tool.

Work on finding the right tools to fill your personal pain toolkit so you are never left trying to hammer in a nail with a screwdriver. And make sure to read Part 1 here to find the right topicals to add to your toolkit as well, 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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Authored by: Ginevra Liptan, MD

Ginevra Liptan, MD, developed fibromyalgia while in medical school. She is a graduate of Tufts University School of Medicine and board-certified in internal medicine. Dr. Liptan is the founder and medical director of The Frida Center for Fibromyalgia and the author of The Fibro Manual: A Complete Fibromyalgia Treatment Guide for You...And Your Doctor and The Fibro Food Formula: A Real-Life Approach to Fibromyalgia Relief.

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Alan Edwards

Ibin well stated what the esteemed doctor did not. Fibromyalgia, as I have, did not yield to a toolkit approach. My condition includes spondylitis, chronic migraines, and spastic cerebral palsy with associated brain trauma. My neuropathy became unbearable and is successfully being treated with horrible lyrica and opiods. My opioid dose was reduced resulting in increased pain which has been countered by the pregabalin. What was gained by reducing the opioid dosage? Pain. So severe sleep became impossible. The touch of pillows and sheets induced a burning, aching supersensation which enveloped my ears, head arms and torso. Lyrica at the current dosage is not totally effective and Medicare refused the 4, 75mg. capsules prescribed by my neurologist even though I offered to pay 100 percent.
It is telling that the doctors toolkit does not include effective medications and is just another politically correct article exhibited by NPR.


There can be many different “ways” to deal with fibromyalgia and the best way is, the way that works for the……individual. I have seen my wifes’ health condition with fibro, diagnosed 10 years ago, conitnue to decay. She is no longer able to perform much exercise, even though she was a “champion” bodybuilder. She used no steroids to enhance faster, more efficient muscle growth. That was 35 years ago. In fact, she prefers to use no drugs at all, still. Not even a “tylenol”. However, the flesh will …..yeild, to the pain. My point made, by all means use any method of “healthy” fibro pain management available but, when the condition advances enough, their may be no other relief than what is readily available from our providers. I have met and know many patients, “chronic” pain patients over the kast 23 years that have continuous pain beyond, their bodies own ability to manage. NOT ONE, with stated pain so severe, does not use prescribed, managed, opioid medication, has become unfortunately an alcoholic (don’t beleive alcohol helps with “chronic” pain), uses illicit, illegal substances for pain relief when and if they can get it, or overdoses on “tylenol”. Which one seems the least harmful in pain management?