Rutgers Cancer Institute of New Jersey
195 Little Albany Street
New Brunswick, NJ 08903-2681
Fibromyalgia is a common chronic condition whose main symptoms are specific tender points on various parts of the body, widespread musculoskeletal discomfort, morning stiffness, fatigue, and disturbed sleep. The cause of the condition is unknown, but it occurs most often in women aged 30 to 50. Other symptoms commonly believed to be associated with fibromyalgia are irritable bowel syndrome, urinary frequency, anxiety, headache, and numbness or tingling.
Apart from tender points on the body, physical exams and lab tests for people with fibromyalgia are usually normal. Because of this, some physicians are inclined to believe that the condition is "all in the patient's head." One researcher has noted that many of the symptoms of fibromyalgia, including certain tender points, are common in the general population, and goes so far as to question whether it is a real condition.1
However, the current consensus is that fibromyalgia is real, and the American College of Rheumatologists has given it an official medical definition. It involves the presence of widespread chronic pain and the existence of pain in at least 11 of 18 specific points on the body when pressure is applied. Although the cause of fibromyalgia is not known, it may be related to poor sleeping with incomplete muscular relaxation.
Antidepressants have been shown to help chronic pain from many causes 2 and have been found to be effective in reducing fibromyalgia symptoms, even when given in doses too low to treat depression.3 Other conventional treatment for fibromyalgia may include antidepressants, anti-inflammatory drugs, muscle relaxants, sleeping pills, and anti-anxiety medications.
There are three natural treatments that might be helpful for fibromyalgia, although the evidence is not yet strong: SAMe, 5-HTP, and capsaicin.
SAMe, short for S-adenosylmethionine, is a chemical derived from a combination of methionine, an amino acid, and adenosine triphosphate (ATP), the main molecule for energy in the body. More well known as a treatment for depression and also osteoarthritis, preliminary research suggests that SAMe may be helpful for fibromyalgia as well.
Four double-blind trials have studied the use of SAMe for fibromyalgia,6-9 three of them finding it to be helpful. Unfortunately, most of these studies gave SAMe either intravenously or as an injection into the muscles, sometimes in combination with oral doses. When you inject a medication, the effects can be quite different than when you take it orally. For that reason, these studies are of questionable relevance.
However, the one double-blind study that used only oral SAMe did find positive results.10 In this trial, 44 people with fibromyalgia took 800 mg of SAMe or placebo for 6 weeks. Compared to the group taking placebo, those taking SAMe had improvements in disease activity, pain at rest, fatigue, and morning stiffness, and in one measurement of mood. In other respects, such as the amount of tenderness in their tender points, the group taking SAMe did no better than those taking the placebo.
It is not clear whether SAMe is helping fibromyalgia through antidepressant effects or some other mechanism.
For more information, including dosage and safety issues, see the full SAMe article.
5-HTP, short for 5-hydroxytryptophan, is most commonly used as a treatment for depression. It is thought to work by increasing the amount of serotonin in the brain. However, evidence that it helps fibromyalgia is still preliminary.
One double-blind study of 50 people with fibromyalgia found that those taking 300 mg of 5-HTP for 30 days reported significant decreases in the number of tender points and the amount of pain they experienced, compared to those taking placebo.11 They also noted improvements in sleep patterns, morning stiffness, anxiety, and fatigue. Interestingly, the people taking placebo also noted significant improvements in pain and sleep, although less marked than those experienced with 5-HTP. More studies are needed to determine how much 5-HTP really helps.
For more information, including dosage and safety issues, see the full 5-HTP article.
Capsaicin, the "hot" in cayenne peppers, is widely used as a treatment for various painful conditions, such as shingles and arthritis. One double-blind study of 45 people found that it may be beneficial for fibromyalgia as well.15 In this study, participants used either the capsaicin cream or a placebo 4 times a day for 4 weeks, rubbing it into the tender points on one side of their body. Those who used the real treatment reported less tenderness in their tender points than those using the placebo. Interestingly, the points on their untreated sides were also less tender. There was no difference between those using capsaicin or placebo in the amount of overall pain or sleep quality. It must be noted, however, that it is hard to believe the study was really double-blind, since it is impossible to hide the burning sensation caused by capsaicin!
