Fibromyalgia Treatment

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Published: September 6, 2017
Last reviewed: September 18, 2017

Fibromyalgia develops as a reaction of your nervous system to sustained anxiety, depression, anger or fear [1]. Such emotions are usually a sign of an unresolved conflict you have with yourself, others or your job.

To overcome fibromyalgia, you need to find which work and relationships bring peace into your heart and stick with them. When things become hard, ask yourself if you are still in peace to continue or you need to change something.

For successful work you need enough sleep. Set up a regular sleeping schedule and avoid things that may disturb your sleep, such as daytime naps, caffeine, alcohol and worries before bed.

Fibromyalgia does not involve any tissue damage, so there are no drugs or other therapies that would cure that damage. Certain antidepressants and antiepileptics may have a mild effect on pain or sleep but try to avoid them because they may only mask your underlying problem.

They are usually rheumatologists who treat fibromyalgia, but fibromyalgia is not a rheumatic disease, so medical therapy might not help you. It is important that you discuss your problems with someone who you trust and who takes you seriously.

General Recommendations

Try the following [6,30,44,45]:

  • Become aware of your emotions, especially of the feeling of peace. If necessary, change something regarding your job or relationships, which can be very liberating.
  • Stay physically and otherwise active. Set a single clear goal and try to achieve it step by step. Have a rule about how much you work every day.
  • Have a regular sleeping pattern.
  • Discuss your problems with someone you trust.

Avoid:

  • Unnecessary stress
  • Drugs, supplements, herbs and chiropractic care because they do not likely help

Below is the evidence-based information about the effectiveness of various treatments for fibromyalgia.

Exercise

Moderate-intensity aerobic exercise (“cardio”) or muscle strength training for at least 30 minutes a day, 2-3 times a week for at least 4 weeks, may have a beneficial effect on well-being and physical function but less likely on pain and tender points [2,3,7,46,68].

You do not need to go to the gym to exercise. Walking, running, cycling, swimming  or anything that increases your heart rate by at least 30% can be fine.

There is INSUFFICIENT EVIDENCE about the effect of stretching exercises on pain relief in fibromyalgia [46,47].

Diet

There is no diet for fibromyalgia [30]. Listen to your intuition and choose foods you feel they are good for you and avoid those they are not.

There is SOME EVIDENCE that the following may help relieve some symptoms of fibromyalgia:

  • Vegetarian or vegan diet [89,90,92]
  • Intermittent fasting [91]
  • Avoiding caffeine (tea, coffee, cola, energy drinks) and alcohol (to improve sleep) [30]
  • Weight loss (in obese individuals) [93]

There is INSUFFICIENT EVIDENCE about the effect of avoiding gluten [27,88], monosodium glutamate (MSG) and aspartame [38,60] on fibromyalgia symptoms.

Diet for Fibromyalgia With Irritable Bowel Syndrome

If you have fibromyalgia and irritable bowel syndrome with abdominal pain, bloating, constipation or diarrhea, avoiding FODMAPs (Fermentable Oligo, Di- and Monosaccharides and Polyols) may help you relieve these symptoms [54,95].

A low-FODMAP diet involves limiting foods high in [48]:

  • Fructose: agave, apples, pears, mangoes, watermelon, honey, drinks sweetened with high-fructose corn syrup (HFCS)
  • Lactose: milk, ice cream, yogurt
  • Fructans: artichokes, onions, barley, rye
  • Galacto-oligosaccharides: beans, lentils, peas
  • Polyols or sugar alcohols (maltitol, mannitol, sorbitol and xylitol): “sugar-free” soft drinks and chewing gum, peaches, prunes, sweet cherries

Natural Home Remedies

Ice packs applied for 10 minutes over the trapezius muscle can temporarily relieve upper back pain, according to one study [76].

A rigid neck support may help improve sleep, but more research is warranted [32].

There is INSUFFICIENT EVIDENCE about the effectiveness of woolen underwear and bedding [13] or various mattress types [87] in improving symptoms of fibromyalgia.

There seems to be NO EVIDENCE about the effectiveness of Epsom salt in the pain relief in fibromyalgia.

Treatment of Trigger Points

In individuals with fibromyalgia who also have myofascial pain with muscle knots, treatment by myofascial release massage or dry needling may help relieve overall pain [50,51,74].

Medications

Medications should not be used as the first treatment. Medications are effective only in some individuals with fibromyalgia and their effect is usually delayed, modest and temporary [67]. Medications can have side effects, such as headache, drowsiness, dizziness, nausea, diarrhea, limb swelling, liver damage and addiction [1,67].

Currently, the only drugs approved by the U.S. Food and Drug Administration (FDA) for the treatment of fibromyalgia are duloxetine, milnacipran and pregabalin [49].

There is SOME EVIDENCE that pregabalin can reduce pain in some individuals with fibromyalgia [12,19,22,37,66].

