The goal is to help you function as well as possible on a daily basis. While it is probably not possible to completely relieve all of your symptoms, medication and certain complementary and alternative therapies may help reduce symptoms.
Your doctor may prescribe the following drugs:
- Pregabalin (Lyrica) is the first medication approved by the Food and Drug Administration (FDA) for the treatment of fibromyalgia.
- Sleep disturbances are often treated successfully with low doses of tricyclic antidepressants, such as amitriptyline (Elavil), doxepin (Sinequan), and nortriptyline (Pamelor, Aventyl). Your doctor may also prescribe sleeping pills for short term use.
- Analgesics treat pain. Your doctor may recommend nonsteroidal anti-inflammatory drugs (NSAIDs), such as naproxen sodium (Aleve), ibuprofen (Advil, Motrin), or prescription NSAIDs. These drugs may lessen pain, but they are not effective for everyone. Your doctor may also prescribe tramadol (Ultram), which is often used to treat fibromyalgia pain.
- Muscle relaxants, such as cyclobenazaprine (Flexeril), can help treat muscle spasms.
- A technique called "spray and stretch" is sometimes used. A prescription spray coolant is applied to a painful muscle while the muscle is stretched.
- Pain in specific spots in muscles can be treated with lidocaine or procaine (injected into points where pain is greatest), or with capsaicin (used topically).
- Depression can be treated with antidepressants, such as fluoxetine (Prozac) and sertraline (Zoloft), milnacipran (Savella), and diloxetine (Cymbalta).
- Armour Thyroid, a natural thyroid hormone medication, may be helpful if tests show abnormal thyroid function. People with fibromyalgia may want to have their tests examined by both conventional and holistically oriented doctors because levels of thyroid hormone in the blood are often interpreted differently. Specifically, people with fibromyalgia may want to ask for an assessment of free T3 levels, a lab test that is rarely ordered by conventional doctors.
- Antipsychotics, such as quetiapine, may help alleviate depression and anxiety, while also improving sleep. This is an evolving area of research. Speak with your doctor.
Complementary and Alternative Therapies
Nutritional support, exercise, herbs, and mind-body techniques may help reduce symptoms. If you are pregnant, or thinking about becoming pregnant, do not use any CAM therapies unless directed to do so by your physician.
Nutrition and Supplements
These nutritional tips may help reduce symptoms:
- Eliminate potential food allergens, including dairy, wheat (gluten), corn, soy, preservatives, and food additives. Your doctor may want to test for food sensitivities.
- Eat antioxidant foods, including fruits (such as blueberries and cherries), and vegetables (such as kale, spinach, and bell peppers).
- Avoid refined foods, such as white breads, pastas, and sugar.
- Eat fewer red meats and more lean meats, cold-water fish, tofu (soy, if no allergy) or beans for protein.
- Use healthy cooking oils, such as olive oil or coconut oil.
- Reduce or eliminate trans fatty acids, found in commercially baked goods, such as cookies, crackers, cakes, French fries, onion rings, donuts, processed foods, and margarine.
- Avoid alcohol, tobacco, and caffeine, and limit foods that are high in sugar, salt, and fat. Avoid foods with additives such as monosodium glutamate (MSG).
- Drink 6 to 8 glasses of filtered water daily.
You can address nutritional deficiencies with the following supplements:
- Omega-3 fatty acids, such as fish oil, 1 to 2 capsules or 1 to 2 tablespoons of oil daily, to help reduce inflammation and improve immunity. Talk to your doctor before taking omega-3 supplements if you are taking blood-thinning medications, such as aspirin or warfarin (Coumadin).
- A multivitamin daily, containing the antioxidant vitamins A, C, D, E, the B-vitamins, and trace minerals, such as magnesium, calcium, zinc, and selenium.
- Vitamin C, 500 to 1,000 mg daily, as an antioxidant and for immune support.
- Alpha-lipoic acid, 25 to 50 mg, twice daily, for antioxidant support. Alpha-lipoic acid may decrease thiamine levels. It may also act with certain medications, particularly some medicines used in chemotherapy and in the treatment of thyroid conditions. Speak with your doctor.
- L-carnitine, 500 to 2,000 mg daily, for muscular support. L-carnitine may make symptoms of hypothyroidism worse, and can potentially increase the likelihood of seizure in people with a history of seizures.
- Magnesium, for symptoms of fibromyalgia. If you have kidney disease, talk to your doctor before taking magnesium. Magnesium can potentially interact with certain medications, including high blood pressure medicines and some antibiotics.
- S-adenosylmethionine or SAMe, 800 mg daily, for mental and immune support. People who have manic or bipolar disorder should not take SAMe. SAMe may potentially have negative side effects in people with Parkinson's disease. If you are taking any psychoactive medication, speak with your doctor before taking SAMe.
- Probiotic supplement (containing Lactobacillus acidophilus), 5 to 10 billion CFUs (colony forming units) a day, when needed for maintenance of gastrointestinal and immune health. Some acidophilus products may need refrigeration -- check labels carefully. If you are severely immune compromised, or if you take immune suppressive drugs, talk to your physician before taking probiotic supplements.
- Calcium/vitamin D supplement, for support of muscle and skeletal weakness.
- Coenzyme Q10, 100 to 200 mg at bedtime, for antioxidant, immune, and muscular support. Coenzyme Q10 can interfere with the actions of some blood-thining medications, such as warfarin (Coumadin) and others. Talk with your doctor.