For more information, including dosage and safety issues, see the full Cayenne Pepper article.
The blue-green algae Chlorella pyrenoidosa might be helpful for fibromyalgia. In a double-blind, placebo-controlled trial, 37 people with fibromyalgia were given either placebo or chlorella supplements at a dose of 10 g daily.16 At the end of 3 months, people were switched to the opposite group, and then treated for an additional 3 months. The results showed significant improvements in symptoms when participants used chlorella as compared to placebo. Note : There are serious safety concerns about blue-green algae. For more information, see the full Blue-green Algae article.
A pilot double-blind study found benefit with a proprietary mixture containing camphor oil, rosemary oil, eucalyptus oil, peppermint oil, aloe vera oil, lemon oil, and orange oil.47 These essential oils were applied topically.
A mixture of malic acid and magnesium has been widely marketed as a treatment for fibromyalgia. However, in a double-blind study of 24 people, this treatment proved no more effective than placebo.23 Good results were seen in open trials,24,25 but such studies cannot eliminate the placebo effect and, for that reason, are not reliable. (For more information on this complicated issue, see Why Does This Database Rely on Double-blind Studies?)
A substantial study marred by poor design (specifically, far too many primary endpoints) found equivocal evidence that L-carnitine, taken at dose of 500 mg three times daily, might be more effective than placebo for the treatment of fibromyalgia.51
Other proposed natural supplements for fibromyalgia include vitamin B1, vitamin E, and selenium, but there is no real evidence that they work. A study that purportedly found melatonin helpful was, in fact, too poorly designed to provide meaningful evidence.36
The effectiveness of IV-infused micronutrient therapy (eg, Myers' Cocktail) is unclear. In a small 2009 study of 34 adults, weekly IV micronutrient infusions for 8 weeks were reported to improve tender point scores from baseline, but the results were not significantly better than placebo.57
Acupuncture added to standard medications was associated with symptom improvement in a randomized trial of 164 patients with fibromyalgia. Improvements were noted in pain intensity, pain threshold, quality of life, and physical functioning when compared to sham acupuncture. Treatment lasted for 9 weeks, but the effects of the acupuncture lasted through the 1-year follow-up period.69
Other alternative treatments with minimal supporting evidence include:
The martial art Tai Chi has also been studied as a treatment for fibromylgia. In a small randomized, controlled trial, Tai Chi appeared to improve symptoms, function, and quality of life in fibromyalgia patients compared to wellness education and stretching.59
Osteopathic manipulative therapy, which focuses on manual treatment of the musculoskeletal system, has some evidence to support its use as a treatment for fibromyalgia.35,61. In one trial, 93 women (average age 53) with fibromyalgia were randomized to receive sham treatment or craniosacral therapy (one-hour sessions twice a week for 20 weeks).61 Craniosacral therapy involves manipulating external tissues of the head. This is done to help facilitate the natural rhythmic pulsation, which are thought to travel through brain and spinal cord. Compared to the sham group, women in the craniosacral therapy group experienced a decrease in pain at 20 weeks, which persisted for a least one year. In another randomized trial, 94 people with fibromyalgia received either myofascial release (a type of treatment that involves palpitation of the fascial tissue surrounding muscles) or sham therapy for 40 sessions (20 weeks).63 At the 6-month follow-up, the people in the treatment group reported less pain and more physical ability. But, only some of these results lasted until the 1-year follow-up.
