Fibromyalgia: In Depth
What’s the Bottom Line?
What do we know about the effectiveness of complementary health approaches for fibromyalgia?
Psychological and Physical Approaches
- Although some studies of tai chi, yoga, mindfulness meditation, and biofeedback for fibromyalgia have had promising results, the evidence is too limited to allow definite conclusions to be reached about whether these approaches are helpful.
- It’s uncertain whether acupuncture is helpful for fibromyalgia pain.
- Some preliminary research on transcranial magnetic stimulation (TMS) for fibromyalgia symptoms has had promising results.
- Vitamin D supplements may reduce pain in people with fibromyalgia who are deficient in this vitamin.
What do we know about the safety of complementary health approaches for fibromyalgia?
- The psychological and physical approaches discussed here generally have good safety records. However, some may need to be adapted to make them safe and comfortable for people with fibromyalgia.
- Some of the dietary supplements that have been studied for fibromyalgia may have side effects or interact with medications.
- Headaches sometimes occur as a side effect of TMS for fibromyalgia. TMS and other procedures involving magnets may not be safe for people who have metal implants or medical devices such as pacemakers in their bodies.
What Is Fibromyalgia?
Fibromyalgia is a common disorder that involves widespread pain, tenderness, fatigue, and other symptoms. It’s not a form of arthritis, but like arthritis, it can interfere with a person’s ability to perform everyday activities. An estimated 5 million American adults have fibromyalgia. Between 80 and 90 percent of people with fibromyalgia are women, but men and children can also have this condition.
More About Fibromyalgia
In addition to pain and fatigue, people with fibromyalgia may have other symptoms, such as cognitive and memory problems, sleep disturbances, morning stiffness, headaches, painful menstrual periods, numbness or tingling of the extremities, restless legs syndrome, temperature sensitivity, and sensitivity to loud noises or bright lights.
A person may have two or more coexisting chronic pain conditions. Such conditions can include chronic fatigue syndrome, endometriosis, fibromyalgia, irritable bowel syndrome, interstitial cystitis, temporomandibular joint dysfunction, and vulvodynia. It’s not known whether these disorders share a common cause.
The exact cause of fibromyalgia is unclear, but it may be related to injury, emotional distress, or viruses that change the way the brain perceives pain. There’s no diagnostic test for fibromyalgia, so health care providers diagnose it by examining the patient, evaluating symptoms, and ruling out other conditions.
The U.S. Food and Drug Administration has approved several drugs to treat fibromyalgia, but medication is just one part of conventional medical treatment. Nondrug approaches such as exercise and good sleep habits can also help manage symptoms. Research has repeatedly shown that regular exercise is one of the most effective treatments for fibromyalgia. People with fibromyalgia who have too much pain or fatigue to do vigorous exercise should begin with walking or other gentle exercise and build their endurance and intensity slowly.
For more information about fibromyalgia, visit the National Institute of Arthritis and Musculoskeletal and Skin Diseases website.
What the Science Says About Complementary Health Approaches for Fibromyalgia
Complementary approaches can be classified by their primary therapeutic input (how the therapy is taken in or delivered), which may be:
- Nutritional (e.g., special diets, dietary supplements, herbs, probiotics, and microbial-based therapies).
- Psychological (e.g., meditation, hypnosis, music therapies, relaxation therapies).
- Physical (e.g., acupuncture, massage, spinal manipulation).
- Combinations such as psychological and physical (e.g., yoga, tai chi, dance therapies, some forms of art therapy) or psychological and nutritional (e.g., mindful eating).
Nutritional approaches include what the National Center for Complementary and Integrative Health (NCCIH) previously categorized as natural products, whereas psychological and/or physical approaches include what was referred to as mind and body practices.
A variety of complementary approaches have been studied for fibromyalgia. The following sections summarize the evidence on the effectiveness and safety of specific approaches.
Psychological and Physical Approaches
- Acupuncture is a technique in which practitioners stimulate specific points on the body, known as acupuncture points. This is most often done using needles that penetrate the skin (manual acupuncture), but other techniques, such as using electrical current (electroacupuncture), may also be used.
- Limited evidence indicates that people with fibromyalgia who receive acupuncture have improvements in symptoms such as pain and stiffness when compared to those who don’t receive it (for example, people on a waiting list). However, acupuncture hasn’t been shown to be more effective than simulated acupuncture in relieving fibromyalgia symptoms. Electroacupuncture may produce better results than manual acupuncture.
