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:
Manage discomfort
Nonsteroidal anti-inflammatory drugs like ibuprofen (Motrin),
naproxen (Naprosyn), meloxicam (Mobic), and celecoxib (Celebrex) are often prescribed to treat
pain
Exercise
Low-intensity exercise (like walking or swimming) is the best
known treatment
Address your stress
Reducing stress and unpleasant emotions may also reduce
symptoms
Try 5-HTP
100 mg of the supplement 5-hydroxytryptophan three times a day may
ease symptoms
Check out SAMe
800 mg of the supplement S-adenosyl-l-methionine a day may help
symptoms
Talk to your doctor
The antidepressant duloxetine (Cymbalta) is sometimes prescribed
to treat symptoms
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.
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About
Product ratings
Symptoms
Dietary changes
Lifestyle changes
Other therapies
Vitamins
Holistic options
References
About fibromyalgia
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
experienced.
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
fibromyalgia.
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.
Product ratings for
fibromyalgia
Science Ratings
Nutritional Supplements
Herbs
5-HTP
Acetyl-L-carnitine
SAMe
Chlorella
Magnesium
Malic acid
Melatonin
Ribose
Vitamin B1
Vitamin E
See also: Homeopathic Remedies for Fibromyalgia
Reliable
and relatively consistent scientific data showing a substantial health benefit. Contradictory, insufficient, or preliminary studies
suggesting a health benefit or minimal health benefit. For an herb, supported by traditional use but minimal
or no scientific evidence. For a supplement, little scientific support and/or minimal health
benefit.
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
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,4 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 weight.
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
ingested.5
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.678 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;9 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.10
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
fibromyalgia.
Other therapies
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
recommended treatments.
Vitamins that may be helpful
In a double-blind trial, supplementation with
acetyl-L-carnitine in the amount of 1,500 mg per day for ten weeks was significantly more
effective than a placebo in improving musculoskeletal pain, depression, and general health in
people with fibromyalgia.11
People with fibromyalgia often have low serotonin levels in their blood.12
1314 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.1819 The clinical significance of these findings remains
unknown.
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 SAMe (S-adenosylmethionine)
given to people with fibromyalgia reduced pain and depression in two double-blind
trials;2122 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
mood.24
In a preliminary trial, supplementation with
ribose in the amount of 5 grams three times per day for approximately three weeks improved
energy, sleep, mental clarity, pain, and general well-being in people with
fibromyalgia.25 Placebo-controlled trials are needed to rule out the possibility
that these improvements were due to a placebo effect. If ribose is effective for people with
fibromyalgia, it may work by improving the body's capacity to produce energy.
A preliminary trial found that a combination of magnesium and malic acid might lessen muscle pain in people with
fibromyalgia.26 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.27 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.28
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.29
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.30 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.31 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.32 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.33 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 study34 found that almost half of people with fibromyalgia who received
chiropractic care had “moderate to good” improvement. A small preliminary
trial35 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 trial36 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.
References (To view, roll mouse over the "References" heading; to hide, click on the heading)
1. Griep EN, Boersma JW, Lentjes EG, et al. Function of the
hypothalamic-pituitary-adrenal axis in patients with fibromyalgia and low back pain. J
Rheumatol 1998;25:1374–81.
2. Anonymous. Is fibromyalgia caused by a glycolysis impairment? Nutr
Rev 1994;52(7):248–50.
3. Wolfe F, Ross K, Anderson J, Russell IJ. Aspects of fibromyalgia in
the general population: Sex, pain threshold, and FM symptoms. J Rheumatol
1995;22(1):151–5.
4. Kaartinen K, Lammi K, Hypen M, et al. Vegan diet alleviates
fibromyalgia symptoms. Scand J Rheumatol 2000;29:308–13.
5. Smith JD, Terpening CM, Schmidt SOF, Gums JG. Relief of fibromyalgia
symptoms following discontinuation of dietary excitotoxins. Ann Pharmacother
2001;35:702–6.
6. Wilke W. Fibromyalgia: Recognizing and addressing the multiple
interrelated factors. Postgrad Med 1996;100(1):153–70.
7. Carette S. Fibromyalgia 20 years later: What have we really
accomplished? J Rheumatol 1995;22(4):590–4.
8. Mengshail AM, Komnaes HB, Forre O. The effects of 20 weeks of physical
fitness training in female patients with fibromyalgia. Clin Exp Rheumatol
1992;10:345–9.
9. Gowans SE, deHueck A, Voss S, Richardson M. A randomized, controlled
trial of exercise and education for individuals with fibromyalgia. Arthritis Care Res
1999;12:120–8.
10. Mannerkorpi K, Nyberg B, Ahlmen M, Ekdahl C. Pool exercise combined
with an education program for patients with fibromyalgia syndrome. A prospective, randomized
study. J Rheumatol 2000;27:2473–81.