Yoga is another alternative therapy that has been studied for fibromyalgia. In a small trial involving 53 women with fibromyalgia, those that participated in an 8-week yoga program experienced an improvement in their symptoms, including pain, fatigue, stiffness, and tenderness.60
A single-blind study of somewhat convoluted design provides weak evidence that a gown made from a special “electromagnetic shielding fabric” can reduce fibromyalgia symptoms.46 The rationale for using this fabric is, however, somewhat scientifically implausible.
One study purportedly found that use of cosmetics increases fibromyalgia symptoms, but it was too poorly designed to show anything at all.42 An equally meaningless study purported to show that intravenous nutrients are helpful for fibromyalgia.48
The use of transcranial direct current stimulation (tDCS) was associated with pain relief in 3 small randomized trials when compared to sham treatment. One trial found improvements in daily quality of life. Though there were significant changes in the tDCS group, the changes were short-term. However, the review only had a total of 96 patients, more research is needed with larger groups to determine its clinical benefit.66-68
The Homeopathy section of the database also has an article on Fibromyalgia.
1. Croft P, Schollum J, Silman A. Population study of tender point counts and pain as evidence of fibromyalgia. BMJ. 1994;309:696-699.
2. Fauci AS, Braunwald E, Isselbacher KJ, et al, eds. Harrison's Principles of Internal Medicine. 14th ed. New York, NY: McGraw-Hill; 1998.
3. Rossy LA, Buckelew SP, Dorr N, et al. A meta-analysis of fibromyalgia treatment interventions. Ann Behav Med. 1999;21:180-191.
4. Rossy LA, Buckelew SP, Dorr N, et al. A meta-analysis of fibromyalgia treatment interventions. Ann Behav Med. 1999;21:180-191.
5. Meyer BB, Lemley KJ. Utilizing exercise to affect the symptomology of fibromyalgia: a pilot study. Med Sci Sports Exerc. 2000;32:1691-1697.
6. 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(5A):107-110.
7. Tavoni A, Jeracitano G, Cirigliano G. Evaluation of S-adenosylmethionine in secondary fibromyalgia: a double-blind study. Clin Exp Rheumatol. 1998;16:106-107.
8. Jacobsen S, Danneskiold-Samsoe B, Andersen RB. Oral S-adenosylmethionine in primary fibromyalgia. Double-blind clinical evaluation. Scand J Rheumatol. 1991;20:294-302.
9. 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;26:206-211.
10. Jacobsen S, Danneskiold-Samsoe B, Andersen RB. Oral S-adenosylmethionine in primary fibromyalgia. Double-blind clinical evaluation. Scand J Rheumatol. 1991;20:294-302.
11. Caruso I, Sarzi Puttini P, Cazzola M, et al. Double-blind study of 5-hydroxytryptophan versus placebo in the treatment of primary fibromyalgia syndrome. J Int Med Res. 1990;18:201-209.
15. McCarty DJ, Csuka M, McCarthy, et al. Treatment of pain due to fibromyalgia with topical capsaicin: A pilot study. Semin Arthritis Rheum. 1994;23(suppl 3):41-47.
16. Merchant RE, Andre CA. A review of recent clinical trials of the nutritional supplement Chlorella pyrenoidosa in the treatment of fibromyalgia, hypertension, and ulcerative colitis. Altern Ther Health Med. 2001;7:79-80,82-91.
17. Pouria S, de Andrade A, Barbosa J, et al. Fatal microcystin intoxication in haemodialysis unit in Caruaru, Brazil. Lancet. 1998;352:21-26.
18. Gilroy DJ, Kauffman KW, Hall RA, et al. Assessing potential health risks from microcystin toxins in blue-green algae dietary supplements. Environ Health Perspect. 2000;108:435-439.
19. Islam MS, Rahim Z, Alam MJ, et al. Association of Vibrio cholerae O1 with the cyanobacterium, Anabaena sp., elucidated by polymerase chain reaction and transmission electron microscopy. Trans R Soc Trop Med Hyg. 1999;93:36-40.
