Fibromyalgia: In Depth
What’s the Bottom Line?
What do we know about the effectiveness of complementary health approaches for fibromyalgia?
- 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.
- Vitamin D supplements may reduce pain in people with fibromyalgia who are deficient in this vitamin.
- Some preliminary research on transcranial magnetic stimulation (TMS) for fibromyalgia symptoms has had promising results.
What do we know about the safety of complementary health approaches for fibromyalgia?
- The mind and body 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 natural products 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 Web site.
What the Science Says About Complementary Health Approaches for Fibromyalgia
Mind and Body Practices
- 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.
- 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.
Meditative Movement Practices (Tai Chi, Qi Gong, and Yoga)
- Tai chi and qi gong, 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, qi gong, 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 qi gong. However, these practices may need to be modified to make them suitable for people with fibromyalgia.
- 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.
Other Mind and Body Practices
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 mind and body 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 natural products that have been studied for fibromyalgia include dietary supplements such as soy, S-adenosyl-L-methionine (SAMe), and creatine, and topical products containing capsaicin (the substance that gives chili peppers their heat). There’s not enough evidence to determine whether these products are helpful.
- “Natural” doesn’t necessarily mean “safe.” Natural products 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.
- 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.
- 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.
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.
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.
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.
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.
- Assefi N, Bogart A, Goldberg J, et al. Reiki for the treatment of fibromyalgia: a randomized controlled trial. Journal of Alternative and Complementary Medicine. 2008;14(9):1115–1122.
- Deare JC, Zheng Z, Xue CC, et al. Acupuncture for treating fibromyalgia. Cochrane Database of Systematic Reviews. 2013;(5):CD007070. Accessed at www.cochranelibrary.com on April 8, 2016.
- De Silva V, El-Metwally A, Ernst E, et al. Evidence for the efficacy of complementary and alternative medicines in the management of fibromyalgia: a systematic review. Rheumatology. 2010;49(6):1063–1068.
- Glombiewski JA, Bernardy K, Häuser W. Efficacy of EMG- and EEG-biofeedback in fibromyalgia syndrome: a meta-analysis and a systematic review of randomized controlled trials. Evidence-Based Complementary and Alternative Medicine: eCAM. 2013;2013:962741.
- Jones KD, Sherman CA, Mist SC, et al. A randomized controlled trial of 8-form tai chi improves symptoms and functional mobility in fibromyalgia patients. Clinical Rheumatology. 2012;31(8):1205–1214.
- Kalichman L. Massage therapy for fibromyalgia symptoms. Rheumatology International. 2010;30(9):1151–1157.
- Langhorst J, Klose P, Dobos GJ, et al. Efficacy and safety of meditative movement therapies in fibromyalgia syndrome: a systematic review and meta-analysis of randomized controlled trials. Rheumatology International. 2013;33(1):193–207.
- Lauche R, Cramer H, Dobos G, et al. A systematic review and meta-analysis of mindfulness-based stress reduction for the fibromyalgia syndrome. Journal of Psychosomatic Research. 2013;75(6):500–510.
- Lauche R, Cramer H, Häuser W, et al. A systematic overview of reviews for complementary and alternative therapies in the treatment of the fibromyalgia syndrome. Evidence-Based Complementary and Alternative Medicine: eCAM. 2015;2015:610615.
- Marlow NM, Bonilha HS, Short EB. Efficacy of transcranial direct current stimulation and repetitive transcranial magnetic stimulation for treating fibromyalgia syndrome: a systematic review. Pain Practice. 2013;13(2):131–145.
- Meeus M, Nijs J, Vanderheiden T, 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. Clinical Rehabilitation. 2015;29(3):221–233.
- Naumann J, Sadaghiani C. Therapeutic benefit of balneotherapy and hydrotherapy in the management of fibromyalgia syndrome: a qualitative systematic review and meta-analysis of randomized controlled trials. Arthritis Research & Therapy. 2014;16(4):R141.
- Perry R, Terry R, Ernst E. A systematic review of homoeopathy for the treatment of fibromyalgia. Clinical Rheumatology. 2010;29(5):457–464.
- Terhorst L, Schneider MJ, Kim KH, et al. Complementary and alternative medicine in the treatment of pain in fibromyalgia: a systematic review of randomized controlled trials. Journal of Manipulative and Physiological Therapeutics. 2011;34(7):483–496.
- Theadom A, Cropley M, Smith HE, et al. Mind and body therapy for fibromyalgia. Cochrane Database of Systematic Reviews. 2015;(4):CD001980. Accessed at http://www.thecochranelibrary.com on April 8, 2016.
