Written by: Leah Bedrosian, MPH
Published on: April 17, 2020
Updated on: November 1, 2019
Reviewed by: Gerda Endemann, PhD
Our science and research team launched goop PhD to compile the most significant studies and information on an array of health topics, conditions, and diseases. If there is something you’d like them to cover, please email us at [email protected].
Fibromyalgia (sometimes called fibrositis) is a chronic neurological disorder that changes the way the brain and nervous system process pain, leading to widespread pain and aches throughout the body. The symptoms vary from person to person, may come and go, and often mimic other conditions, which can make diagnosis difficult. Fibromyalgia is poorly understood in the medical community—there is no blood test or biomarker for diagnosis, and historically, people with symptoms have too often been ignored and stigmatized. Today, there is more research available, and scientists are beginning to better understand the disorder, its symptoms, and how to successfully manage it.
Primary Symptoms of Fibromyalgia
The primary symptom of fibromyalgia is widespread muscle pain throughout the body that is often described as a constant, dull ache. A person with fibromyalgia may also experience pain in tender points and trigger points. Tender points are areas of the body such as the elbows or knees that are sensitive when pressure is applied. Trigger points cause pain in another area of the body when pressure is applied. For example, a person may feel pain in the hip when pressure is applied to their knee. People with fibromyalgia may also experience significant fatigue, headaches, and sleep, memory, and mood disturbances. One of the most common symptoms is “fibro fog,” in which people have difficulty concentrating. All of these symptoms can interfere with normal functioning and impact quality of life.
Who Is Affected by Fibromyalgia?
Somewhere between 2 and 8 percent of the population has fibromyalgia, making it the second most common rheumatic condition after osteoarthritis. Fibromyalgia is twice as common in women as it is in men, and fibromyalgia is especially prevalent among middle-aged women (Clauw, 2014).
Potential Causes and Related Health Concerns
Like most diseases, fibromyalgia is believed to be caused by a combination of genetics and environmental triggers, such as infections or stress. Fibromyalgia is closely related to other health concerns, including irritable bowel syndrome (IBS), migraines, autoimmune disorders, and mental health disorders.
Causes of Fibromyalgia
Fibromyalgia tends to run in families, so there is likely a genetic component to the disease. There is a rare gene that has been shown to increase pain sensitivity by reducing serotonin, and some people with chronic pain conditions carry this gene (Khoury et al., 2019). But the majority of people with chronic pain do not have this gene, and other potential causes of fibromyalgia are still largely unknown. Several theories have suggested that infections (like the Epstein-Barr virus, Lyme disease, or hepatitis), stress, and physical and psychological trauma may trigger fibromyalgia to develop.
Why Do People with Fibromyalgia Feel More Pain?
People with fibromyalgia have a heightened response to physical stimuli, which is called sensitization. People with fibromyalgia feel pain when others would perceive normal touch. While the exact mechanism is not fully understood, some studies have suggested that this may be due to altered blood flow in the brain, particularly to areas that are involved in pain processing (Duschek et al., 2012; Foerster et al., 2011). New research suggests that brain connectivity and nerve damage may play a role.
Related Health Concerns
People with fibromyalgia often have a history of IBS, migraines, chronic fatigue, gastrointestinal disorders, painful bladder syndrome, or endometriosis (Clauw, 2014). People with fibromyalgia are also likely to have celiac disease or gluten sensitivity (see the dietary changes section). Fibromyalgia’s symptoms are similar to other catchall diagnoses that are not adequately understood, such as chronic fatigue syndrome and multiple chemical sensitivity.
Mental Health and Fibromyalgia
Mental health problems are very common among people with fibromyalgia, with some studies suggesting that up to a third of patients suffer from either anxiety or depression. Managing fibromyalgia can be difficult both physically and psychologically, so a multifaceted approach that prioritizes mental health is important (see the conventional treatment section).
People with fibromyalgia often report gastrointestinal symptoms such as abdominal pain, bloating, gas, and nausea. These symptoms often coincide with a diagnosis of IBS or celiac disease or gluten sensitivity. A 2002 review found that almost 50 percent of fibromyalgia patients also have IBS (Whitehead et al., 2002).
Several studies have shown that people with fibromyalgia are likely to be obese and some of these studies have suggested that a higher BMI is associated with more severe symptoms and poorer quality of life. One reason could be that the more severe fibromyalgia symptoms are, the less likely a person is to be active, which could increase their likelihood of gaining weight (Ursini et al., 2011). Exercise is important for managing fibromyalgia (more on that in the conventional treatments section).
Chronic Fatigue Syndrome
Another condition that is as stigmatized as fibromyalgia is chronic fatigue syndrome. And it appears quite similar symptomatically too: tiredness, confusion, anxiety, muscle weakness, and painful body aches. The difference is that the primary symptom of fibromyalgia is muscle pain throughout many areas of the body, whereas the primary symptom of chronic fatigue syndrome is fatigue. Both fibromyalgia and chronic fatigue syndrome can be catchall diagnoses that are given to patients whose symptoms are unexplained. It is quite common for people to be diagnosed with both fibromyalgia and chronic fatigue syndrome. Treatment and management of these two disorders are sometimes lumped together, but some researchers believe that they have different underlying mechanisms that require their own distinct treatments (Bourke, 2015).