- Acupuncture is generally considered safe when performed by an experienced practitioner using sterile needles. Improperly performed acupuncture can cause potentially serious side effects.
- Biofeedback techniques measure body functions and give you information about them so that you can learn to control them.
- A small number of short-term studies of biofeedback, particularly electromyographic (EMG) biofeedback, in which people learn to control and decrease muscle tension, indicate that it may reduce fibromyalgia pain. However, the overall evidence on biofeedback is so limited that no definite conclusions can be reached about whether it’s helpful for fibromyalgia symptoms.
- In studies of EMG biofeedback for fibromyalgia, some participants reported that the procedure was stressful. No other side effects were reported.
- Guided imagery is a technique in which people are taught to focus on pleasant images to replace negative or stressful feelings. Guided imagery may be self-directed or led by a practitioner or a recording.
- Studies of guided imagery for fibromyalgia symptoms have had inconsistent results. In some studies, patients who were taught guided imagery had decreases in symptoms such as pain and fatigue, but in other studies it had no effect.
- Guided imagery is one of a group of approaches called relaxation techniques. Relaxation techniques are generally considered safe for healthy people. Occasionally, however, people report unpleasant experiences such as increased anxiety.
More information about guided imagery and other relaxation techniques
- Static (permanent) magnets are found in magnetic mattress pads, shoe inserts, bracelets, and other products. There’s not enough evidence on static magnets to allow any conclusions to be reached.
- Electromagnets are used in a type of treatment called transcranial magnetic stimulation (TMS), which influences brain activity. The U.S. Food and Drug Administration has approved certain TMS devices for treating migraine and treatment-resistant depression. A small number of preliminary studies have evaluated TMS for fibromyalgia symptoms, and some have had promising results.
- Magnets and magnetic devices may not be safe for people who have metal implants or medical devices such as pacemakers in their bodies. Headaches have been reported as a side effect in several studies of TMS for fibromyalgia.
- Massage therapy includes a variety of techniques in which practitioners manipulate the soft tissues of the body.
- Several studies have evaluated various types of massage therapy for fibromyalgia. Most indicated that massage could provide short-term relief of some fibromyalgia symptoms. However, the current evidence is too limited to be considered conclusive. Experts recommend that massage therapy for fibromyalgia should not cause pain. It may be necessary to start with very gentle massage and increase the intensity gradually over time.
- Massage therapy appears to have few risks when performed by a trained practitioner.
- Mindfulness meditation is a type of meditation that involves completely focusing on experiences on a moment-to-moment basis.
- In several studies, mindfulness meditation training has led to short-term improvements in pain and quality of life in people with fibromyalgia. However, the number of studies is small, and the quality of the evidence is relatively low, so no definite conclusions can be reached. Frequent practice of mindfulness techniques may be important for good results. In a 2014 study of mindfulness for fibromyalgia, those participants who practiced mindfulness more frequently had a greater reduction in symptoms.
- Mindfulness and other forms of meditation are generally considered to be safe for healthy people. However, they may need to be modified to make them safe and comfortable for people with some health conditions.
Meditative Movement Practices (Tai Chi, Qigong, and Yoga)
- Tai chi and qigong, which originated in China, and yoga, which is of Indian origin, all involve a combination of physical postures or movements, a focus on breathing, and meditation or relaxation. Because these three practices have so many features in common, they are sometimes grouped together as meditative movement practices.
- Exercise is beneficial for people with fibromyalgia, so meditative movement practices may be helpful because of the physical activity they involve. It’s also possible that the meditative component of these practices might help too. Some individual studies of tai chi, qigong, or yoga for fibromyalgia symptoms have had promising results. However, there isn’t enough high-quality evidence on these approaches to allow definite conclusions to be reached about their effects.
- Meditative movement practices generally have good safety records when practiced under the guidance of a qualified instructor. Few side effects have been reported in studies of yoga, tai chi, or qigong. However, these practices may need to be modified to make them suitable for people with fibromyalgia.
Other Psychological and Physical Approaches
So little research has been done on chiropractic care and hypnosis for fibromyalgia that no conclusions can be reached about these practices.
An approach called amygdala retraining, which includes various psychological and physical practices, has been proposed as a treatment for fibromyalgia. Because almost no research has been done on this approach, its effectiveness and safety cannot be evaluated.
- It has been suggested that deficiencies in vitamin D might worsen fibromyalgia symptoms. In one study of women with fibromyalgia who had low vitamin D levels, 20 weeks of vitamin D supplementation led to a reduction in pain.
