Lyme Disease Pain Treatment

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How to Treat Lyme Disease Pain Image by Marty Ross MD

Overview of Lyme Disease Pain Control

Most people with Lyme have pain. In this article I review the causes of Lyme pain and the steps a person can take to control and eliminate pain. I provide a strategy for controlling Lyme disease pain which uses:

  • Sleep,
  • Diet,
  • Anti-cytokine herbs and supplements to lower inflammation,
  • Supplements that support repair of mitochondria cell energy factories,
  • Low dose naltrexone (LDN),
  • Medical marijuana and/or CBD oil,
  • Magnesium to relax muscles,
  • Acupuncture, and
  • Prescriptions medications.

Types of Pain in Lyme Disease

There are three types of pain occuring in chronic Lyme disease. They are

  • inflammation,
  • neurologic, and
  • muscle spasm.

Cytokine Inflammation in Lyme Disease Pain

It is well known that Lyme disease triggers white blood cells to make excess inflammation chemicals called cytokines. These cytokines cause pain. For a detailed description of this and a review of treatments see Control Cytokines: A Guide to Fix Lyme Symptoms & The Immune System.

Lyme disease Pain Strategy

So one strategy to lower pain in Lyme disease is to take herbs and supplements that may support lowering cytokines. These include curcumin and liposomal glutathione. Low dose naltrexone (LDN), a prescription medicine, can also lower cytokines.

Neurologic Pain in Lyme Disease

Lyme disease can also cause neurologic pain. Nerve pain has qualities of sharp, stabbing, shooting, piercing, or electrical type pain. These qualities of pain occur when Lyme germs directly injure nerves. Or it occurs as a result of inflammation of those nerves from cytokines.

There is a second type of nerve pain known to occur in people with fibromyalgia and MS, that likely occurs in people with Lyme disease. This is due to infection in the brain activating a brain immune cell called “microglia”. When infections activate Toll-like receptors on microglia, this leads to neurologic pain felt throughout the body. Some think this is the cause of the muscle pain (myalgia) seen in people with fibromyalgia. It is also likely a major cause of the myalgia seen in Lyme disease.  

Lyme Disease Pain Strategy

For nerve pain due to microglia activation in the brain, one strategy is to block the Toll-like receptors to stop the microglia from turning on. LDN helps with this.

Another strategy is to decrease the inflammation of nerves. LDNanti-cytokine herbs, and medical marijuana/cbd oil may help with this.

The last nerve strategy is to decrease the nerve signals that transmit nerve pain. Sleep helps with this, medical marijuana/cbd, prescriptions anti-seizure prescriptions and anti-depression prescriptions can help this too. 

Muscle Spasm Pain in Lyme Disease

Due to inflammation or nerve injury, many with Lyme have pain due to muscle spasm. In addition to strategies to lower cytokines and to control nerve pain signals, muscle relaxers can help with this situation.

Lyme Disease Pain Strategy

Magnesium is a useful supplement that supports muscle relaxation. The salt forms of magnesium that are most helpful for this are Magnesium Malate and Magnesium Citrate. Prescription muscle relaxers are also helpful.

Additional Pain Factors in Lyme Disease

Sleep in Lyme Disease Pain Management

The center of a pain control strategy in Lyme disease is sleep. Sleep helps in two ways.

  1. Getting adequate sleep decreases pain sensitivity, which increases pain tolerance.
  2. Sleep also lowers inflammation cytokines that lead to Lyme pain.

Lyme Disease Pain Strategy

Get 7-9 hours of sleep a night. To do this use good sleep hygiene, sleep herbs and supplements, and/or sleep prescriptions. See Sleep in Lyme Disease: The Basic StepsSleep: The Natural Medicines, and Sleep: The Prescription Medicines.

Mitochondria Dysfunction and Chronic Pain

Mitochondria are the energy factories found in every cell. By some estimates there are 300 to 400 mitochondria in a cell. Chronic infection can damage the mitochondria. There is a growing body of science showing damaged mitochondria leads to chronic pain.

Lyme Disease Pain Strategy

It is possible to repair mitochondria. See How to Fix Mitochondria & Get Energy in Lyme Disease for steps to repair the injured mitochondria.

One other strategy is to eat low inflammatory foods which support mitochondria. See The Best Brain, Inflammation, Pain, Energy, and Detox Diet Ever for more information about an effective paleo diet.

Traditional Pharmaceuticals for Lyme Disease Pain

Pharmaceutical medicines can control pain. However, they carry increased risks of side effects. In general, unlike the functional medicine approaches I described above, these medicines mask the symptoms, but do not fix the underlying problems that give pain.


Non-steroidal anti-inflammatory drugs (NSAIDS) like ibuprofen and naprosyn, may lower inflammation and help with pain. However, they have significant risk of hurting cartilage, stomach lining irritation and bleeding, or even nausea. So I do not recommend these for long-term use.

Lyrica and Cymbalta 

Both of these medications are approved by the US Food and Drug Administration to manage nerve pain and fibromyalgia. Lyrica is very costly, so some insurance companies will not pay for it. And both medications have significant side effect risk of sleepiness and some nervous system side effects too. Cymbalta is useful for depression. So, these medications can help with muscle achiness pain and nerve pain seen in Lyme.

