Fibromyalgia Treatment

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Published: September 6, 2017
Last reviewed: October 23, 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.

  • References

      1. Martinez-Lavin M et al, 20017, Biology and therapy of fibromyalgia. Stress, the stress response system, and fibromyalgia  PubMed Central
      2. Busch AJ et al, 2007, Aerobic exercise for fibromyalgia  Cochrane
      3. Bidonde J et al, 2017, Exercise for adults with fibromyalgia  Cochrane
      4. Li YH et al, 2014, Massage therapy for fibromyalgia: a systematic review and meta-analysis of randomized controlled trials  PubMed
      5. Yuan SL et al, 2015, Effectiveness of different styles of massage therapy in fibromyalgia: a systematic review and meta-analysis  PubMed
      6. Boomershine CS, Fibromyalgia  Emedicine
      7. Winkelmann A et al, 2012, Physiotherapy and physical therapies for fibromyalgia syndrome. Systematic review, meta-analysis and guideline  PubMed
      8. Siler AC et al, 2011, Systematic review of the comparative effectiveness of antiepileptic drugs for fibromyalgia  PubMed
      9. Brockow T et al, 2007, A randomized controlled trial on the effectiveness of mild water-filtered near infrared whole-body hyperthermia as an adjunct to a standard multimodal rehabilitation in the treatment of fibromyalgia  PubMed
      10. Gaskell H et al, 2016, Oxycodone for pain in fibromyalgia in adults  Cochrane
      11. Cooper TE and al, 2017, Gabapentin for pain in adults with fibromyalgia  Cochrane
      12. Wiffen PJ et al, 2013, Antiepileptic drugs to treat neuropathic pain or fibromyalgia- an overview of Cochrane reviews  Cochrane
      13. Kiyak EK, 2009, A new nonpharmacological method in fibromyalgia: the use of wool  PubMed
      14. Moore R et al, 2015, Amitriptyline for fibromyalgia in adults  Cochrane
      15. Walitt B et al, 2016, Cannabis products for people with fibromyalgia  Cochrane
      16. Deare JC et al, 2013, Acupuncture for fibromyalgia  Cochrane
      17. Derry S et al, 2016, Oral NSAIDs for treating fibromyalgia pain in adults  Cochrane
      18. Walitt B et al, 2016, Antipsychotics for fibromyalgia  Cochrane
      19. Derry S et al, 2016, Pregabalin for treating fibromyalgia pain in adults  Cochrane
      20. Mayhew E et al, 2007, Acupuncture for fibromyalgia–a systematic review of randomized clinical trials  PubMed
      21. Cao H et al, 2010, Traditional Chinese Medicine for treatment of fibromyalgia: a systematic review of randomized controlled trials  PubMed
      22. Tzellos TG et al, 2010, Gabapentin and pregabalin in the treatment of fibromyalgia: a systematic review and a meta-analysis  PubMed
      23. Knijnik LM et al, 2016, Repetitive Transcranial Magnetic Stimulation for Fibromyalgia: Systematic Review and Meta-Analysis  PubMed
      24. De Silva V et al, 2010, Evidence for the efficacy of complementary and alternative medicines in the management of fibromyalgia: a systematic review  PubMed
      25. Ernst E, 2009, Chiropractic treatment for fibromyalgia: a systematic review  PubMed
      26. Perry R et al, 2010, A systematic review of homoeopathy for the treatment of fibromyalgia  PubMed
      27. Volta U, 2014, Gluten-free diet in the management of patients with irritable bowel syndrome, fibromyalgia and lymphocytic enteritis  PubMed
      28. Hadhazy VA et al, 2000, Mind-body therapies for the treatment of fibromyalgia. A systematic review  PubMed
      29. Fibromyalgia: in depth  National Center for Complementary and Integrative Health
      30. Questions and answers about fibromyalgia  National Institute of Arthritis and Musculoskeletal and Skin Diseases
      31. Wepner F et al, 2014, Effects of vitamin D on patients with fibromyalgia syndrome: a randomized placebo-controlled trial  PubMed
      32. Ambrogio N et al, 1998, A comparison of three types of neck support in fibromyalgia patients  PubMed
      33. Gur A et al, 2009, Advances in diagnostic and treatment options in patients with fibromyalgia syndrome  PubMed Central
