Pain is the result of inflammation and direct injury of certain tissues. In Lyme, white blood cells that attack germs produce inflammatory cytokines like interleukin-6 and tissue necrosis factor alpha. These cytokines have many effects that ultimately produce inflammatory prostaglandins and hypercoagulability (easy clotting) of the blood. Hypercoagulability can lead to poor blood flow into tissues fed by small blood vessels because the blood becomes more “sticky”. This can lead to poor oxygenation of all tissues including the muscles. When muscles do not receive sufficient oxygen they ache and can develop spasms. Common over-the-counter treatments for pain like ibuprofen and aspirin lower prostaglandins by blocking COX enzymes that are used to produce them. One way that cytokines increase pain is to increase the production of COX enzymes. Treatment approaches to reduce pain in Lyme work to lower inflammatory cytokines, decrease prostaglandins, improve blood flow to the tissues, and decrease muscle spasms.