There is INSUFFICIENT EVIDENCE about the effectiveness of anticonvulsants (gabapentin) [8,11,12,22,68], antipsychotics (olanzapine, quetiapine, ziprasidone) [18,33,67], centrally-acting muscle relaxants (cyclobenzaprine) [66,67,68], dextromethorphan [60], dopamine agonists (pramipexole, sibutramine) [63,64], intravenous immunoglobulin (IVIG) [70,71], melatonin [33,61], memantine [60], methylphenidate, monoamino oxidase inhibitors (phenelzine) [63,68], selective serotonin reuptake inhibitors or SSRIs (citalopram, escitalopram, fluoxetine, paroxetine, sertraline) [64,66,68], serotonin-norepinephrine reuptake inhibitors or SNRIs (duloxetine, milnacipran) [63,64,65,66], tegaserod [33], tramadol [68] and tricyclic antidepressants (amitriptyline) [14,65,66,68] in the treatment of fibromyalgia.

There seems to be NO CONVINCING EVIDENCE about the effectiveness of antiepileptics (carbamazepine, lacosamide, lamotrigene, phenytoin, topiramate [59], valproate) [12], antispasmodics (baclofen, dantrolene, metaxalone) [63,69], anxiolytics (benzodiazepines: alprazolam, clonazepam) [61,63], dronabinol, fentanyl patch, flupirtine [63], hormones (calcitonin [61], growth hormone [68], thyroxine [63]), guaifenesin [60,61,63], interferon [63], injections of local anesthetics (lidocaine) [63], metilphenidate [33], modafinil [33], nabilone (a synthetic marijuana product) [15,66], narcotics (oxycodone, morphine) [10,68], nonsteroidal anti-inflammatory drugs (aspirin, etoricoxib, ibuprofen, naproxen) [17,66], opioid antagonists (naltrexone) [44,57,58,67], pyridostigmine [33], sodium oxybate [63,68], steroids (prednisone) [63,68] and stimulants (ketamine) [60,63] in the pain relief in fibromyalgia.

Supplements, Including Minerals and Vitamins

There is INSUFFICIENT EVIDENCE about the effectiveness of calcium, coenzyme Q10 [94], creatine [29], D-ribose [80], 5-hydrokytryptophan (5-HTP) [35], iron [78], magnesium [41,42,77], S-adenosylmethionine (SAMe) [24,29], vitamins C and D [29,31,43] in the treatment of fibromyalgia.

There seems to be NO EVIDENCE about the effectiveness of chondroitin sulfate, dimethylsulfoxide (DMSO), glucosamine, probiotics or taurine in the treatment of fibromyalgia [39].

Herbs and Essential Oils

There is INSUFFICIENT EVIDENCE about the effectiveness of any natural products, including anthocyanidins [24], capsaicin [68], soy oil [24,63], ashwagandha [79] and other herbs (Boswellia, chlorella, ginger, ginseng, kratom, St. John’s Wort, turmeric, Valeria) [34] and essential oils [34] in pain relief in fibromyalgia.

Antimicrobials

Certain infections, such as Lyme disease or Mycoplasma pneumonia might be associated with fibromyalgia, but it is more likely that the stress associated with the infection is a trigger rather than the microbes . In one study in individuals with fibromyalgia who had previosly had Lyme disease, treatment with antibiotics did not improve symptoms [97].

Other Substances

There is INSUFFICIENT EVIDENCE about the effectiveness of alpha-lipoic acid [55], creatine [29], DHEA [34,61], L-carnitine [63,82], malic acid [63] in the treatment of fibromyalgia.

There is also insufficient evidence about the effect of moderate alcohol drinking on the pain relief in fibromyalgia [72].

Physical and Alternative Treatments

There is SOME EVIDENCE about the effectiveness of the following treatments for fibromyalgia:

  • Hydrotherapy (spa, mineral springs) [68,73]
  • Infrared sauna [9,53]

There is NO CONVINCING EVIDENCE about the long-term effectiveness of the following treatments for fibromyalgia:

  • Acupuncture [16,20,68,81], massage [4,5,68,75], other chiropractic care [25,63,68] or traditional Chinese medicine (cupping) [21]
  • Whole body cryotherapy [62,63] 
  • Repetitive transcranial magnetic stimulation [23,29], transcutaneous electric nerve stimulation (TENS) [34,63],
  • Mind-body therapies, including biofeedback, guided imagery, cognitive-behavioral therapy and meditative techniques (qigong, reiki, tai chi, yoga) and hypnosis [28,29,34,40,56,63,68]
  • Hyperbaric oxygen, magnetotherapy, laser therapy and ultrasound [34,63,74]
  • Homeopathy [26,63,68]

Complications and Prognosis

Fibromyalgia is a chronic condition, which can be life-long but in general, it improves with time [30,85]. In fibromyalgia, life expectancy is not shortened [83].

Fibromyalgia does not cause damage to the joints or other tissues and is not fatal [30,83]. It does not increase the risk of rheumatoid arthritis, heart attack, stroke, cancer or other health conditions but can be quite disabling [46,83,84].

Remission (a short- or long-term disappearance of symptoms) is possible with appropriate treatment that includes physical exercise and learning how to cope with stress [86].

Disability

The US Social Security Administration website describes criteria for disability benefits for fibromyalgia.

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