      34. Hasset AL et al, 2009, Nonpharmacologic Treatment for Fibromyalgia: Patient Education, Cognitive-Behavioral Therapy, Relaxation Techniques, and Complementary and Alternative Medicine  PubMed Central
      35. 5-hydroxytryptophan (5-HTP)  MedlinePlus
      36. Fibromyalgia  Cleveland Clinic
      37. Boomershine CS, 2010, Pregabalin for the management of fibromyalgia syndrome  PubMed Central
      38. Vellisca MY et al, 2014, Monosodium glutamate and aspartame in perceived pain in fibromyalgia  PubMed
      39. Parcell S, 2002, Sulfur in human nutrition and applications in medicine  PubMed
      40. Theadom A, et all, 2015, Interventions focusing on the link between the mind and body for adults with fibromyalgia  Cochrane
      41. Engen DJ et al, 2015, Effects of transdermal magnesium chloride on quality of life for patients with fibromyalgia: a feasibility study  PubMed
      42. Bagis S et al, 2103, Is magnesium citrate treatment effective on pain, clinical parameters and functional status in patients with fibromyalgia?  PubMed
      43. Jesus CA et al, 2013, The role of vitamin D in pathophysiology and treatment of fibromyalgia  PubMed
      44. Clauw DJ, 2014, Fibromyalgia clinical review  CiteSeerX
      45. Fibromyalgia facts sheet The Centers of Disease Control and Prevention
      46. Häuser W et al, 2010, Efficacy of different types of aerobic exercise in fibromyalgia syndrome: a systematic review and meta-analysis of randomised controlled trials  PubMed Central
      47. Lorena SB et al, 2015, Effects of muscle stretching exercises in the treatment of fibromyalgia: a systematic review  PubMed
      48. Examples of low and high FODMAP foods  Monash University
      49. Living with Fibromyalgia, Drugs Approved to Manage Pain  U.S. Food and Drug Administration
      50. Alonso-Blanco C et al, 2011, Multiple active myofascial trigger points reproduce the overall spontaneous pain pattern in women with fibromyalgia and are related to widespread mechanical hypersensitivity  PubMed
      51. Dommerholt J, 2011, Dry needling — peripheral and central considerations  PubMed Central
      52. Casanueva B et al, 2014, Short-term improvement following dry needle stimulation of tender points in fibromyalgia  PubMed
      53. Matsushita K et al, 2008, Efficacy of Waon therapy for fibromyalgia PubMed
      54. Marum AP et al, 2017, A low fermentable oligo-di-mono-saccharides and polyols (FODMAP) diet is a balanced therapy for fibromyalgia with nutritional and symptomatic benefits  PubMed
      55. Gilron I et al, 2017, Innovations in the Management of Musculoskeletal Pain With Alpha-Lipoic Acid (IMPALA Trial): Study protocol for a Double-Blind, Randomized, Placebo-Controlled Crossover Trial of Alpha-Lipoic Acid for the Treatment of Fibromyalgia Pain  PubMed Central
      56. Bellato E et al, 2012, Fibromyalgia Syndrome: Etiology, Pathogenesis, Diagnosis, and Treatment  PubMed Central
      57. Younger J et al, 2014, The use of low-dose naltrexone (LDN) as a novel anti-inflammatory treatment for chronic pain  PubMed Central
      58. Ringerike T et al, 2015, The Use of Naltrexone in Low Doses Beyond the Approved Indication  PubMed
      59. Wiffen PJ et al, 2013, Topiramate for treating neuropathic pain or fibromyalgia  Cochrane
      60. Littlejohn G et al, 2017, Modulation of NMDA Receptor Activity in Fibromyalgia  PubMed Central
      61. Jacobson SA et al, 2015, Characterization of Fibromyalgia Symptoms in Patients 55 to 95 Years Old: a Longitudinal Study Showing Symptom Persistence with Suboptimal Treatment  PubMed Central
      62. Whole Body Cryotherapy (WBC): A “Cool” Trend that Lacks Evidence, Poses Risks  U.S. Food and Drug Administration
      63. Ablin J et al, 2013, Treatment of Fibromyalgia Syndrome: Recommendations of Recent Evidence-Based Interdisciplinary Guidelines with Special Emphasis on Complementary and Alternative Therapies  PubMed Central
      64. Okifuji A et al, 2013, Management of Fibromyalgia Syndrome: Review of Evidence  PubMed Central
      65. Häuser W et al, 2011, Comparative efficacy and acceptability of amitriptyline, duloxetine and milnacipran in fibromyalgia syndrome: a systematic review with meta-analysis  PubMed
