A Complete Guide to Fibromyalgia Treatment

Living with fibromyalgia is challenging. People with fibromyalgia deal with many different symptoms on a daily basis, including pain all over their body, sensitivity to touch, and fatigue. They may also experience numbness and tingling, memory problems (brain fog), and sleeping trouble — to name just a few.  

But there are treatments — from mind-body therapies to exercise to medications — that can help. Here’s what works (and what doesn’t) when it comes to fibromyalgia treatment. 

What are the goals of fibromyalgia treatment?

Fibromyalgia is a chronic (long-term) condition. There’s no cure for fibromyalgia, and research has not shown that one single treatment can eliminate all fibromyalgia symptoms. But there’s hope. There are a lot of treatments that can help.  

The goals of treating fibromyalgia are different for everyone. But in general, treatments aim to:

• Reduce pain and fatigue

• Improve quality of life

• Improve level of function

What are the most effective treatments for fibromyalgia?

Believe it or not, the best treatments for fibromyalgia aren’t medications. Non-medication therapies, like exercise and lifestyle changes, come first. And for good reason — studies show they work.

Exercise

The first and most important part of fibromyalgia treatment is exercise. Studies confirm that exercise improves pain, physical function, and well-being in people with fibromyalgia. 

So what kind of exercise is best? Fortunately, we aren’t talking about running a marathon or joining an exclusive gym. We’re talking about gentle exercise that gets the body moving and keeps the heart rate normal (fewer than 100 beats per minute). The goal is 30 minutes of exercise per day.  Examples include:

• Walking

• Biking

• Swimming

• Walking in the shallow end of a pool (great for people with joint pain that makes walking difficult)

When your body hurts and you’re tired from fibromyalgia, exercise might sound impossible. But with small steps, you can work your way up to an exercise routine that will get you feeling and moving better. 

Meet yourself where you are. If that means starting with 5 minutes of exercise a day (or even just 1 minute), that’s OK. The next week, try to increase by an extra minute. Eventually, you’ll reach the 30 minutes per day goal.

If you aren’t sure where to start, a physical therapist can help with graded exercise therapy.  This typically requires a referral from your provider.

Tai chi

Tai chi is a gentle exercise that originated in ancient China. It involves slow movement, meditation, and deep breathing. One study showed that tai chi improved fibromyalgia symptoms and quality of life. You may be able to attend tai chi classes near your home. But you can also find free tai chi videos online.

Cognitive behavioral therapy (CBT) 

CBT is a type of therapy that helps people with fibromyalgia understand and cope with the pain they experience. It teaches them how to identify different triggers and sensations in their body. CBT also teaches people mental techniques about how to calm these sensations. Studies show that CBT may help reduce pain, disability, and the negative feelings that come with fibromyalgia. 

Sleep

Fibromyalgia can cause sleep disturbances, making it harder to fall asleep and stay asleep. But studies show that better sleep can improve fibromyalgia symptoms. It can be a challenge to reverse the cycle of poor sleep and fibromyalgia symptoms. Each one feeds the other. But to improve your sleep, try to focus on sleep hygiene. These are simple things you can do to increase the chances of a good night’s rest.

Studies also show that treating sleep apnea can decrease sensitivity to pain. Sleep apnea causes your oxygen levels to drop below normal while you’re sleeping, leading to lower-quality sleep that doesn’t feel refreshing. It’s common in people who have fibromyalgia and in people who snore. Consider discussing sleep apnea testing with your healthcare provider.

Stress reduction

Stress can take a toll on your physical health, making fibromyalgia symptoms worse. Part of fibromyalgia management is caring for yourself and your mental health. There are some simple ways you can keep stress levels low, such as participating in a support group and practicing deep breathing.

Self-education

Education about fibromyalgia is an important part of the healing process. The more you know and understand about this condition, the better you will understand your body, your symptoms, and the treatments that work best for you. And that means you’ll be better prepared to handle the tougher days. The FibroGuide from the University of Michigan (a world leader in fibromyalgia research) is a great place to start. 

Medications for fibromyalgia pain

If the recommendations above aren’t helping enough, adding medications may be the next best step. Treatment guidelines and studies show that medications may reduce pain by about 30% in some people. To date, there’s no “best” medication for fibromyalgia. And it’s important to note that medications are not likely to help without using the non-medication treatments listed above, too.

There are three FDA-approved medications for fibromyalgia treatment. These are:

1. Pregabalin (Lyrica): This is also FDA approved to treat nerve pain (numbness, tingling, burning), so this might be a good choice if you have both.

2. Duloxetine (Cymbalta): This is also FDA approved to treat depression and/or anxiety, so it’s another good choice if you have both conditions.

3. Milnacipran (Savella): This medication works similar to other antidepressants, but it’s only FDA approved for fibromyalgia. There are ongoing studies to see if it should also be approved for depression. 

Healthcare providers sometimes recommend other off-label medications. This means the medications aren’t FDA approved to treat fibromyalgia, but studies support their use and safety. These medications include:

• Amitriptyline: This may also help with sleep when you take it at night.

• Gabapentin: This is also FDA approved to treat nerve pain, so it might be a good choice if you have both.

• Cyclobenzaprine (Flexeril): The evidence isn’t as good for this one, but it may help people who have muscle spasms.

The medication that’s right for you depends on your other medical issues and medication list. There’s no one-size-fits-all approach, so the process may require a bit of trial and error. But together, you and your provider can search for a medication that helps you feel better.

Medications that don’t help

Not all pain relievers work for fibromyalgia pain. Medications that have not been shown to help include:

• Acetaminophen (Tylenol)

• Nonsteroidal anti-inflammatory drugs (NSAIDs, like ibuprofen)

• Opioids: Studies show that opioids, like morphine and oxycodone, may actually worsen fibromyalgia symptoms and your level of function.

• Steroids: Steroids, like prednisone, may help fibromyalgia pain at first, since they can treat many different types of pain. But experts don’t recommend it because of serious long-term side effects, like weight gain, insomnia, and an increased risk of heart disease.

Natural treatments for fibromyalgia pain relief

Scientists are working to better understand if natural treatments are safe and effective for people with fibromyalgia. There are currently limited studies. But the following treatments may help: 

• Acupuncture: This involves applying thin needles to specific areas of the body to improve energy flow. It may be helpful for a variety of chronic pain conditions.

• Yoga: This is another form of exercise that combines gentle movement and deep breathing. There are many different types of yoga, and beginner classes are a good place to start. You may find classes near you or for free online.

• Cannabidiol (CBD): CBD is a product derived from the hemp plant that may help with chronic pain. It comes in different forms, like oil, salves, and edible foods. More studies on humans are needed to find out if CBD is an effective and safe treatment.

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Written by:

Samantha C. Shapiro, MD

Samantha Shapiro, MD, is a board-certified rheumatologist and internist with expertise in autoimmune and inflammatory conditions. She founded the division of rheumatology at Dell Medical School at The University of Texas at Austin.

Edited by:

Katie E. Golden, MD

Katie E. Golden, MD, is a board-certified emergency medicine physician and a medical editor at GoodRx.

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