Multiple Chemical Sensitivity
People with fibromyalgia may be sensitive to things that others have more of a tolerance of, such as touch and perhaps also environmental chemicals. The symptoms of fibromyalgia are similar to and may meet the criteria for another syndrome called multiple chemical sensitivity, which has also been quite controversial in the medical community (MCS) (Hu & Baines, 2018). MCS often begins with either an intense short period of chemical exposure—from a chemical spill, for example—or chronic, long-term exposure to something like cigarette smoke. People with MCS may experience headaches, rashes, asthma, muscle aches, fatigue, memory loss, or confusion. MCS is debated, and some medical practitioners believe that these are symptoms of something psychiatric rather a distinct medical diagnosis (Johns Hopkins, 2018).
How Fibromyalgia Is Diagnosed
If a person has widespread pain that lasts longer than three months without any other known medical condition that could be causing the pain—such as an autoimmune disease, neurological disorder, or muscle disorder—they likely have fibromyalgia. Fibromyalgia is diagnosed according to the 2016 Fibromyalgia Diagnostic Criteria, explained below.
While there isn’t a specific medical test that can confirm fibromyalgia, doctors may use certain tests and diagnostic criteria to rule out other conditions that may present with similar symptoms such as posttreatment Lyme disease syndrome, chronic fatigue syndrome, autoimmune diseases like lupus, and small-fiber polyneuropathy (SFPN) (see the new research section for more on SFPN). Diagnostic tests may include a complete blood count, tests for specific antibodies that would signal an autoimmune disease, and thyroid function tests.
2016 Fibromyalgia Diagnostic Criteria
In 2016, a team of doctors and researchers formed a committee to review the 2010/2011 diagnostic criteria for fibromyalgia set forth by the American College of Rheumatology. They found that the existing criteria were inadequate and may lead to misclassification—particularly the requirement of having a certain number of tender points at designated locations in the body (Wolfe et al., 2016). Their new 2016 criteria state that an adult may be diagnosed as having fibromyalgia if the following conditions are met:
1. The person is experiencing generalized pain in at least four of five regions in the body. Regions include the left upper region (left jaw, shoulder, or arm), right upper region, left lower region (left hip or leg), right lower region, and axial region (neck, back, chest or abdomen).
2. Symptoms have been present at a similar level for at least three months.
3. The number of specific areas that are painful are added up to give a widespread pain index (WPI). The severity of symptoms is added up to give a symptom severity scale (SSS) score. A WPI > 7/19 and a SSS score > 5/12 OR WPI > 4-6/19 and symptom severity scale (SSS) score > 9/12 satisfy the third condition for fibromyalgia diagnosis.
4. A diagnosis of fibromyalgia is valid irrespective of other diagnoses. A diagnosis of fibromyalgia does not exclude the presence of other clinically important illnesses.
There is a need for more studies assessing dietary changes for fibromyalgia. A 2018 review found that raw vegetarian diets, low-calorie diets, and low FODMAP diets were associated with improvement in pain scores as well quality of life, sleep, anxiety, and depression among people with fibromyalgia. However, most of these studies were not robust and had low sample sizes or were uncontrolled (Silva et al., 2019). Below, we’ve summarized some of the studies on dietary changes that you may want to know more about—including gluten-free diets, FODMAPs, inflammatory foods, and food additives.
Because people with fibromyalgia may also have celiac disease or gluten sensitivity (perhaps related to IBS), a gluten-free diet may be beneficial. One study found that 30 percent of people who had been diagnosed with fibromyalgia and IBS also tested positive for celiac disease, and adherence to a gluten-free diet helped improve both their digestive and fibromyalgia symptoms (Rodrigo et al., 2013).
But what about a gluten-free diet for people who haven’t specifically been diagnosed with celiac disease? A 2017 study found that whether people with fibromyalgia who were not diagnosed as celiac were placed on a gluten-free diet or a low-calorie diet for twenty-four weeks, they reported similar small improvements in symptoms (Slim et al., 2017). Thus, it is not clear whether a gluten-free diet is helpful for people who haven’t been specifically diagnosed with celiac. But responses to dietary changes are totally individual so you may want to work with a registered nutritionist and try removing gluten to see if it helps you. There is a clinical trial recruiting subjects in Italy to determine if a gluten-free diet helps with symptoms of fibromyalgia.
How to Do an Elimination Diet
Everyone responds to food differently. While gluten causes a problem for some people with fibromyalgia in particular studies, your body may be fine with gluten. That’s why elimination diets can be useful to help you better understand what foods you may want to avoid. It works like this: You avoid the specific foods for a few weeks, then reintroduce them one at a time to see which ones cause an adverse reaction. Always work with a registered dietitian to make sure you are going about it correctly and getting proper nutrients.