Anti-seizure medicines 

LyricaNeurontin (gabapentin), GabitrilTopamax, and other anti seizure medicines are useful for nerve pain. These medicines bind to the GABA-benzodiazepine receptors and nerve cells to change the transmission of pain by nerves.

Anti-depression medicines 

These are medicines like amitriptylinenortriptylinedesipramine, and imipramine. The medicines are from an older family of anti-depression medicines called the tricyclic antidepressant medicines. Cymbalta also is an anti-depression medicine.

Muscle relaxers

These include Flexeril (cyclobenzaprine), Robaxin (Methocarbamol), and Skelaxin (metaxalone).


As a last resort, narcotics are an option. These are medicines like oxycodonePercocethydrocodoneVicodinmethadonefentanyl, and others. Because of the risk of addiction, these should only be used as a last resort. They usually are used in combination with anti-seizure medicines or anti-depression medicines

Putting It All Together

Basic Approach

Enhanced Basic Approach

If the basic approach is not effective, then add one or more of the following.

  • LDN. This is useful for ongoing myalgia pain, nerve pain, and inflammation pain. But be aware it can take 3 or more months to work. This is a slower approach. LDN is made by a compounding pharmacist. Start at 1.5mg a day and work up to 4.5mg a day. See full prescribing information and side effect issues in Low Dose Naltrexone (LDN) & Lyme
  • CBD Oil or Medical Marijuana. This is very useful for nerve pain. It can sometimes help with myalgia pain too. This is a quick acting approach. The trick is to find the right dose. Generally, use CBD starting at 5mg 2 times a day. For night time use, use medical marijuana which is higher in THC. CBD is upping, which is useful in the day,  and THC causes sleep. Also start this at 5mg. For CBD and THC marijuana, dosing is very individual. For full information about options for taking and using CBD and THC see Medical Marijuana, Cannabis, & CBD for Lyme.
  • Repair Mitochondria. For chronic pain which is not responding to the basic approach, especially if you have low energy, consider taking steps to repair the mitochondria energy factories. At a minimum start NT Factor Phospholipids 2 pills 3 times a day for 2 months, then decrease to 1 pill 3 times a day for 4 months. Take this with liposomal glutathione 400 to 500 mg 1 time a day. For a more detailed plan see How to Fix Mitochondria & Get Energy in Lyme Disease
  • Acupuncture. This is very usefull for nerve and muscle pain.

Enhanced Basic Approach Plus Drugs

If the above approaches are not working then consider working with a physician to add anti-seizure medicines or anti-depression medicines including Lyrica or Cymbalta. As a last option, consider narcotics.

Muscle Spasms

Decrease muscle spasms with Magnesium Malate or Magnesium Citrate 400 to 600 mg at bed time. Decrease the dose if diarrhea develops. Take at night because it can make a person sleepy. If this does not work, then consider adding prescription muscle relaxers.


The ideas and recommendations on this website and in this article are for informational purposes only. For more information about this, see the sitewide Terms & Conditions.


View Citations

  1. Bellato E, Marini E, Castoldi F, et al. Fibromyalgia syndrome: etiology, pathogenesis, diagnosis, and treatment. Pain Research and Treatment. 2012;2012:426130. doi:10.1155/2012/426130.
  2. Mariani MM, Kielian T. Microglia in infectious diseases of the central nervous system. Journal of Neuroimmune Pharmacology : The Official Journal of the Society on Neuroimmune Pharmacology. 2009;4(4):448-461. doi:10.1007/s11481-009-9170-6.
  3. Finan PH, Goodin BR, Smith MT. The association of sleep and pain: An update and a path forward. The Journal of Pain: Official Journal of the American Pain Society. 2013;14(12):1539-1552. doi:10.1016/j.jpain.2013.08.007.
  4. Milrad SF, Hall DL, Jutagir DR, et al. Poor sleep quality is associated with greater circulating pro-Inflammatory cytokines and severity and frequency of chronic fatigue syndrome/ myalgic encephalomyelitis (CFS/ME) symptoms in women. Journal of Neuroimmunology. 2017;303:43-50. doi:10.1016/j.jneuroim.2016.12.008.
  5. Sui B, Xu T, Liu J, et al. Understanding the role of mitochondria in the pathogenesis of chronic pain. Postgraduate Medical Journal 2013;89:709-714.
  6. For references about cytokines, LDN, and medical marijuana, see individual articles on this site.
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About The Author

Marty Ross, MD is a passionate Lyme disease educator and clinical expert. He helps Lyme sufferers and their physicians see what really works based on his review of the science and extensive real-world experience. Dr. Ross is licensed to practice medicine in Washington State (License: MD00033296) where he has treated thousands of Lyme disease patients in his Seattle practice.

Marty Ross, MD is a graduate of Indiana University School of Medicine and Georgetown University Family Medicine Residency. He is a member of the International Lyme and Associated Disease Society (ILADS) and The Institute for Functional Medicine.

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