- U.S. Food and Drug Administration, Living with Fibromyalgia, Drugs Approved to Manage Pain. U.S. Food and Drug Administration Web site. Accessed at www.fda.gov/downloads/ForConsumers/ConsumerUpdates/UCM107805.pdf (207KB PDF) on April 8, 2016.
- Wepner F, Scheuer R, Schuetz-Wieser B, et al. Effects of vitamin D on patients with fibromyalgia syndrome: a randomized placebo-controlled trial. Pain. 2014;155(2):261–268.
All Other References
- Ablin JN, Häuser W, Buskila D. Spa treatment (balneotherapy) for fibromyalgia—a qualitative-narrative review and a historical perspective. Evidence-Based Complementary and Alternative Medicine: eCAM. 2013;2013:638050.
- Alves CR, Santiago BM, Lima FR, et al. Creatine supplementation in fibromyalgia: a randomized, double-blind, placebo-controlled trial. Arthritis Care & Research. 2013;65(9):1449–1459.
- Astin JA, Shapiro SL, Eisenberg DM, et al. Mind-body medicine: state of the science, implications for practice. Journal of the American Board of Family Practice. 2003;16(2):131–147.
- Bagis S, Karabiber M, As I, et al. Is magnesium citrate treatment effective on pain, clinical parameters and functional status in patients with fibromyalgia? Rheumatology International. 2013;33(1):167–172.
- Bai Y, Guo Y, Wang H, et al. Efficacy of acupuncture on fibromyalgia syndrome: a meta-analysis. Journal of Traditional Chinese Medicine. 2014;34(4):381–391.
- Baranowsky J, Klose P, Musial F, et al. Qualitative systemic review of randomized controlled trials on complementary and alternative medicine treatments in fibromyalgia. Rheumatology International. 2009;30(1):1–21.
- Bernardy K, Füber N, Klose P, et al. Efficacy of hypnosis/guided imagery in fibromyalgia syndrome—a systematic review and meta-analysis of controlled trials. BMC Musculoskeletal Disorders. 2011;12:133.
- Birdee GS, Wayne PM, Davis RB, et al. T’ai chi and qigong for health: patterns of use in the United States. Journal of Alternative and Complementary Medicine. 2009;15(9):969–973.
- Boyer L, Dousset A, Roussel P, et al. rTMS in fibromyalgia: a randomized trial evaluating QoL and its brain metabolic substrate. Neurology. 2014;82(14):1231–1238.
- Carson JW, Carson KM, Jones KD, et al. Follow-up of yoga of awareness for fibromyalgia: results at 3 months and replication in the wait-list group. Clinical Journal of Pain. 2012;28(9):804–813.
- Cash E, Salmon P, Weissbecker I, et al. Mindfulness meditation alleviates fibromyalgia symptoms in women: results of a randomized clinical trial. Annals of Behavioral Medicine. November 26, 2014. Epub ahead of print.
- Cramer H, Krucoff C, Dobos G. Adverse events associated with yoga: a systematic review of published case reports and case series. PLoS One. 2013;8(10):e75515.
- Dantas F, Fisher P, Walach H, et al. A systematic review of the quality of homeopathic pathogenetic trials published from 1945 to 1995. Homeopathy. 2007;96(1):4–16.
- Ernst E. Acupuncture-a critical analysis. Journal of Internal Medicine. 2006;259(2):125–137.
- Guidelli GM, Tenti S, De Nobili E, Fioravanti A. Fibromyalgia syndrome and spa therapy: myth or reality? Clinical Medicine Insights: Arthritis and Musculoskeletal Disorders. 2012;5:19–26.
- Jesus CA, Feder D, Peres MF. The role of vitamin D in pathophysiology and treatment of fibromyalgia. Current Pain and Headache Reports. 2013;17(8):355.
- Kuehn BM. Despite health claims by manufacturers, little oversight for homeopathic products. JAMA. 2009;302(15):1631–1634.
- Lao L. Safety issues in acupuncture. Journal of Alternative and Complementary Medicine. 1996;2(1):27–31.
- Lee MS, Pittler MH, Ernst E. Effects of Reiki in clinical practice: a systematic review of randomised clinical trials. International Journal of Clinical Practice. 2008;62(6):947–954.