There’s a group of fermentable carbs that may cause digestive issues for some people—they are called fermentable oligo-di-monosaccharides and polyols (aka FODMAPs) and they are present in a wide variety of foods. Oligosaccharides are found in foods including wheat, rye, some fruits and vegetables, and legumes. Disaccharides are found in foods such as milk, yogurt, and cheese. Monosaccharides are found in some fruit and honey. Polyols include sorbitol, xylitol, other sweeteners and some fruits and vegetables. A FODMAP diet avoids these carbs and has been shown to help with IBS.
A 2017 study found that adhering to a FODMAP diet for eight weeks was beneficial for people with fibromyalgia, successfully improving gastrointestinal and fibromyalgia symptoms as well as pain score (Marum et al., 2017). The diet specifically avoided all dairy products; cereals except rice; cashews; all fruit except banana, citrus, pineapples, red berries, strawberries, and kiwi; and all vegetables except pumpkin, cabbage, lettuce, tomato, carrot, and cucumber. These results are quite promising. Further large clinical trials are needed, though, as this is just one study. See our goop PhD article about IBS for additional information about FODMAPs.
There is conflicting evidence about inflammation in fibromyalgia. While fibromyalgia pain is not related to inflammation in the joints, there has been evidence of certain subgroups of people that have elevated levels of inflammatory markers (Metyas et al., 2015). In a study of ninety-five women with fibromyalgia, people who reported eating a diet high in inflammatory foods (scored by the Dietary Inflammation Index) also reported having higher sensitivity to pain in tender points (Correa-Rodríguez et al., 2019). According to the the Dietary Inflammatory Index, some high-inflammatory dietary components include saturated fat, trans fat, carbohydrates, and cholesterol (Shivappa et al., 2014). You may consider working with a nutritionist to reduce inflammatory foods in your diet.
Food Additives and Sweeteners
In two case studies, an artificial sweetener called aspartame was found to be associated with fibromyalgia symptoms (Ciappuccini & Ansemant, 2010). People have also reported headaches, nausea, fatigue, and other symptoms from a food additive called monosodium glutamate (MSG). And some believe it may be associated with fibromyalgia, too.
A 2012 study assigned people who had been diagnosed with both fibromyalgia and IBS to a four-week diet free of food additives. This excluded MSG and aspartame. Eighty-four percent of the subjects had significant IBS and fibromyalgia symptom improvement while on the diet. Next, the subjects who showed improvement were assigned to drink either a placebo juice or a juice containing five grams of MSG for three days. Those who drank the MSG juice had significant worsening of symptoms (Holton et al., 2012). The authors suggested that MSG may be a culprit behind fibromyalgia symptoms. However, a follow-up study in 2014 found that avoiding dietary MSG and aspartame did not improve fibromyalgia symptoms. It may be an individual thing, as most dietary changes are. You can try avoiding MSG and aspartame to see if it helps.
Nutrients and Supplements for Fibromyalgia
Vitamin D may be related to pain sensitivity. Be sure you’re getting enough vitamin D and supplement if you are deficient. Glucosamine and omega-3 fatty acids are two of the most commonly taken supplements among people with fibromyalgia; however, there hasn’t been solid evidence on their efficacy.
People with fibromyalgia have been shown to have lower blood levels of vitamin D (Makrani et al., 2017). And low vitamin D levels have been associated with a number of other pain-related conditions, suggesting that vitamin D may play a role in pain sensitivity (Oliveira et al., 2017). A handful of studies have investigated whether supplementing with vitamin D can improve pain and other fibromyalgia symptoms, and some positive results have been reported.
A 2014 study recruited a group of thirty women with fibromyalgia who were vitamin D deficient and gave them vitamin D supplements (ranging from 1,200 to 2,400 IU depending on severity of deficiency) for twenty weeks. Compared to control subjects, the women who received the vitamin D supplements showed improvements in physical functioning and perception of pain (Wepner et al., 2014). Other studies have also shown that vitamin D supplementation improves physical functioning among people with fibromyalgia. But no other studies have been able to replicate the finding that vitamin D supplementation reduces pain (Dogru et al., 2017; Ellis et al., 2018).
Consider finding out whether you are vitamin D deficient. You can’t get much vitamin D from your diet. The primary source of vitamin D is sun exposure. And unless you’re outside every day for plenty of time, without a thick layer of sunscreen, you’re probably not getting enough vitamin D, so you may want to take vitamin D supplements. Talk to your doctor about getting your vitamin D levels tested to see if you are deficient and ask what dose of supplement you should take. While the RDA is 600 IU, some health practitioners recommend a much larger dose, like what was given in the studies mentioned above (NIH, 2019).
Common Supplements for Fibromyalgia
There haven’t been many studies for supplements that are effective for fibromyalgia symptoms. A 2009 study found that most commonly reported supplements used by people with fibromyalgia are omega-3 fatty acids, glucosamine, and ginkgo (Shaver et al., 2009). While glucosamine and omega-3 fatty acids are often considered helpful for neuropathic pain conditions, there isn’t evidence for their efficacy for fibromyalgia specifically. A small, uncontrolled 2002 study found that people with fibromyalgia who took 200 milligrams of ginkgo and 200 milligrams of coenzyme Q10 daily for three months reported improvement in their quality of life (Lister, 2002). Further research with a larger sample size and control group are needed on ginkgo as well as other herbs and supplements for fibromyalgia.