- Researchers are investigating whether low magnesium levels contribute to fibromyalgia and if magnesium supplements might help to reduce symptoms.
- Other substances of natural origin that have been studied for fibromyalgia include dietary supplements such as soy, S-adenosyl-L-methionine (SAMe), and creatine. There’s not enough evidence to determine whether these products are helpful.
- “Natural” doesn’t necessarily mean “safe.” Products of natural origin can have side effects, and some may interact with medications. Even vitamins and minerals (including vitamin D and magnesium) can be harmful if taken in excessive amounts.
Other Complementary Approaches
- Balneotherapy is the technique of bathing in tap or mineral water for health purposes; it also includes related practices such as mud packs. Although some research has been done on balneotherapy for fibromyalgia, there’s not enough evidence to reach definite conclusions on whether it relieves symptoms.
- Balneotherapy has a good safety record.
- Homeopathy is a medical system based on the unconventional idea that a disease can be cured by highly diluted solutions of a substance that causes similar symptoms in healthy people. Studies of homeopathy have not demonstrated that it is beneficial for fibromyalgia.
- Highly diluted homeopathic remedies are generally safe. However, not all products labeled as homeopathic are highly dilute; some may contain substantial amounts of ingredients and therefore could cause side effects.
- Reiki is a complementary health approach in which practitioners place their hands lightly on or just above a person, with the goal of facilitating the person’s own healing response. An NCCIH-funded study examined the use of Reiki for fibromyalgia-related pain. The study showed no effect of Reiki on pain or any of the other outcomes measured in the study (physical and mental functioning, medication use, and visits to health care providers).
- Reiki appears to be generally safe.
Topical Herbal Products
- Topical products containing capsaicin (the substance that gives chili peppers their heat) have been studied for fibromyalgia. There's not enough evidence to determine whether these products are helpful.
Recent NCCIH-sponsored studies have been investigating various aspects of complementary and integrative interventions for fibromyalgia, including:
- The effectiveness of traditional Chinese medicine for treating fibromyalgia
- How tai chi compares to aerobic exercise as an adjunctive treatment for fibromyalgia symptoms
- Whether brain responses to placebos differ between people with fibromyalgia and healthy people.
More To Consider
- Be aware that some complementary health approaches—particularly dietary supplements—may interact with conventional medical treatments. To learn more about using dietary supplements, see the NCCIH fact sheet Using Dietary Supplements Wisely and the NCCIH interactive module Understanding Drug-Supplement Interactions.
- If you’re considering a practitioner-provided complementary health approach such as acupuncture, check with your insurer to see if the services will be covered, and ask a trusted source (like your fibromyalgia health care provider or a nearby hospital or medical school) to recommend a practitioner.
- Tell all your health care providers about any complementary or integrative health approaches you use. Give them a full picture of what you do to manage your health. This will help ensure coordinated and safe care.
For More Information
The NCCIH Clearinghouse provides information on NCCIH and complementary and integrative health approaches, including publications and searches of Federal databases of scientific and medical literature. The Clearinghouse does not provide medical advice, treatment recommendations, or referrals to practitioners.
Toll-free in the U.S.: 1-888-644-6226
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National Institute of Arthritis and Musculoskeletal and Skin Diseases (NIAMS)
The mission of NIAMS is to support research into the causes, treatment, and prevention of arthritis and musculoskeletal and skin diseases; the training of basic and clinical scientists to carry out this research; and the dissemination of information on research progress in these diseases.
Toll-free in the U.S.: 1-877-22-NIAMS
Know the Science
NCCIH and the National Institutes of Health (NIH) provide tools to help you understand the basics and terminology of scientific research so you can make well-informed decisions about your health. Know the Science features a variety of materials, including interactive modules, quizzes, and videos, as well as links to informative content from Federal resources designed to help consumers make sense of health information.
Explaining How Research Works (NIH)
Know the Science: 9 Questions To Help You Make Sense of Health Research
A service of the National Library of Medicine, PubMed® contains publication information and (in most cases) brief summaries of articles from scientific and medical journals. For guidance from NCCIH on using PubMed, see How To Find Information About Complementary Health Approaches on PubMed.
Mind and Body Practices for Fibromyalgia—Systematic Reviews/Reviews/Meta-analyses
Mind and Body Practices for Fibromyalgia—Randomized Controlled Trials
To provide resources that help answer health questions, MedlinePlus (a service of the National Library of Medicine) brings together authoritative information from the National Institutes of Health as well as other Government agencies and health-related organizations.
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