Fibromyalgia is a common chronic condition whose main symptoms are specific tender points on various parts of the body, widespread musculoskeletal discomfort, morning stiffness, fatigue, and disturbed sleep. The cause of the condition is unknown, but it occurs most often in women aged 30 to 50. Other symptoms commonly believed to be associated with fibromyalgia are irritable bowel syndrome, urinary frequency, anxiety, headache, and numbness or tingling.
Apart from tender points on the body, physical exams and lab tests for people with fibromyalgia are usually normal. Because of this, some physicians are inclined to believe that the condition is "all in the patient's head." One researcher has noted that many of the symptoms of fibromyalgia, including certain tender points, are common in the general population, and goes so far as to question whether it is a real condition. 1
However, the current consensus is that fibromyalgia is real, and the American College of Rheumatologists has given it an official medical definition. It involves the presence of widespread chronic pain and the existence of pain in at least 11 of 18 specific points on the body when pressure is applied. Although the cause of fibromyalgia is not known, it may be related to poor sleeping with incomplete muscular relaxation.
Antidepressants have been shown to help chronic pain from many causes 2 and have been found to be effective in reducing fibromyalgia symptoms, even when given in doses too low to treat depression. 3 Other conventional treatment for fibromyalgia may include antidepressants, anti-inflammatory drugs, muscle relaxants, sleeping pills, and anti-anxiety medications.
Various forms of exercise , 4,5,43,53,54 especially aerobic exercise, have been shown to be helpful for symptoms associated with fibromyalgia, most notably global well-being and physical functioning. 52
There are three natural treatments that might be helpful for fibromyalgia, although the evidence is not yet strong: SAMe, 5-HTP, and capsaicin.
SAMe, short for S-adenosylmethionine, is a chemical derived from a combination of methionine, an amino acid, and adenosine triphosphate (ATP), the main molecule for energy in the body. More well known as a treatment for depression and also osteoarthritis, preliminary research suggests that SAMe may be helpful for fibromyalgia as well.
Four double-blind trials have studied the use of SAMe for fibromyalgia, 6-9 three of them finding it to be helpful. Unfortunately, most of these studies gave SAMe either intravenously or as an injection into the muscles, sometimes in combination with oral doses. When you inject a medication, the effects can be quite different than when you take it orally. For that reason, these studies are of questionable relevance.
However, the one double-blind study that used only oral SAMe did find positive results. 10 In this trial, 44 people with fibromyalgia took 800 mg of SAMe or placebo for 6 weeks. Compared to the group taking placebo, those taking SAMe had improvements in disease activity, pain at rest, fatigue, and morning stiffness, and in one measurement of mood. In other respects, such as the amount of tenderness in their tender points, the group taking SAMe did no better than those taking the placebo.
It is not clear whether SAMe is helping fibromyalgia through antidepressant effects or some other mechanism.
For more information, including dosage and safety issues, see the full SAMe article.
5-HTP, short for 5-hydroxytryptophan, is most commonly used as a treatment for depression. It is thought to work by increasing the amount of serotonin in the brain. However, evidence that it helps fibromyalgia is still preliminary.
One double-blind study of 50 people with fibromyalgia found that those taking 300 mg of 5-HTP for 30 days reported significant decreases in the number of tender points and the amount of pain they experienced, compared to those taking placebo. 11 They also noted improvements in sleep patterns, morning stiffness, anxiety, and fatigue. Interestingly, the people taking placebo also noted significant improvements in pain and sleep, although less marked than those experienced with 5-HTP. More studies are needed to determine how much 5-HTP really helps.
For more information, including dosage and safety issues, see the full 5-HTP article.
Capsaicin , the "hot" in cayenne peppers, is widely used as a treatment for various painful conditions, such as shingles and arthritis. One double-blind study of 45 people found that it may be beneficial for fibromyalgia as well. 15 In this study, participants used either the capsaicin cream or a placebo 4 times a day for 4 weeks, rubbing it into the tender points on one side of their body. Those who used the real treatment reported less tenderness in their tender points than those using the placebo. Interestingly, the points on their untreated sides were also less tender. There was no difference between those using capsaicin or placebo in the amount of overall pain or sleep quality. It must be noted, however, that it is hard to believe the study was really double-blind, since it is impossible to hide the burning sensation caused by capsaicin!
For more information, including dosage and safety issues, see the full Cayenne Pepper article.