- Lee SJ, Kim DY, Chun MH, et al. The effect of repetitive transcranial magnetic stimulation on fibromyalgia: a randomized sham-controlled trial with 1-mo follow-up. American Journal of Physical Medicine & Rehabilitation. 2012;91(12):1077–1085.
- Li YH, Wang FY, Feng CQ, et al. Massage therapy for fibromyalgia: a systematic review and meta-analysis of randomized controlled trials. PLoS One. 2014;9(2):e89304.
- Liu W, Zahner L, Cornell M, et al. Benefit of qigong exercise in patients with fibromyalgia: a pilot study. International Journal of Neuroscience. 2012;122(11):657–664.
- Lustyk MK, Chawla N, Nolan RS, et al. Mindfulness meditation research: issues of participant screening, safety procedures, and researcher training. Advances in Mind-Body Medicine. 2009;24(1):20–30.
- Lynch M, Sawynok J, Hiew C, et al. A randomized controlled trial of qigong for fibromyalgia. Arthritis Research & Therapy. 2012;14(4):R178.
- Maestú C, Blanco M, Nevado A, et al. Reduction of pain thresholds in fibromyalgia after very low-intensity magnetic stimulation: a double-blinded, randomized placebo-controlled clinical trial. Pain Research & Management. 2013;18(6):e101–e106.
- Menzies V, Lyon DE, Elswick RK Jr, et al. Effects of guided imagery on biobehavioral factors in women with fibromyalgia. Journal of Behavioral Medicine. 2014;37(1):70–80.
- Nahin RL, Boineau R, Khalsa PS, Stussman BJ, Weber WJ. Evidence-based evaluation of complementary health approaches for pain management in the United States. Mayo Clinic Proceedings. September 2016;91(9):1292–1306.
- National Institute of Arthritis and Musculoskeletal and Skin Diseases. Questions and Answers About Fibromyalgia. National Institute of Arthritis and Musculoskeletal and Skin Diseases Web site. Accessed at niams.nih.gov/health_info/fibromyalgia/ on April 8, 2016.
- Nield-Anderson L, Ameling A. Reiki: a complementary therapy for nursing practice. Journal of Psychosocial Nursing and Mental Health Services. 2001;39(4):42–49.
- Office of Dietary Supplements. Magnesium Fact Sheet for Consumers. National Institutes of Health Web site. Accessed at ods.od.nih.gov/pdf/factsheets/Magnesium-Consumer.pdf (297KB PDF) on April 8, 2016.
- Office of Dietary Supplements. Vitamin D Fact Sheet for Consumers. National Institutes of Health Web site. Accessed at ods.od.nih.gov/factsheets/VitaminD-Consumer/ on April 8, 2016.
- Picard P, Jusseaume C, Boutet M, et al. Hypnosis for management of fibromyalgia. International Journal of Clinical and Experimental Hypnosis. 2013;61(1):111–123.
- Pittler MH, Brown EM, Ernst E. Static magnets for reducing pain: systematic review and meta-analysis of randomized trials. CMAJ. 2007;177(7):736–742.
- Porter NS, Jason LA, Boulton A, et al. Alternative medical interventions used in the treatment and management of myalgic encephalomyelitis/chronic fatigue syndrome and fibromyalgia. Journal of Alternative and Complementary Medicine. 2010;16(3):235–249.
- Sarac AJ, Gur A. Complementary and alternative medical therapies in fibromyalgia. Current Pharmaceutical Design. 2006;12(1):47–57.
- Sherman KJ, Cherkin DC, Kahn J, et al. A survey of training and practice patterns of massage therapists in two U.S. states. BMC Complementary and Alternative Medicine. 2005;5:13.
- Toussaint LL, Whipple MO, Abboud LL, et al. A mind-body technique for symptoms related to fibromyalgia and chronic fatigue. Explore. 2012;8(2):92–98.
- Verkaik R, Busch M, Koeneman T, et al. Guided imagery in people with fibromyalgia: a randomized clinical trial of effects of pain, functional status and self-efficacy. Journal of Health Psychology. 2014;19(5):678–688.
- Vickers A, Zollman C, Payne DK. Hypnosis and relaxation therapies. Western Journal of Medicine. 2001;175(4):269–272.
- Wang C, Schmid CH, Rones R, et al. A randomized trial of tai chi for fibromyalgia. New England Journal of Medicine. 2010;363(8):743–754.
- Xu S, Wang L, Cooper E, et al. Adverse events of acupuncture: a systematic review of case reports. Evidence-Based Complementary and Alternative Medicine: eCAM. 2013;2013:581203.
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This page last modified September 01, 2016