Lifestyle Changes for Fibromyalgia
Managing stress and getting proper sleep are paramount.
In a longitudinal study of 166 women with fibromyalgia or chronic widespread pain, the researchers found that women who reported high pain intensity but low levels of stress at the beginning of the study were more likely to report less-intense pain than the women who had higher stress levels when all the participants were surveyed ten to twelve years later (Bergenheim et al., 2019). It’s possible that keeping stress levels low may reduce pain intensity.
There are many mindfulness-based practices that can help reduce stress. Read more in the alternative treatments section.
In a longitudinal study of over ten thousand women, those who reported sleep problems had a higher risk of going on to develop fibromyalgia (Mork & Nilsen, 2012). And further: A 2017 meta-analysis found that people with fibromyalgia have poorer sleep quality and more difficulty falling asleep (Wu et al., 2017). Sleep hygiene is important to allow the brain to reset so that it can function properly, and some research has suggested that sleep deprivation can increase muscle pain and fatigue, which are classic symptoms of fibromyalgia (Choy, 2015). A solid bedtime routine can help set up a good night’s rest. If you have recurring sleep issues, such as sleep apnea or insomnia, consult a health care practitioner for treatment.
Conventional Treatment Options for Fibromyalgia
While treatment for fibromyalgia generally includes some type of prescription to manage pain, medication should not be the only treatment. Fibromyalgia treatment and management is multipronged, incorporating various nonpharmacological and pharmacological techniques, such as patient education, exercise, medications, and behavioral therapies to address the numerous factors that may be maintaining the pain over time. While you can see your primary care doctor for treatment, you may choose to see a rheumatologist, which is a physician who specializes in musculoskeletal and autoimmune diseases.
Helping people with fibromyalgia understand their disease better has been shown to improve symptoms and mental health. Fibromyalgia is a difficult diagnosis and can be confusing, especially when people are not given proper education from their health care practitioner. Patient education should be a foundational level of care. Tame the Beast is an online resource from pain scientist Lorimer Moseley, PhD, that explains the potential causes of chronic pain and offers helpful resources for patients and clinicians. Moseley also has written Explain Pain, a guide to understanding chronic pain, as well as The Explain Pain Handbook, which can be used to understand and work through the many factors that may maintain pain.
Exercise is beneficial for people with fibromyalgia. It has been shown to reduce pain, the severity of fibromyalgia, and the symptoms of depression (Sosa-Reina et al., 2017). It may also have anti-inflammatory effects: A 2015 review found evidence that exercise was associated with a decrease in inflammatory markers among people with fibromyalgia (Sanada et al., 2015). But exercise can sometimes be painful at first for people with fibromyalgia. You may need to start slow and then gradually increase your daily activity level until you have a regular exercise routine (Clauw, 2014).
Work with your health care practitioner to determine what form of exercise is right for you. A 2017 review concluded that aerobic exercise and muscle strengthening were the most effective forms of exercise. Stretching was not found to decrease pain or the severity of fibromyalgia, but it did improve quality of life and symptoms of depression (Sosa-Reina et al., 2017).
Medications for Fibromyalgia
People with fibromyalgia are typically treated with pain medicines, antidepressants, muscle relaxants, and sleep medicines. There are three drugs that are FDA-approved specifically for fibromyalgia treatment: Lyrica, Cymbalta, and Savella. According to a 2014 systematic review, the medications with the best evidence for improving fibromyalgia symptoms are gabapentinoids (Lyrica, Gralise, Horizant, and Neurontin), tricyclic compounds (amitriptyline and cyclobenzaprine), serotonin norepinephrine reuptake inhibitors (Cymbalta and Savella), and some older versions of selective serotonin reuptake inhibitors (such as fluoxetine, strapline, and paroxetine) (Clauw, 2014). Medication use should be combined with other, nonpharmacological therapies.
A 2009 study surveyed women with fibromyalgia via telephone about their medication use and found that a substantial number of these women were taking pain medications that did not have evidence to support their efficacy (Shaver et al., 2009). Specifically, opioids do not have evidence to support their efficacy for fibromyalgia treatment and have a high risk for abuse (more on that below). New research and upcoming clinical trials on alternative pharmacological therapies for fibromyalgia are underway.
Opioid Use and Abuse
Opioid use for treatment of chronic pain has increased over the past decade and so has opioid abuse, because opioids are highly addictive drugs. Current treatment guidelines state that opioids should not be used in the treatment of fibromyalgia; there is a lack of evidence demonstrating their efficacy (Goldenberg et al., 2016). In some cases, opioids may cause hyperalgesia, in which a person’s sensitivity to pain is increased, which could worsen fibromyalgia instead of helping. Despite all of this, opioids are still commonly prescribed for fibromyalgia (Clauw, 2014). If you are prescribed opioids, ask for an alternative pain management technique or talk to your doctor about opioid safety.
