Why Rest Isn’t Fixing Your Chronic Pain or Fatigue
- Dr. Jason Winkelmann
- 4 days ago
- 7 min read
Most people with chronic pain or long-term fatigue eventually arrive at the same confusing conclusion: rest doesn’t work. You slow down. You cancel plans. You spend more time lying down, waiting for your body to recover. Yet instead of feeling restored, you often feel weaker, heavier, and more sore. Sometimes as if you just finished an intense workout despite doing very little at all. For many patients, this disconnect diminishes trust in their body and leaves them wondering what they’re missing.
This experience is not unusual, and it is not a personal failure. It reflects a specific physiological problem that is rarely explained clearly in conventional care: impaired energy production at the cellular level. When the systems responsible for generating energy cannot keep up with basic demands, rest alone cannot restore function. In fact, excessive rest can sometimes worsen symptoms, deepening fatigue and amplifying pain.
In this article, we will walk through mitochondrial dysfunction—what it is, why it is so common in chronic pain conditions, and how it explains symptoms like constant muscle soreness, exercise intolerance, and unrelenting fatigue. The goal is not to oversimplify or offer quick fixes, but to give you a coherent biological framework for understanding why your body feels the way it does.
What Mitochondria Actually Do (Beyond “The Powerhouse of the Cell”)
Most people remember mitochondria from school as “the powerhouse of the cell,” then promptly forget about them. That phrase is accurate, but wildly incomplete.
Your body is made up of trillions of cells. Inside most of those cells are mitochondria. Tiny organelles whose primary job is to convert fuel into usable energy in the form of ATP (adenosine triphosphate). ATP is not optional. It is the energy currency required for all bodily functions:
Muscle contraction and relaxation
Tissue repair and healing
Nervous system signaling
Immune regulation
Hormone production
Detoxification and cellular maintenance
You are likely producing just enough ATP to stay alive. But healing, recovery, and adaptation require extra ATP. Chronic pain patients are often surviving energetically, but they are not thriving at the cellular level.
In clinical practice, this distinction matters. Someone can have “normal labs,” adequate sleep time and plenty of rest but still lack the cellular energy required to repair tissue or regulate pain signals.
Why Mitochondrial Dysfunction Is A Hallmark Of Chronic Pain
In chronic pain states, mitochondria are not absent or destroyed. They are underperforming.
Across conditions like fibromyalgia, chronic fatigue–associated pain, post-viral pain syndromes, autoimmune-associated pain, and centrally sensitized pain states, mitochondrial inefficiency shows up repeatedly. In fact, it is rare to see long-standing chronic pain without some degree of impaired mitochondrial function.
When mitochondria cannot produce enough ATP, several things happen simultaneously:
First, damaged tissues do not heal efficiently. Micro-injuries accumulate faster than repair can keep up. Muscles feel sore, tight, or inflamed without clear overuse.
Second, the nervous system becomes metabolically stressed. Pain processing itself is energy-intensive. When ATP is scarce, the nervous system becomes more reactive, less precise, and more prone to amplifying signals.
Third, daily activities begin to exceed energy supply. Showering, cooking, thinking clearly, or leaving the house can feel disproportionately exhausting. Not because the tasks are demanding, but because the energy system is limited.
This is why many people with chronic pain say, “I wake up tired,” or “It feels like my muscles are full of concrete.” These are not metaphors. They reflect real metabolic strain.
How Healthy Mitochondria Make Energy—And Where Things Go Wrong
Under optimal conditions, mitochondria prefer to generate energy using fat and oxygen. This process occurs through aerobic metabolism and produces a high yield of ATP. Roughly nine ATP molecules per gram of fat.
Mitochondria can also produce energy using glucose (from sugar and carbohydrates) through less oxygen-dependent pathways. This produces significantly less ATP and creates a metabolic byproduct: lactic acid. Lactic acid is a normal byproduct after exercises. It is what produces that burning sensation in your muscles.
In a healthy system, lactic acid production is temporary and purposeful. In mitochondrial dysfunction, however, mitochondria rely more heavily on glucose-based energy production even at rest. This leads to chronic, low-grade lactic acid accumulation.
Clinically, this explains a very specific symptom pattern: muscles that burn, ache, or feel “worked out” despite minimal activity. This sensation is especially common in fibromyalgia and chronic widespread pain, where patients often describe feeling sore everywhere, all the time.
Why Rest Alone Can Actually Make Symptoms Worse
This is the part that feels counterintuitive and often deeply frustrating.
When you rest extensively, your body shifts further toward glucose-based metabolism. Movement and gentle activity increase oxygen delivery to tissues; prolonged inactivity reduces it. Even though you are breathing, your cells are not receiving the same oxygen concentration they would during movement.