The blue-green algae Chlorella pyrenoidosa might be helpful for fibromyalgia. In a double-blind, placebo-controlled trial, 37 people with fibromyalgia were given either placebo or chlorella supplements at a dose of 10 g daily. 16 At the end of 3 months, people were switched to the opposite group, and then treated for an additional 3 months. The results showed significant improvements in symptoms when participants used chlorella as compared to placebo. Note : There are serious safety concerns about blue-green algae. For more information, see the full Blue-green Algae article.
A pilot double-blind study found benefit with a proprietary mixture containing camphor oil, rosemary oil , eucalyptus oil , peppermint oil , aloe vera oil, lemon oil, and orange oil. 47 These essential oils were applied topically.
A mixture of malic acid and magnesium has been widely marketed as a treatment for fibromyalgia. However, in a double-blind study of 24 people, this treatment proved no more effective than placebo. 23 Good results were seen in open trials, 24,25 but such studies cannot eliminate the placebo effect and, for that reason, are not reliable. (For more information on this complicated issue, see Why Does This Database Rely on Double-blind Studies? )
A substantial study marred by poor design (specifically, far too many primary endpoints) found equivocal evidence that L-carnitine, taken at dose of 500 mg three times daily, might be more effective than placebo for the treatment of fibromyalgia. 51
Other proposed natural supplements for fibromyalgia include vitamin B 1 , vitamin E , and selenium , but there is no real evidence that they work. A study that purportedly found melatonin helpful was, in fact, too poorly designed to provide meaningful evidence. 36
The effectiveness of IV-infused micronutrient therapy (eg, Myers' Cocktail) is unclear. In a small 2009 study of 34 adults, weekly IV micronutrient infusions for 8 weeks were reported to improve tender point scores from baseline, but the results were not significantly better than placebo. 57
A 2006 review of acupuncture for fibromyalgia found five controlled studies, none of which were of high quality. 45 A subesequent review of seven contorlled trials involving 385 subjects suggested that acupuncture may reduce pain immediately following treatment, but did find evidence of a perisistent effect beyong treatment. 58 Overall, the results do not provide reliable evidence that acupuncture is helpful.
Other alternative treatments with minimal supporting evidence include:
The martial art Tai Chi has also been studied as a treatment for fibromylgia. In a small randomized, controlled trial, Tai Chi appeared to improve symptoms, function, and quality of life in fibromyalgia patients compared to wellness education and stretching. 59
Osteopathic manipulative therapy , which focuses on manual treatment of the musculoskeletal system, has some evidence to support its use as a treatment for fibromyalgia. 35,61 . In one trial, 93 women (average age 53) with fibromyalgia were randomized to receive sham treatment or craniosacral therapy (one-hour sessions twice a week for 20 weeks). 61 Craniosacral therapy involves manipulating external tissues of the head. This is done to help facilitate the natural rhythmic pulsation, which are thought to travel through brain and spinal cord. Compared to the sham group, women in the craniosacral therapy group experienced a decrease in pain at 20 weeks, which persisted for a least one year. In another randomized trial, 94 people with fibromyalgia received either myofascial release (a type of treatment that involves palpitation of the fascial tissue surrounding muscles) or sham therapy for 40 sessions (20 weeks). 63 At the 6-month follow-up, the people in the treatment group reported less pain and more physical ability. But, only some of these results lasted until the 1-year follow-up.
Yoga is another alternative therapy that has been studied for fibromyalgia. In a small trial involving 53 women with fibromyalgia, those that participated in an 8-week yoga program experienced an improvement in their symptoms, including pain, fatigue, stiffness, and tenderness. 60
A single-blind study of somewhat convoluted design provides weak evidence that a gown made from a special “electromagnetic shielding fabric” can reduce fibromyalgia symptoms. 46 The rationale for using this fabric is, however, somewhat scientifically implausible.
One study purportedly found that use of cosmetics increases fibromyalgia symptoms, but it was too poorly designed to show anything at all. 42 An equally meaningless study purported to show that intravenous nutrients are helpful for fibromyalgia. 48
The use of transcranial direct current stimulation (tDCS) was associated with pain relief in 3 small randomized trials when compared to sham treatment. One trial found improvements in daily quality of life. Though there were significant changes in the tDCS group, the changes were short-term. However, the review only had a total of 96 patients, more research is needed with larger groups to determine its clinical benefit.66-68
The Homeopathy section of the database also has an article on Fibromyalgia .