Signs of Opioid Abuse and How to Get Help
Signs of opioid addiction include changes in normal behavior, such as changes in mood and eating and sleeping patterns. Opioid withdrawal symptoms may include drug cravings, anxiety, insomnia, irritability, vomiting, or diarrhea. Opioid withdrawal can last between three and ten days and can be dangerous. Do not try to quit cold turkey; seek help from a doctor. If you or a loved one needs help for an opioid addiction, call the Substance Abuse and Mental Health Services Administration help line at 800.662.HELP (4357).
Signs of an opioid overdose include shallow breathing, sleepiness, inability to talk, and dark skin or lips. If you believe someone is experiencing an overdose, try to wake them and call 911. If they do not have a pulse or are not breathing, perform CPR immediately while you wait for emergency help to arrive.
Cognitive Behavioral Therapy (CBT)
A type of psychotherapy called cognitive behavioral therapy (CBT) has been shown to be one of the most effective treatments for fibromyalgia (Clauw, 2014). The CBT sessions primarily focus on pain management by modifying thoughts and behaviors around the pain. Coexisting anxiety and depression are also addressed during treatment. Sessions can be administered in a one-on-one setting with a therapist, in a group, or online—online therapy sessions are gaining more popularity.
While CBT has been shown to be an effective treatment, one issue with the therapy is that people often feel that their diagnosis is being minimized into a purely psychological issue (which was what doctors historically believed fibromyalgia was). It’s important to recognize that all illnesses likely have some psychosocial aspect because we are not just isolated bodies but dynamic human beings who exist in cultural and social environments (more on that in our Q&A with Lorimer Moseley, PhD). One way CBT may work is by reducing catastrophizing (excessive worrying)—more on this in the research section below.
Alternate and Complementary Treatment Options for Fibromyalgia
Because fibromyalgia is such a complex diagnosis that must be treated in a multifaceted way, alternative treatments for fibromyalgia are a necessary part of any holistic treatment process that addresses both mind and body. Some of these therapies include music therapy, emotional awareness and expression therapy, acupuncture, yoga, massage, mindfulness-based stress reduction, and cannabis or CBD.
Most of us know intuitively that listening to music can be relaxing. It’s also been shown empirically to lessen the symptoms of a variety of chronic conditions. In a 2013 study, listening to a one-hour tape of classical music or salsa daily for four weeks was associated with a significant reduction in pain and depression in thirty people with fibromyalgia compared to controls (Onieva-Zafra et al., 2013). Listening to music may reduce pain through distraction, relaxation, and creating a general positive feeling (Pando-Naude et al., 2019). During pain flare-ups, it may be helpful to put on relaxing music or a favorite album.
Emotional Awareness and Expression Therapy (EAET)
A type of psychotherapy called emotional awareness and expression therapy (EAET) focuses on identifying the role that emotions play in activating the central nervous system and causing feelings of pain. It’s a combination of multiple types of therapy and involves educating patients about the role their brain plays in pain and encouraging patients to work through trauma and difficult emotions, while developing more-adaptive life skills (Lumley & Schubiner, 2019). A 2017 study found that EAET was more effective than basic education and was slightly superior to CBT in terms of pain reduction (Lumley et al., 2017). More clinical research is needed on EAET for fibromyalgia to validate these findings and determine which therapies are most effective for fibromyalgia treatment.
In traditional Chinese medicine, acupuncture uses needles to stimulate areas of the body that are believed to be associated with different symptoms and illnesses—¬called “acupoints.” A 2019 meta-analysis of eight randomized controlled trials found that acupuncture significantly reduced pain, while improving sleep quality and general health status in people with fibromyalgia compared to placebo (sham acupuncture treatments) (Kim et al., 2019).
You may benefit from regular acupuncture treatments in combination with other conventional treatments. Keep in mind that treatment is highly individual for acupuncture depending on the individual’s needs and which acupoints the practitioner targets. Acupuncture is often given in combination with moxibustion, in which dried mugwort (moxa) is burned near particular painful areas of the person’s body to create heat and healing. While people with fibromyalgia commonly try acupuncture in combination with moxibustion therapy, there isn’t solid evidence for its efficacy (Bai et al., 2014).
Holistic approaches often require dedication, guidance, and working closely with an experienced practitioner. There are several certifications that designate an herbalist. The American Herbalists Guild provides a listing of registered herbalists, whose certification is designated RH (AHG). Traditional Chinese medicine degrees include LAc (licensed acupuncturist), OMD (doctor of Oriental medicine), or DipCH (NCCA) (diplomate of Chinese herbology from the National Commission for the Certification of Acupuncturists). Traditional Ayurvedic medicine from India is accredited in the US by the American Association of Ayurvedic Professionals of North America (AAPNA) and the National Ayurvedic Medical Association (NAMA). There are also functional, holistic-minded practitioners (MDs, DOs, NDs, and DCs) who may use herbal protocols.
Massages can be a more enjoyable add-on to help with pain while also allowing for relaxation and stress release. A 2015 study reviewed the effectiveness of different styles of massage therapy for the treatment of fibromyalgia and found that myofascial release was associated with decreases in pain, fatigue, stiffness, anxiety, and depression as well as better quality of life compared to placebo in two clinical studies. Myofascial release is a type of massage that targets fascia, the connective tissue beneath the skin. The review concluded that there was limited evidence for the benefits of other types of massage, such as Swedish, Shiatsu, lymphatic drainage, and connective tissue massage (Yuan et al., 2015). You may benefit from regular massages in addition to regular treatment.
