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As the amount of research into fibromyalgia has grown over the last 30 years, one of the biggest questions remains: What type of therapies can relieve the widespread pain, chronic fatigue, and brain fog people commonly experience with fibromyalgia?
Despite growing research, some healthcare providers still disagree about the best ways to treat the symptoms of fibromyalgia.
Here’s a look at the science behind the most commonly tested fibromyalgia treatments, including medications, diet, exercise, therapy, and complementary and alternative remedies.
What is fibromyalgia pain?
Fibromyalgia (FM) is an often misunderstood medical condition characterized by chronic muscle and joint pain. Researchers consider it to be a type of neurosensory disorder. In people affected by fibromyalgia, the brain processes pain signals differently (Bhargava, 2020).
Fibromyalgia pain affects multiple areas all around the body. It may initially start with tender points in the neck and shoulders, but then more areas become affected. Despite the pain, there is usually no evidence of inflammation (Bhargava, 2020).
FM is a chronic condition that currently has no cure. However, there are treatments you can use to manage your symptoms and improve your quality of life. The treatment of fibromyalgia is typically a combination of therapies. These include medications, lifestyle changes, psychotherapy, and complementary therapies.
Fibromyalgia: what is it, symptoms, testing, treatment
What are the most common fibromyalgia treatments?
The two most commonly used non-medication treatment options for fibromyalgia are exercise therapy and psychotherapy.
Exercise therapy has been found to improve the ability to do daily activities for people living with fibromyalgia. People using exercise therapy report improved pain management and quality of life (Maffei, 2020).
The following types of exercise have explicitly been studied and found to be helpful for people with symptoms of FM (Busch, 2011):
- Tai chi
- Aerobic exercise
- Chi Gong
- Nordic walking
For any exercise program, the key to getting the most benefit and continuing long-term is to avoid exercise-related fatigue and injuries. Exercise therapy programs should take your symptoms and goals into account. The intensity of the exercise should progress slowly from low to moderate intensity to avoid causing more pain and prevent injury (Busch, 2011).
The prevalence of anxiety and depression is already fairly high in the general population, but the challenges that come with fibromyalgia can increase your risk. Up to 74% of people diagnosed with fibromyalgia will experience depression at some point. About 60% will experience an anxiety disorder. Research supports learning therapeutic relaxation techniques and participating in a formal stress reduction program (Bhargava, 2020).
Talk therapies such as cognitive-behavioral therapy (CBT) can help you learn strategies to cope with chronic pain and stress, develop self-care routines, and reframe negative thoughts about your illness (U.S. National Library of Medicine, 2021).
Psychotherapy: everything you need to know
Are there fibromyalgia medications?
Researchers have studied using several different classes of medications to manage the pain associated with fibromyalgia. No particular drug has been shown to be more helpful than the others, and some are not recommended for use with FM (Maffei, 2020).
Over-the-counter pain relievers
Studies show that most people with fibromyalgia attempt to manage their own symptoms before seeing a healthcare provider. They may attempt to use basic pain relievers such as acetaminophen, ibuprofen, or naproxen. There has not been much evidence that these medications are helpful long-term (Arnold, 2016).
There are two medications in the class called selective serotonin-norepinephrine reuptake inhibitors (SNRIs) approved for treating fibromyalgia pain in the United States. These are duloxetine (Cymbalta; see Important Safety Information) and milnacipran (Savella). These have been shown to help the key symptoms of FM—namely, sleep problems, fatigue, and pain (Maffei, 2020).
SNRIs: what are they, uses, side effects, and risks
While surveys have shown that many people with fibromyalgia prefer opioid medications for pain relief, studies have found that they may not truly be that helpful. Opioid medications have been found to have more negative effects in people with FM than other therapies. Researchers theorize that people with fibromyalgia process opiates differently in the body, making them less effective (Maffei, 2020).
Gabapentinoids are a class of anti-seizure medications also used to treat pain. The U.S. Food and Drug Administration (FDA) has approved the drug pregabalin (Lyrica) to treat pain from fibromyalgia. A similar medication called gabapentin (Neurontin) is often prescribed off-label for FM. This is likely because it is substantially less expensive (Maffei, 2020).
Does CBD oil for fibromyalgia help?
Cannabidiol (CBD) oil, the part of marijuana that does not cause a high, is commonly used to self-treat pain and inflammation in various health conditions. Currently, there is little evidence available to show that it is an effective treatment for fibromyalgia, though this is still an emerging field of research. The other primary compound in marijuana, tetrahydrocannabinol (THC)—the part that does cause a high—has also been studied. Results were positive but inconsistent (Maffei, 2020).
A small clinical trial was conducted to determine the benefit of THC-rich cannabis oil on symptoms and quality of life in 17 women with fibromyalgia. The researchers found that cannabinoids could be a low-cost and well-tolerated therapy to reduce symptoms and increase the quality of life. However, they also concluded that more studies were needed to see if there was any long-term benefit and to compare different varieties of cannabinoids (Chaves, 2020).