As a result, mitochondria lean even more heavily on inefficient energy pathways. Lactic acid production increases which begins to damage cellular DNA. Muscles become more acidic, more irritable, and more painful. Fatigue deepens rather than resolves.
This creates a negative feedback loop: Pain leads to rest. Rest worsens mitochondrial inefficiency. Mitochondrial inefficiency increases pain and fatigue.
From the outside, this can look like “deconditioning” or “avoidance.” From the inside, it feels like your body punishes you for trying to recover.
Chronic Pain And Fatigue Are Not A Motivation Problem
At this point, it is important to state something clearly: chronic pain and fatigue are not problems of effort, mindset, or discipline.
If energy production at the cellular level is impaired, no amount of determination can override that physiology. This is why pushing through often backfires, and why resting without addressing metabolism also fails.
Understanding this shifts the conversation away from blame and toward biology. The question becomes not “Why can’t I do more?” but “What is limiting my energy production?”
Supporting Mitochondrial Function: Where Treatment Actually Begins
Fixing mitochondrial dysfunction is not simple, and it is never one-size-fits-all. That said, there are several easy and free ways to improve mitochondrial health.
Fat over Carbs and Sugar
The first is fuel selection. Mitochondria function more efficiently when they have access to dietary fat rather than being forced to rely primarily on sugar and refined carbohydrates. This does not mean extreme dieting or eliminating carbohydrates entirely. It means recognizing that fat is essential and constant glucose dependence can worsen lactic acid burden and reduce net ATP availability.
Breathing Exercises
The second is oxygen delivery. If movement is limited, intentional breathing becomes more important. Simple breathing exercises can significantly improve oxygen saturation at the cellular level, supporting mitochondrial energy production even in bed- or house-bound individuals. There are many to choose from and there are great YouTube videos to help guide you here.
Cold Exposure
The third is mitochondrial density and signaling. Certain tissues, such as brown adipose tissue, are densely packed with mitochondria. While this tissue declines with age, you can produce more by practicing regular cold exposure. The most common method is cold showers or baths. Importantly, cold intolerance in chronic pain often reflects underlying blood flow and autonomic regulation issues, not failure. These systems must be addressed before cold exposure is tolerable or helpful.
Supplements
Finally, there is biochemical support. Compounds like CoQ10 and creatine play direct roles in ATP production and recycling. CoQ10 supports the electron transport chain—the final step in energy generation—while creatine helps rapidly regenerate ATP once it has been used. These supports do not “fix” mitochondrial dysfunction on their own, but they can improve capacity while deeper regulatory issues are addressed.
Putting It All Together
When chronic pain and fatigue persist despite rest, the problem is rarely rest itself. It is energy availability.
Mitochondrial dysfunction explains why muscles burn without exertion, why fatigue feels disproportionate, and why recovery never quite arrives. It also explains why simplistic advice like “just rest more” or “just push through” misses the physiology entirely.
Chronic pain is not a moral failing. It is not a lack of resilience. At its core, it is often a problem of energy production and regulation.
When you understand that, the path forward becomes clearer—not easier, but more coherent. Treatment begins not with forcing the body to comply, but with restoring the systems that allow it to generate energy, regulate signals, and heal.
And that is where real recovery starts, not with more rest, but with better physiology.
For an even deeper understanding of mitochondrial dysfunction, how it contributes to chronic pain and fatigue syndromes, and how to treat yourself you can view the presentation I gave the US Pain Foundation below.
Written By:
Dr. Jason Winkelmann
Chronic Pain Specialist and Educator
Frequently Asked Questions
Why doesn’t rest fix chronic pain like it does acute pain?
Rest helps acute pain because the pain originates from a specific injury that needs time to heal. Chronic pain, however, involves altered nervous system signaling, central sensitization, and systemic contributors that don’t resolve simply with inactivity. In chronic cases, prolonged rest can even worsen pain by reducing movement, lowering circulation, and reinforcing protective nervous system patterns.
Can too much rest actually make chronic fatigue worse?
Yes. Extended rest without structured conditioning can lead to deconditioning, disrupted sleep patterns, reduced metabolism, and increased nervous system threat responses. In chronic fatigue, optimal recovery usually requires a balance of restorative sleep, graded activity, regulated stress responses, and lifestyle support—not just physical rest.
What’s the difference between rest and recovery?
Rest is simply reducing activity; recovery is the body’s ability to return to baseline after stress. True recovery involves quality sleep, nervous system regulation, balanced lifestyle inputs, and appropriate movement. Rest alone addresses only one component, while recovery addresses systems that support resilience and healing.
If rest isn’t enough, what should I be doing instead?
For chronic pain and fatigue, interventions should focus on nervous system regulation, graded and guided movement, improved sleep quality, stress management, nutrition optimization, and addressing underlying physiological contributors. Structured activity, lifestyle changes, and targeted therapies help reset protective pain and fatigue responses rather than simply suppressing symptoms.
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