Meditative movement therapies (MMT) such as yoga may be beneficial for people with fibromyalgia. A 2013 meta-analysis of seven studies found that MMT significantly reduced sleep disturbances, fatigue, and depression and improved quality of life among people with fibromyalgia. Yoga was found to have some beneficial effects on key symptoms of fibromyalgia in the short term. This emphasizes the need for a consistent practice: The benefits may be short-lived, occurring only immediately after practice, if you don’t continue doing yoga on a regular basis (Langhorst et al., 2013). Another 2013 review study assessing yoga for rheumatic diseases found that there was weak evidence for the benefits of yoga among people with fibromyalgia (Cramer et al., 2013). Most recently, a small study found that fifteen women with fibromyalgia who did six weeks of a gentle daily yoga routine incorporating breathwork, yoga postures, yoga for sleep, and meditation reported reduced stress and pain and improved mood, sleep, and self-confidence (Lazaridou et al., 2019).
Mindfulness practices emphasize bringing a calm awareness to the present moment. Specific therapies have been developed around mindfulness to address stress and chronic pain. Mindfulness-based stress reduction (MBSR) is an eight-week program that incorporates aspects of meditation, yoga, and mind-body practices. It was developed by Jon Kabat-Zinn in the 1970s and has been shown in several clinical trials to reduce stress for a variety of chronic illnesses.
Newer research has shown that MBSR is beneficial for people with fibromyalgia. A 2015 study of women with fibromyalgia found that MBSR was associated with reduced stress and severity of fibromyalgia for up to two months after the therapy ended. And those who practiced mindfulness more frequently showed greater symptom relief (Cash et al., 2015). A 2019 study found that MBSR in addition to regular treatment for fibromyalgia was superior to regular treatment alone in both the short and long term (Pérez-Aranda et al., 2019).
Second-generation mindfulness interventions have been developed that differ from MBSR. Most notably, these interventions add a more spiritual aspect to mindfulness that may confer additional benefits to well-being and health outcomes. One such intervention is called mindfulness awareness training (MAT), which is an eight-week program comprising eight weekly two-hour workshops. The workshops involve self-practice, group discussion, and guided meditation and mindfulness exercises. In a 2017 study, MAT was associated with significantly reduced pain and fibromyalgia symptoms as well as increased sleep quality and psychological well-being compared to control subjects who were assigned to group CBT (Van Gordon et al., 2017).
Another type of treatment that has been shown to be effective for some people with fibromyalgia is called FibroQoL, which includes eight weeks of both psychoeducation and self-hypnosis training in a group setting. It begins with psychoeducation that describes pathology, diagnosis, and symptom management, followed by a self-hypnosis training that is designed to help with relaxation and pain management (Pérez-Aranda et al., 2017). A 2017 meta-analysis found evidence that hypnosis may reduce pain and psychological distress associated with fibromyalgia when used alone or in combination with CBT (Zech et al., 2017).
Cannabis and CBD
Nabilone is a synthetic cannabinoid that mimics the effects of THC—the psychoactive compound in cannabis that gets you high. Nabilone has traditionally been used to treat nausea related to cancer treatments but there’s interest in using it (and cannabis generally) for pain conditions, such as fibromyalgia. A 2014 clinical review of fibromyalgia found that there was high-quality evidence to support the use of cannabinoids, such as nabilone, for the treatment of fibromyalgia (Clauw, 2014). However, a 2016 review found a lack of convincing evidence to suggest that nabilone is effective for treating fibromyalgia. National guidelines do not accept cannabis use for fibromyalgia—due to both a lack of adequate evidence and the potential for cannabis abuse (Walitt et al., 2016).
Another cannabinoid is cannabidiol—i.e., CBD—which has become increasingly popular for a variety of symptoms such as fatigue and pain. CBD doesn’t give you that same high feeling as nabilone or cannabis. There hasn’t been adequate research yet on CBD’s effectiveness for people with fibromyalgia, but some may find that they benefit from it. Cannabinoids may not be for everyone—talk to your doctor first.
New and Promising Research on Fibromyalgia
In the past few years, new studies on fibromyalgia have begun to determine some of the causative and maintaining factors of fibromyalgia—such as catastrophizing, insulin resistance, hyperactive brain networks, and small-fiber polyneuropathy. The most exciting research is on new medications and a potential diagnostic blood test.
How Do You Evaluate Clinical Studies and Identify Promising Results?
The results of clinical studies are described throughout this article, and you may wonder which treatments are worth discussing with your doctor. When a particular benefit is described in only one or two studies, consider it of possible interest, or perhaps worth discussing, but definitely not conclusive. Repetition is how the scientific community polices itself and verifies that a particular treatment is of value. When benefits can be reproduced by multiple investigators, they are more likely to be real and meaningful. We’ve tried to focus on review articles and meta-analyses that take all the available results into account; these are more likely to give us a comprehensive evaluation of a particular subject. Of course, there can be flaws in research, and if by chance all of the clinical studies on a particular therapy are flawed—for example with insufficient randomization or lacking a control group—then reviews and meta-analyses based on these studies will be flawed. But in general, it’s a compelling sign when research results can be repeated.