11. Rossini M, Di Munno O, Valentini G, et al. Double-blind, multicenter
trial comparing acetyl l-carnitine with placebo in the treatment of fibromyalgia patients.
Clin Exp Rheumatol 2007;25:182–8.
12. Fava M, Rosenbaum JF, MacLaughlin R, et al. Neuroendocrine effects of
S-adenosyl-L-methionine, a novel putative antidepressant. J Psychiatr Res
1990;24:177–84.
13. Bell KM, Potkin SG, Carreon D, Plon L. S-adenosylmethionine blood
levels in major depression: changes with drug treatment. Acta Neurol Scand
1994;154(suppl):15–8.
14. Bell KM, Potkin SG, Carreon D, Plon L. S-adenosylmethionine blood
levels in major depression: changes with drug treatment. Acta Neurol Scand
1994;154(suppl):15–8.
15. Puttini PS, Caruso I. Primary fibromyalgia syndrome and
5-hydroxy-L-tryptophan: a 90-day open study. J Int Med Res 1992;20:182–9.
16. Moldofsky H, Warsh JJ. Plasma tryptophan and musculoskeletal pain in
non-articular rheumatism (“fibrositis syndrome”). Pain
1978;5:65–71.
17. Caruso I, Sarzi Puttini P, Cazzola M, Azzolini V. Double-blind study
of 5-hydroxytryptophan versus placebo in the treatment of primary fibromyalgia syndrome. J
Int Med Res 1990;18:201–9.
18. Eisinger J, Zakarian H, Plantamura A, et al. Studies of transketolase
in chronic pain. J Adv Med 1992;5:105–13.
19. Eisinger J, Bagneres D, Arroyo P, et al. Effects of magnesium, high
energy phosphates, piracetam, and thiamin on erythrocyte transketolase. Magnesium Res
1994;7(1):59–61.
20. Steinberg CL. The tocopherols (vitamin E) in the treatment of primary
fibrositis. J Bone Joint Surg 1942;24:411–23.
21. Tavoni A, Jeracitano G, Cirigliano G. Evaluation of
S-adenosylmethionine in secondary fibromyalgia: A double-blind study. Clin Exp
Rheumatol 1998;16:106–7 [letter].
22. Tavoni A, Vitali C, Bombardieri S, et al. Evaluation of
S-adenosylmethionine in primary fibromyalgia: A double-blind crossover study. Am J
Med 1987;83(suppl 5A):107–10.
23. 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;26:206–11.
25. Teitelbaum JE, Johnson C, St Cyr J. The use of D-ribose in chronic
fatigue syndrome and fibromyalgia: a pilot study. J Altern Complement Med
2006;12:857–62.
26. Abraham G, Flechas J. Management of fibromyalgia: Rationale for the
use of magnesium and malic acid. J Nutr Med 1992;3:49–59.
27. Russell IJ, Michalek J, Flechas J, et al. Treatment of fibromyalgia
syndrome with SuperMalic: A randomized, double-blind, placebo-controlled, crossover pilot
study. J Rheumatol 1995;22(5):953–7.
28. Citera G, Arias MA, Maldonado-Cocco JA, et al. The effect of
melatonin in patients with fibromyalgia: a pilot study. Clin Rheumatol
2000;19:9–13.
29. Kaplan KH, Goldberg DL, Galvin-Naduea M. The impact of a
meditation-based stress reduction program on fibromyalgia. Gen Hosp Psychiatry
1993;15:284–9.
30. Sprott H, Franke S, Kluge H, Hein G. Pain treatment of fibromyalgia
by acupuncture. Rheumatol Int 1998;18:35–6.
31. Waylonis GW. Long-term follow-up on patients with fibrositis treated
with acupuncture. Ohio State Med J 1977;73:299–302.
32. Deluze C, Bosia L, Zirbs A, et al. Electroacupuncture in
fibromyalgia: results of a controlled trial. BMJ 1992;305(6864):1249–52.
33. Berman BM, Ezzo J, Hadhazy V, Swyers JP. Is acupuncture effective in
the treatment of fibromyalgia? J Fam Pract 1999;48:213–8.
34. Wolfe F. The clinical syndrome of fibrositis. Am J Med
1986;81(Supp 3A):7–14.
35. Blunt KL, Moez HR, Rajwani MH, Guerriero RC. The effectiveness of
chiropractic management of fibromyalgia patients: a pilot study. J Manipulative Physiol
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36. Hains G, Hains F. Combined ischemic compression and spinal
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The information presented in Healthnotes is for informational purposes
only. It is based on scientific studies (human, animal, or in vitro), clinical
experience, or traditional usage as cited in each article. The results reported may not
necessarily occur in all individuals. For many of the conditions discussed, treatment with
prescription or over the counter medication is also available. Consult your doctor,
practitioner, and/or pharmacist for any health problem and before using any supplements or
before making any changes in prescribed medications. Information expires September 2008.
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Reliable
and relatively consistent scientific data showing a substantial health benefit.