9. Volkmann H, Norregaard J, Jacobsen S, et al. Double-blind, placebo-controlled cross-over study of intravenous S-adenosyl-L-methionine in patients with fibromyalgia. Scand J Rheumatol. 1997;26:206-211.
16. Merchant RE, Andre CA. A review of recent clinical trials of the nutritional supplement Chlorella pyrenoidosa in the treatment of fibromyalgia, hypertension, and ulcerative colitis. Altern Ther Health Med. 2001;7:79-80,82-91.
19. Islam MS, Rahim Z, Alam MJ, et al. Association of Vibrio cholerae O1 with the cyanobacterium, Anabaena sp., elucidated by polymerase chain reaction and transmission electron microscopy. Trans R Soc Trop Med Hyg. 1999;93:36-40.
23. Russell IJ, Michalek JE, Flechas JD, et al. Treatment of fibromyalgia syndrome with Super Malic®: a randomized, double blind, placebo controlled, crossover pilot study. J Rheumatol. 1995;22:953-958.
24. Russell IJ, Michalek JE, Flechas JD, et al. Treatment of fibromyalgia syndrome with Super Malic®: a randomized, double blind, placebo controlled, crossover pilot study. J Rheumatol. 1995;22:953-958.
26. Feldman D, da Costa Sao Paulo ED. Treatment of fibromyalgia with acupuncture: a randomized, placebo controlled trial of 16 weeks duration. American College of Rheumatology Annual Meeting. Nov 2001. San Francisco, CA.
35. Gamber RG, Shores JH, Russo DP, et al. Osteopathic manipulative treatment in conjunction with medication relieves pain associated with fibromyalgia syndrome: results of a randomized clinical pilot project. J Am Osteopath Assoc. 2002;102:321-325.
39. Harris RE, Tian X, Williams DA, et al. Treatment of fibromyalgia with formula acupuncture: investigation of needle placement, needle stimulation, and treatment frequency. J Altern Complement Med. 2005;11:663-671.
41. Astin JA, Berman BM, Bausell B, et al. The efficacy of mindfulness meditation plus qigong movement therapy in the treatment of fibromyalgia: a randomized controlled trial. J Rheumatol. 2003;30:2257-2262.
43. Jones KD, Adams D, Winters-Stone K, Burckhardt CS. A comprehensive review of 46 exercise treatment studies in fibromyalgia (1988-2005). Health Qual Life Outcomes. 2006;4:67. Available at: http://www.hqlo.com/content/pdf/1477-7525-4-67.pdf . Accessed October 2, 2006.
47. Ko GD, Hum A, Traitses G, Berbrayer D. Effects of topical O24 essential oils on patients with fibromyalgia syndrome: a randomized, placebo controlled pilot study. J Musculoskelet Pain. 2007;15:11-19.
58. Langhorst J, Klose P, Musial F, et al. Efficacy of acupuncture in fibromyalgia syndrome--a systematic review with a meta-analysis of controlled clinical trials. Rheumatology (Oxford). 2010;49:778.
61. Castro-Sánchez AM, Matarán-Peñarrocha GA, Sánchez-Labraca N, et al. A randomized controlled trial investigating the effects of craniosacral therapy on pain and heart rate variability in fibromyalgia patients. Clin Rehabil. 2011;25(1):25-35.
63. Castro-Sánchez AM, Matarán-Peñarrocha GA, Arroyo-Morales M, Saavedra-Hernández M, Fernández-Sola C, Moreno-Lorenzo C. Effects of myofascial release techniques on pain, physical function, and postural stability in patients with fibromyalgia: a randomized controlled trial. Clin Rehabil. 2011;25(9):800-813.
64. Hargrove JB, Bennett RM, Simons DG, et al. A randomized placebo-controlled study of noninvasive cortical electrostimulation in the treatment of fibromyalgia patients. Pain Med. 2012;13(1):115-124.
65. Meeus M, Nijs J, et al. The effect of relaxation therapy on autonomic functioning, symptoms and daily functioning, in patients with chronic fatigue syndrome or fibromyalgia: A systematic review. Clin Rehabil. 2014 Sep 8 [Epub ahead of print].
67. Villamar MF, Wivatvongvana P, Patumanond J. Focal modulation of the primary motor cortex in fibromyalgia using 4×1-ring high-definition transcranial direct current stimulation (HD-tDCS): immediate and delayed analgesic effects of cathodal and anodal stimulation. J Pain. 2013;14(4):371-383.
Last reviewed September 2014 by EBSCO CAM Review Board
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