Also indexed as: Fibromyositis, Fibrositis, Myofascial Pain
Syndrome, Myofibrositis, Primary Fibromyalgia Syndrome
Fibromyalgia—an unsolved mystery—is a complex
syndrome with no known cause or sure cure. According to research or other evidence, the
following self-care steps may be helpful:
- Low-intensity exercise (like walking or swimming) is the best
- Address your stress
- Reducing stress and unpleasant emotions may also reduce
- Try 5-HTP
- 100 mg of the supplement 5-hydroxytryptophan three times a day may
- Check out SAMe
- 800 mg of the supplement S-adenosyl-l-methionine a day may help
These recommendations are not comprehensive and are not intended to replace
the advice of your doctor or pharmacist. Continue reading the full fibromyalgia article for
more in-depth, fully-referenced information on medicines, vitamins, herbs, and dietary and
lifestyle changes that may be helpful.
Fibromyalgia is a complex syndrome with no known cause or cure. Its predominant symptom is
pain in the fibrous tissues, muscles, tendons, and ligaments, although other symptoms may be
Research has demonstrated that the axis connecting the three glands primarily responsible
for the stress response (hypothalamus, pituitary, adrenals) may be dysfunctional in people
with fibromyalgia.1 Inflammation of the involved structures is generally absent in
Of the estimated three to six million people2 affected by this disorder in the
United States, the vast majority are women between 25 and 45 years of age.
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What are the symptoms?
Trigger-point pain at characteristic locations is the defining symptom of fibromyalgia. The
most commonly affected locations are on the occiput (nape of the neck), the neck itself,
shoulders, trunk, low back, and thighs. Other symptoms may also be experienced, including
fatigue, chest pain, low-grade fever, swollen lymph nodes, insomnia, frequent abdominal pain, irritable bowel syndrome, and depression.3
Over the counter pain relievers, such as
aspirin (Bayer®, Ecotrin®, Bufferin®), ibuprofen (Motrin®, Advil®), and acetaminophen (Tylenol®), may be recommended.
However, one double-blind trial found no difference between ibuprofen and placebo with respect
to treating fibromyalgia symptoms.4
Treatment commonly involves a combination of medications, including one of several antidepressants, such as amitriptyline (Elavil®), fluoxetine (Prozac®), sertraline (Zoloft®), paroxetine (Paxil®), and fluvoxamine (Luvox®), to help diminish pain and
improve sleep. Some individuals might benefit from a muscle relaxant, such as cyclobenzaprine (Flexeril®).
Low-impact exercise programs to improve aerobic fitness, stretching techniques to relax
tense muscles, and cognitive therapy for coping with stress and emotional disorders are
Dietary changes that may be helpful
A vegan diet (includes no animal products) that is also low in salt may help women with
fibromyalgia. In a controlled clinical trial,5 women with fibromyalgia were put on
a special diet consisting only of raw foods—primarily fruits,
vegetables, nuts, seeds,
legumes, and cereals (such as rolled
oats). The diet also contained several fermented foods, including a fermented yogurt-food made
from oats, a fermented beverage made from wheat berries (called Rejuvalac), and several types
of fermented vegetables, particularly cabbage. During the three-month trial, women following
the therapeutic diet experienced a significant reduction in body weight,
pain, morning sickness, use of
painkillers, depression, and the number of
sore fibromyalgia points, compared with those who continued to eat their regular diet. Due to
the liberal use of nuts and seeds, this diet was not low in fat; for example, 31% of all
calories came from fat. Nonetheless, the total number of calories was relatively low (less
than 1,900 calories per day), which was probably responsible for the decrease in body
In a preliminary report, four women with fibromyalgia experienced marked improvement or
complete resolution of their symptoms within months after eliminating monosodium glutamate
(MSG) or MSG plus aspartame from their diet. In each case, symptoms recurred whenever MSG was
Lifestyle changes that may be helpful
Low-intensity exercise may improve fibromyalgia symptoms. People with fibromyalgia who
exercise regularly have been reported to suffer less severe symptoms than those who remain
sedentary.7 8 9 In a controlled trial, a program consisting
of two 25-minute exercise classes plus two educational sessions per week for six weeks
resulted in immediate and sustained improvement in walking distance, fatigue, and well-being
in a group of people with fibromyalgia;10 however, no reductions in pain,
anxiety, or depression were seen. In a
more recent controlled trial, a 35-minute exercise program in a warm pool once a week for six
months, coupled with counseling sessions, led to improvements in hand-grip strength and
endurance, as well as to reductions in pain, distress, depression, and anxiety.11
The results of this trial, and other similar trials, suggest that underwater exercise
training, in combination with a counseling intervention, should be considered by people with
Vitamins that may be helpful
People with fibromyalgia often have low serotonin levels in their blood.12
13 14 Supplementation with
5-HTP may increase serotonin synthesis in these cases. Both preliminary15
16 and double-blind trials17 have reported that 5-HTP supplementation (100 mg
three times per day) relieves some symptoms of fibromyalgia.