- Chlorella (Chlorella pyrenoidosa), a blue-green algae, may help lessen symptoms. Participants in a clinical study took a dose of 10 g of Sun chlorella tablets and 100 ml of the liquid chlorella extract Wasaka Gold and showed significant improvement in symptoms. More studies are needed. Chlorella contains large amounts of vitamin K, a nutrient that helps the body's clotting function and may interfere with blood-clotting effects of certain medications, such as warfarin (Coumadin) and others. If you are severely immune compromised, or if you take immune suppressive drugs, talk to your physician before taking chlorella supplements.
- NADH (nicotinamide adenine dinucleotide), 5 to 20 mg daily, for energy. People who have anxiety should start NADH at a lower dose and work up slowly.
- Melatonin, 0.5 to 3 mg, once daily before bed, for sleep and immune support. Talk to your doctor first if you are taking antidepressants or other neurological or psychiatric medications.
It may seem odd to suggest exercising when your muscles are sore and you are in pain, but a number of studies show that regular, low-intensity exercise is one of the most effective treatments for fibromyalgia. Although you may experience a slight increase in pain and soreness when you start, as you continue you will help lessen muscle tension and stiffness, improve sleep quality, and raise serotonin and endorphin levels, helping to reduce pain. Exercise programs should include multiple dimensions, including strength, endurance, flexibility, and balance. Many people with fibromyalgia find warm water aquatic exercises to be helpful. Talk to your doctor or physical therapist to design an exercise program that is right for you.
Herbs are a way to strengthen and tone the body's systems. As with any therapy, you should work with your doctor to diagnose your problem before starting any treatment. You may use herbs as dried extracts (capsules, powders, teas), glycerites (glycerine extracts), or tinctures (alcohol extracts). Unless otherwise indicated, make teas with 1 tsp. of herb per cup of hot water. Steep covered 5 to 10 minutes for leaf or flowers, and 10 to 20 minutes for roots. Drink 2 to 4 cups per day. You may use tinctures alone or in combination as noted.
Herbal therapies aim to reduce the symptoms of fibromyalgia, or those of common conditions associated with fibromyalgia.
- Green tea (Camelia sinensis), for antioxidant and immune effects. Use caffeine-free products. You may also prepare teas from the leaf of this herb.
- Cat's claw (Uncaria tomentosa), for inflammation, immune, and antifungal activity. Cat's claw can interfere with a variety of medications, and may worsen certain conditions, such as leukemia and some autoimmune disorders. Talk to your doctor.
- Bromelain (Ananus comosus), for pain and inflammation. Bromelain can have a blood thinning effect and increase the effectiveness of blood-thinning medications, such as aspirin and warfarin (Coumadin). People with peptic ulcers should not take bromelain. Bromelain can affect the absorption of certain antibiotics, 5-fluoracil and vincristine, and medications that cause drowsiness, such as benzodiazepines lorazepam (Ativan) or diazepam (Valium), some antidepressants, and narcotics, such as codeine, and barbituates, such as phenobarbitol.
- Turmeric (Curcuma lon ga), for inflammation. Turmeric can have a blood-thinning effect and can increase the effectiveness of blood-thinning medications, such as aspirin and warfarin (Coumadin).
- Rhodiola (Rhodiola rosea), for antioxidant, anti-stress, and immune activity.
- Capsicum or capsaicin (Zostrix), as a cream containing .025% capsaicin, applied topically (on the skin), 1 to 3 times daily.
Before prescribing a remedy, homeopaths take into account a person's constitutional type -- your physical, emotional, and intellectual makeup. An experienced homeopath assesses all of these factors when determining the most appropriate remedy for a particular individual. Some of the homeopathic remedies used for fibromyalgia include:
- Arnica, for someone who feels sore and bruised, and does not want to be touched. Laying down is difficult, and the patient is restless when trying to find a comfortable position. Soreness stays after gentle exercise.
- Bryonia, used when the slightest movement aggravates pain. The person is usually very thirsty. Pain is worse at night and upon waking in the morning.
- Calcarea carbonica, for people who tend to move slowly, look pasty, and are always chilly. Exertion leaves them weak and breathless. They feel better when lying down. Being warm relieves symptoms.
- Rhus toxicodendron, for joint stiffness, worse when starting to move, then easing with more movement. Stiffness is worse in the morning and in cold or damp weather.
- Ruta graveolens, for sore, bruised pain in the joints and tendons that feel worse when lying on the affected area.
Stress makes symptoms of fibromyalgia worse, so mind-body therapies including meditation and biofeedback can be helpful in learning relaxation techniques.
Using 2 to 4 cups of Epsom salts in a warm bath can soothe aching muscles.
Acupuncturists treat people with fibromyalgia based on an individualized assessment of the excesses and deficiencies of qi located in various meridians. In fibromyalgia, a qi deficiency is usually detected in the spleen or kidney meridians. Moxibustion (a technique in which the herb mugwort is burned over specific acupuncture points) is used to strengthen the entire energy system. Qualified practitioners may also advise people with fibromyalgia on lifestyle and diet, and provide recommendations on the use of herbal medicines.
According to a review of the research, compared with no treatment and standard therapy, acupuncture improves pain and stiffness in people with fibromyalgia. However, studies show acupuncture does not differ from treatment in reducing pain, or fatigue, or improving sleep and well being.
Because fibromyalgia generally includes low back pain or neck pain (for which spinal manipulation is beneficial), chiropractors commonly treat people who have this condition. In one small study, women with fibromyalgia reported a 77% reduction in pain intensity, 63% improvement in sleep quality, and 75% improvement in fatigue level after receiving 30 chiropractic treatments. Symptom relief continued for 1 month after treatment ended.
Massage may reduce stress, improve circulation, and soothe sore muscles. Find a massage therapist who has experience working with fibromyalgia.
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