Are there any natural remedies for fibromyalgia?
The two most well-studied natural therapies for fibromyalgia are acupuncture and dietary modifications. There are many other complementary therapies you can try for managing fibromyalgia, but there isn’t enough evidence to say how effective they are.
There is some evidence that acupuncture can improve pain and stiffness in people with fibromyalgia. Electro‐acupuncture was likely more effective than standard acupuncture. Researchers found the effects to last from one to six months. Acupuncture for FM is generally safe and can be used alone or combined with other therapies (Deare, 2013).
Ear acupuncture for pain: does it work?
It’s not unusual for people with fibromyalgia to have food intolerances and changes in their gut microbiome. Many try out different dietary approaches to improve their symptoms.
Researchers have found that people with FM reported less pain and better overall function when following a low calorie, raw vegetarian, or low FODMAPs (a type of fermentable carbohydrate) diet. However, some of these studies have been of low quality. Some of their results may be due to the placebo effect. In other words, some people might have felt better because they believed they were doing something that could help, not because their FM was specifically treated by the change (Silva, 2019).
However, there isn’t much downside to eating a healthier diet, so there is little reason not to explore making healthy dietary changes to see if it helps your symptoms.
Other complementary therapies
People with fibromyalgia may use many other alternative and complementary therapies to manage their fibromyalgia pain. More research is still needed to tell how effective these treatments are (Maffei, 2020; U.S. Department of Health and Human Services, 2017).
- Thermal therapies such as body warming and cryotherapy
- Hyperbaric oxygen therapy (HBOT)
- Low-level laser therapy
- Guided imagery
- Mindfulness meditation
Talking with your healthcare provider about fibromyalgia treatment
Talk with your healthcare provider if you are experiencing symptoms that might be connected to fibromyalgia. Your provider can rule out any other medical conditions that might be causing your symptoms. If it is fibromyalgia, your healthcare provider can help you come up with a plan and discover what fibromyalgia treatments may work best for you.
- Arnold, L. M., Gebke, K. B., & Choy, E. H. (2016). Fibromyalgia: management strategies for primary care providers. International Journal Of Clinical Practice, 70(2), 99–112. doi: 10.1111/ijcp.12757. Retrieved from https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6093261/
- Bhargava J, Hurley JA. Fibromyalgia. [Updated 2020 Nov 19]. In: StatPearls [Internet]. Treasure Island (FL): StatPearls Publishing; 2021 Jan-. Retrieved from: https://www.ncbi.nlm.nih.gov/books/NBK540974/
- Busch, A. J., Webber, S. C., Brachaniec, M., Bidonde, J., Bello-Haas, V. D., Danyliw, A. D., et al. (2011). Exercise therapy for fibromyalgia. Current Pain And Headache Reports, 15(5), 358–367. doi: 10.1007/s11916-011-0214-2. Retrieved from https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3165132/
- Chaves, C., Bittencourt, P., & Pelegrini, A. (2020). Ingestion of a THC-rich cannabis oil in people with fibromyalgia: a randomized, double-blind, placebo-controlled clinical trial. Pain Medicine (Malden, Mass.), 21(10), 2212–2218. doi: 10.1093/pm/pnaa303. Retrieved from https://www.ncbi.nlm.nih.gov/pmc/articles/PMC7593796/
- Deare, J. C., Zheng, Z., Xue, C. C. L., Liu, J. P., Shang, J., Scott, S. W., et al. (2013). Acupuncture for treating fibromyalgia. The Cochrane Database of Systematic Reviews, 2013(5). doi: 10.1002/14651858.CD007070.pub2. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4105202/
- Maffei M. E. (2020). Fibromyalgia: recent advances in diagnosis, classification, pharmacotherapy and alternative remedies. International Journal Of Molecular Sciences, 21(21), 7877. doi: 10.3390/ijms21217877. Retrieved from https://www.ncbi.nlm.nih.gov/pmc/articles/PMC7660651/
- Silva, A. R., Bernardo, A., Costa, J., Cardoso, A., Santos, P., de Mesquita, M. F., et al. (2019). Dietary interventions in fibromyalgia: a systematic review. Annals Of Medicine, 51(sup1), 2–14. doi: 10.1080/07853890.2018.1564360. Retrieved from https://www.ncbi.nlm.nih.gov/pmc/articles/PMC7888848/
- U.S. Department of Health and Human Services. (2017). Mind and body practices for fibromyalgia: what the science says. National Center for Complementary and Integrative Health. Retrieved from https://www.nccih.nih.gov/health/providers/digest/mind-and-body-practices-for-fibromyalgia-science
- U.S. National Library of Medicine. (2021). Fibromyalgia | FMS. MedlinePlus. Retrieved from https://medlineplus.gov/fibromyalgia.html
Dr. Steve Silvestro is a board-certified pediatrician and Senior Manager, Medical Content & Education at Ro.