Some studies have found low vitamin B1
(thiamine) levels and reduced activity of some thiamine-dependent enzymes among people with
fibromyalgia.18 19 The clinical significance of these findings remains
One early preliminary study described the use of vitamin E supplements in the treatment of
“fibrositis”—the rough equivalent of what is today called fibromyalgia.
Several dozen individuals were treated with vitamin E using amounts ranging from 100–300
IU per day. The results were positive and sometimes dramatic.20 Double-blind trials
are needed to confirm these preliminary observations.
Intravenous S-adenosylmethionine (SAMe)
given to people with fibromyalgia reduced pain and depression in two double-blind
trials;21 22 but no benefit was seen in a short (ten-day)
trial.23 Oral SAMe (800 mg per day for six weeks) was tested in one double-blind
trial and significant beneficial effects were seen, such as reduced pain, fatigue, and stiffness, and improved
A preliminary trial found that a combination of magnesium and malic acid might lessen muscle pain in people with
fibromyalgia.25 The amounts used in this trial were 300–600 mg of elemental
magnesium and 1,200–2,400 mg of malic acid per day, taken for eight weeks. A
double-blind trial by the same research group using 300 mg magnesium and 1,200 mg malic acid
per day found no reduction in symptoms, however.26 Though these researchers claimed
that magnesium and malic acid appeared to have some effect at higher levels (up to 600 mg
magnesium and 2,400 mg malic acid), the positive effects were not demonstrated under blinded
study conditions. Therefore, the evidence supporting the use of these supplements for people
with fibromyalgia remains weak and inconclusive.
Melatonin supplementation may be useful in
the treatment of fibromyalgia. In a preliminary trial, 3 mg of melatonin at bedtime was found
to reduce tender points and to improve sleep and other measures of disease severity, though
pain and fatigue improved only slightly.27
Are there any side effects or interactions?
Refer to the individual supplement for information about any side effects or interactions.
Holistic approaches that may be helpful
Stress is believed by some researchers to be capable of aggravating fibromyalgia symptoms.
Stress-reduction techniques, such as
meditation, have proven helpful in preliminary research.28
Acupuncture may be useful for short-term
relief of fibromyalgia symptoms. In one preliminary trial, acupuncture produced a significant
decrease in pain and point tenderness along with related biochemical changes measured in the
fibromyalgia patients’ blood.29 Another uncontrolled trial used
electroacupuncture (acupuncture with electrical stimulation) treatment in people with
fibromyalgia who were unresponsive to conventional medical therapies. After an average of
seven treatments per person, 46% claimed that electroacupuncture provided the best relief of
symptoms when compared to all other therapies, and 64% reported using less medication for pain
relief than prior to electroacupuncture.30 A double-blind trial compared fake
acupuncture to electroacupuncture and reported significant differences in improvement in five
of eight outcome measurements among people with fibromyalgia.31 Short-term pain
reduction in people with fibromyalgia has been reported in other studies, some of which were
at least partially controlled; however, long-term benefits have never been investigated in a
controlled clinical trial.32 Long-term controlled trials are necessary to
conclusively determine whether acupuncture is a useful treatment for fibromyalgia.
Joint manipulation, chiropractic, and
related treatments may be helpful for relieving some of the symptoms of fibromyalgia. A
preliminary study33 found that almost half of people with fibromyalgia who received
chiropractic care had “moderate to good” improvement. A small preliminary
trial34 evaluated the effect of four weeks of chiropractic treatment (three to five
times per week) consisting of soft tissue massage, stretching, spinal manipulation, and
general advice and information. Treatment resulted in a significant decrease in pain and an
increase in range of neck movement, but there was no improvement in tender points or in
ability to function in daily life. Another preliminary trial35 evaluated a longer
treatment period (30 sessions) consisting of spinal manipulation and deep pressure massage to
tender points in the muscles. More benefit was reported by this study, as 60% of the patients
experienced significant pain reduction, reduced sensed of fatigue, and improved sleep. These
benefits persisted one month after the treatment was completed. People who did not feel better
after 15 treatments were not likely to benefit from this type of treatment. No controlled
research has evaluated manipulation therapies for fibromyalgia.
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