      66. Kia S et al, 2017, Update on Treatment Guideline in Fibromyalgia Syndrome with Focus on Pharmacology  PubMed Central
      67. Häuser W et al, 2013, Review of pharmacological therapies in fibromyalgia syndrome  PubMed Central
      68. Macfaralne GJ et al, 2017, EULAR revised recommendations for the management of fibromyalgia  BMJ Journals
      69. Boomershine CS et al, 2010, The FIBRO System: A Rapid Strategy for Assessment and Management of Fibromyalgia Syndrome  PubMed Central
      70. Caro XJ et al, 2008, A subset of fibromyalgia patients have findings suggestive of chronic inflammatory demyelinating polyneuropathy and appear to respond to IVIg  PubMed
      71. Stangel M et al, 2008, New Advances in the Treatment of Neurological Diseases Using High Dose Intravenous Immunoglobulins  PubMed Central
      72. Kim CH et al, 2013, Association between alcohol consumption and symptom severity and quality of life in patients with fibromyalgia  PubMed Central
      73. McVeigh MH et al, 2008, The effectiveness of hydrotherapy in the management of fibromyalgia syndrome: a systematic review  PubMed
      74. Castro-Sánchez AM et al, 2010, Benefits of Massage-Myofascial Release Therapy on Pain, Anxiety, Quality of Sleep, Depression, and Quality of Life in Patients with Fibromyalgia  PubMed Central
      75. Clar C et al, 2014, Clinical effectiveness of manual therapy for the management of musculoskeletal and non-musculoskeletal conditions: systematic review and update of UK evidence report  PubMed Central
      76. Yilmaz N et al, 2017, The effects of local cold application on fibromyalgia pain  PubMed
      77. Fibromyalgia  National Center for Complementary and Integrative Health
      78. Joustra ML et al, 2017, Vitamin and mineral status in chronic fatigue syndrome and fibromyalgia syndrome: A systematic review and meta-analysis  PubMed Central
      79. Ashwagandha MedlinePlus
      80. Teitelbaum JE et al, 2006, The use of D-ribose in chronic fatigue syndrome and fibromyalgia: a pilot study  PubMed
      81. Langhorst J et al, 2010, Efficacy of acupuncture in fibromyalgia syndrome–a systematic review with a meta-analysis of controlled clinical trials  PubMed
      82. Porter NS et al, 2010, Alternative medical interventions used in the treatment and management of myalgic encephalomyelitis/chronic fatigue syndrome and fibromyalgia  PubMed
      83. Is fibromyalgia life threatening?  John Hopkins Medicine
      84. Goldenberg DL et al, Patient education: Fibromyalgia (Beyond the Basics)  UpToDate
      85. Schaefer CP et al, 2016, Fibromyalgia Outcomes Over Time: Results from a Prospective Observational Study in the United States  PubMed Central
      86. Granges G et al, 1994, Fibromyalgia syndrome: assessment of the severity of the condition 2 years after diagnosis  PubMed
      87. Beth Israel Medical Center, 2010, Study of Mattress Type in Fibromyalgia  ClinicalTrials
      88. Isasi C et al, 2014, Fibromyalgia and non-celiac gluten sensitivity: a description with remission of fibromyalgia
        PubMed Central
      89. Kaartinen K et al, 2000, Vegan diet alleviates fibromyalgia symptoms  PubMed
      90. Donaldson MS et al, 2001, Fibromyalgia syndrome improved using a mostly raw vegetarian diet: An observational study  PubMed
      91. Sueiro Blanco F et al, 2008, Potential Benefits of Non-Pharmacological Therapies in Fibromyalgia  PubMed
      92. Häuser V et al, 2008, Management of fibromyalgia syndrome – an interdisciplinary evidence-based guideline  PubMed Central
      93. Senna MK et al, 2012, Effect of weight reduction on the quality of life in obese patients with fibromyalgia syndrome: a randomized controlled trial  PubMed
      94. Cordero MD et al, 2013, Can coenzyme q10 improve clinical and molecular parameters in fibromyalgia?  PubMed
      95. Nanayakkara WS et al, 2016, Efficacy of the low FODMAP diet for treating irritable bowel syndrome: the evidence to date  PubMed Central
      96. Fibromyalgia  American College of Rheumatology
      97. Lantos PM, 2015, Chronic Lyme disease  PubMed

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