When something goes wrong, we can tend to think the worst—letting our minds run through potential scenarios that often make the situation even harder. This is called catastrophizing and it can affect how our brains process chronic pain. When we feel something unpleasant, our brains go into fight or flight mode, gearing up our nervous system in order to protect us from harm. But when the pain is constant, like it is for people with fibromyalgia, this brain response is no longer helpful—it can start to exacerbate the pain.
In a recent study, a team of researchers from Harvard Medical School studied sixteen people with fibromyalgia who scored high in catastrophizing (meaning they showed many signs of things like pain complaints, anxiety, and excessive worrying). The researchers randomly assigned the sixteen people to either CBT or fibromyalgia education for four weeks. They also scanned their brains before and after treatment using fMRI to assess connectivity between different areas of their brains related to pain. The subjects who received CBT were shown to have a greater reduction in catastrophizing compared to the education subjects. And they also had less connectivity between their primary somatosensory cortex (receives information from the senses) and their anterior/medial insula (plays a role in pain perception and emotions). The important findings of this study are twofold: CBT seems to affect brain pathways related to pain, and it may have benefits for catastrophizing among people with fibromyalgia (Lazaridou et al., 2017).
New Drugs for Fibromyalgia
There are various new drugs being studied for fibromyalgia treatment that use different biological pathways to combat pain. Naltrexone is an opiate antagonist, meaning it blocks the effects of opioid medications. In smaller doses, naltrexone also has an anti-inflammatory effect on the body that has been suggested to help with pain in chronic conditions such as fibromyalgia. It’s inexpensive compared to other drugs. In a small study from Stanford University, women with fibromyalgia who took low doses of naltrexone for twelve weeks had a significantly greater reduction in pain compared to those who were assigned to placebo (Younger et al., 2013). Since that study’s publication, the researchers have conducted two clinical trials on low dose naltrexone for fibromyalgia which verified its benefits; however, there is a need for larger studies with long-term data on naltrexone’s safety.
Another interesting pharmacological direction has been studying a drug that treats insulin resistance, metformin. A study published in 2019 found that a small group of people with fibromyalgia had significantly higher blood sugar levels (HgA1c) than would be expected on average for someone their age based off of national data. They then treated those who met criteria for pre-diabetes (HgA1c > 5.7) with 500 milligrams (mg) of metformin twice a day and found that these people had a significant decrease in pain after this treatment (Pappolla et al., 2019). Future research is needed to confirm these findings and determine the role that insulin resistance plays in fibromyalgia.
See the clinical trials section for other drug trials that are recruiting now.
Blood Test for Fibromyalgia
Fibromyalgia is a difficult condition to diagnose and carries with it a stigma that has only recently begun to be lessened through better research and public education. Most recently, a blood test has been developed that may mitigate some of these problems and allow for better diagnosis. The blood test was developed by researchers at Ohio State University who were able to successfully identify the disorder in fifty people based on a molecular signature in their blood and differentiate them from control subjects who had rheumatoid arthritis, osteoarthritis, or lupus (Hackshaw et al., 2019). This is extremely exciting news for the fibromyalgia community. Hopefully, future research will validate this study’s findings so that this blood test can be implemented in the standard diagnostic process.
Note: There is a blood test available online that you may have heard of called the FM/a test. It does not appear to be covered by insurance companies and is not scientifically validated. This means it’s not clear whether the results are accurate and can confirm a diagnosis, so be wary.
Hyperactive Brain Networks
While we still don’t know what precisely causes fibromyalgia, there are various theories, and one involves exploding brain networks. Explosive synchronization (ES) is a term for hypersensitive brain networks that respond in extreme ways to minor changes. Researchers at the University of Michigan believe that this may explain why people with fibromyalgia experience such hypersensitivity to pain—a small sensation can set off a whole array of activity in the brain at once. The researchers examined the electrical activity of the brain in ten women with fibromyalgia and found evidence for ES as well as an association between high ES and higher reports of pain (Lee et al., 2018). The study provides evidence that these explosive brain networks may play a role in the biological mechanisms of fibromyalgia and perhaps other chronic pain conditions.
Small-Fiber Polyneuropathy (SFPN)
Small-fiber polyneuropathy (SFPN) is a condition that, like fibromyalgia, is characterized by severe pain. The symptoms of SFPN are caused by damage to small sensory nerves in the skin, and it is often related to diabetes. To determine if there is any overlap between SFPN and fibromyalgia, researchers at Massachusetts General Hospital studied twenty-seven people with fibromyalgia and took their skin biopsies to test for the presence of nerve damage from SFPN. The researchers found that 41 percent of these people had evidence of SFPN, leading the authors to suggest that many cases labeled as fibromyalgia may actually be undetected SFPN (Oaklander et al., 2013). While further research is needed, this study suggests that doctors should be ruling out SFPN before diagnosing patients with fibromyalgia. You may want to talk to your doctor about SFPN. A clinical trial is recruiting people with fibromyalgia to test Sudoscan, a new noninvasive device that the researchers hope will detect SFPN quickly.
Clinical Trials for Fibromyalgia
Clinical trials are research studies intended to evaluate a medical, surgical, or behavioral intervention. They are done so that researchers can study a particular treatment that may not have a lot of data on its safety or effectiveness yet. If you’re considering signing up for a clinical trial, it’s important to note that if you’re placed in the placebo group, you won’t have access to the treatment being studied. It’s also good to understand the phase of the clinical trial: Phase 1 is the first time most drugs will be used in humans so it’s about finding a safe dose. If the drug makes it through the initial trial, it can be used in a larger phase 2 trial to see whether it works well. Then it may be compared to a known effective treatment in a phase 3 trial. If the drug is approved by the FDA, it will go on to a phase 4 trial. Phase 3 and phase 4 trials are the most likely to involve the most effective and safest up-and-coming treatments.
In general, clinical trials may yield valuable information; they may provide benefits for some subjects but have undesirable outcomes for others. Speak with your doctor about any clinical trial you are considering.
Where Do You Find Studies That Are Recruiting Subjects?
You can find clinical studies that are recruiting subjects on clinicaltrials.gov, which is a website run by the US National Library of Medicine. The database consists of all privately and publicly funded studies that are happening around the globe. You can search for a disease or a specific drug or treatment you’re interested in, and you can filter by country where the study is taking place.
There is a need for new drugs for fibromyalgia treatment. One such drug being studied is found in cough suppressants—it’s called dextromethorphan, and it’s believed to reduce pain through anti-inflammatory activity at low doses. Jared W. Younger, PhD, the director of the Neuroinflammation Pain and Fatigue Lab at the University of Alabama at Birmingham, is recruiting women with fibromyalgia for a phase 2 clinical study to see if ten milligrams of dextromethorphan twice daily can reduce pain severity.
A biopharmaceutical company named Aptinyx is working to discover drugs that modulate NDMA receptors that are located in nerve cells in order to improve neural communication in the brain. One such drug called NYX-2925 is being studied for fibromyalgia and painful diabetic peripheral neuropathy. Aptinyx is recruiting adults with fibromyalgia at various study locations across the US for a phase 2 clinical trial to determine if NYX-2925 can help reduce pain symptoms.
Repetitive Transcranial Magnetic Stimulation (rTMS)
A form of brain stimulation therapy called repetitive transcranial magnetic stimulation (rTMS) which uses a magnetic field to send an electric current through the brain is being studied for pain relief in people with fibromyalgia. An international clinical trial led by Daniel Ciampi de Andrade, MD, PhD, at the Pain Center at the University of São Paulo in Brazil is recruiting women with fibromyalgia to determine the effects of high- and low-dose rTMS.
Transcutaneous Electrical Stimulation
Clinical psychologist Robert N. Jamison, PhD, at Brigham and Women’s Hospital in Boston is recruiting people with fibromyalgia for a clinical trial to determine if a wearable device called Quell can improve fibromyalgia symptoms. Quell delivers transcutaneous electrical nerve stimulation that allows the brain to release natural opioids, which may help with pain relief. Participants will be randomized to receive either a high-frequency or low-frequency device.
Many people enjoy saunas and baths and find them calming. There isn’t solid empirical evidence that these types of treatments can improve symptoms like pain in people with fibromyalgia, but one study is investigating the effects of hot baths. A clinical trial led by professors Paige Geiger, PhD, and Andrea L. Nicol, MD, from the University of Kansas School of Medicine is recruiting people with fibromyalgia. The researchers want to determine if heat therapy—immersion in a hot tub for forty-five minutes, twelve times a week, for four weeks—can ease the pain of fibromyalgia.
Whole Body Vibration
Whole body vibration (WBV) involves standing on a platform that delivers either vertical or rotational vibrations. These machines have become popular with athletes as a type of exercise that is intended to improve muscle performance, but WBV may also be beneficial for people with neuromuscular disorders. Professor José Antonio Mingorance, PhD, at the University of the Balearic Islands is recruiting people with fibromyalgia between the ages of thirty and sixty-five for a clinical study to determine if WBV can improve their pain and ability to walk.
• MyFibroTeam.com provides fibromyalgia information, resources, and an online community.
• National Fibromyalgia and Chronic Pain Association offers resources and support groups for people with fibromyalgia.
• Syndio Health is a community for people with fibromyalgia to share, search, review, and rate treatments.
• Tame the Beast is an online pain education resource for patients and clinicians.
• Explain Pain by David Butler and Lorimer Moseley is a guide to help patients and clinicians better understand chronic pain and therapeutic education.
• The Explain Pain Handbook by David Butler and Lorimer Moseley is a handbook to helo people with chronic pain understand and work through the many factors that maintain pain using the Protectometer.
• Full Catastrophe Living by Jon Kabat-Zinn is an educational book about mindfulness-based stress reduction.
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