21. Deluze C, Bosia L, Zirbs A, Chantraine A, Vischer TL. Electroacupuncture in fibromyalgia: results of a controlled trial. BMJ. 1992;305:1249-1252.
23. Russell IJ, Michalek JE, Flechas JD, et al. Treatment of fibromyalgia syndrome with Super Malic®: a randomized, double blind, placebo controlled, crossover pilot study. J Rheumatol. 1995;22:953-958.
24. Russell IJ, Michalek JE, Flechas JD, et al. Treatment of fibromyalgia syndrome with Super Malic®: a randomized, double blind, placebo controlled, crossover pilot study. J Rheumatol. 1995;22:953-958.
25. Abraham GE, Flechas JD. Management of fibromyalgia: rationale for the use of magnesium and malic acid. J Nutr Med. 1992:3:49-59.
26. Feldman D, da Costa Sao Paulo ED. Treatment of fibromyalgia with acupuncture: a randomized, placebo controlled trial of 16 weeks duration. American College of Rheumatology Annual Meeting. Nov 2001. San Francisco, CA.
27. Haanen HC, Hoenderdos HT, van Romunde LK, et al. Controlled trial of hypnotherapy in the treatment of refractory fibromyalgia. J Rheumatol. 1991;18:72-75.
28. Fors EA, Sexton H, Gotestam KG. The effect of guided imagery and amitriptyline on daily fibromyalgia pain: a prospective, randomized, controlled trial. J Psychiatr Res. 2002;36:179-187.
29. Sunshine W, Field T, Quintino O, et al. Fibromyalgia benefits from massage therapy and transcutaneous electrical stimulation. J Clin Rheumatol. 1996;2:18-22.
30. Offenbacher M, Stucki G. Physical therapy in the treatment of fibromyalgia. Scand J Rheumatol Suppl. 2000;113:78-85.
31. Brattberg G. Connective tissue massage in the treatment of fibromyalgia. Eur J Pain. 1999;3:235-244.
32. Smith WA. Fibromyalgia syndrome. Nurs Clin North Am. 1998;33:653-669.
33. Alfano AP, Taylor AG, Foresman PA, et al. Static magnetic fields for treatment of fibromyalgia: a randomized controlled trial. J Altern Complement Med. 2001;7:53-64.
34. Colbert AP, Markov MS, Banerji M, et al. Magnetic mattress pad use in patients with fibromyalgia: a randomized double-blind pilot study. J Back Musculoskeletal Rehabilitation. 1999;13:19-31.
35. Gamber RG, Shores JH, Russo DP, et al. Osteopathic manipulative treatment in conjunction with medication relieves pain associated with fibromyalgia syndrome: results of a randomized clinical pilot project. J Am Osteopath Assoc. 2002;102:321-325.
36. 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.
37. Finckh A, Berner IC, Aubry-Rozier B, et al. A randomized controlled trial of dehydroepiandrosterone in postmenopausal women with fibromyalgia. J Rheumatol. 2005;32:1336-1340.
38. Assefi NP, Sherman KJ, Jacobsen C, et al. A randomized clinical trial of acupuncture compared with sham acupuncture in fibromyalgia. Ann Intern Med. 2005;143:10-19.
39. Harris RE, Tian X, Williams DA, et al. Treatment of fibromyalgia with formula acupuncture: investigation of needle placement, needle stimulation, and treatment frequency. J Altern Complement Med. 2005;11:663-671.
40. Smania N, Corato E, Fiaschi A, et al. Repetitive magnetic stimulation A novel therapeutic approach for myofascial pain syndrome. J Neurol. 2005 Feb 23. [Epub ahead of print]
41. Astin JA, Berman BM, Bausell B, et al. The efficacy of mindfulness meditation plus qigong movement therapy in the treatment of fibromyalgia: a randomized controlled trial. J Rheumatol. 2003;30:2257-2262.
42. Sverdrup B. Use less cosmetics—suffer less from fibromyalgia? J Womens Health (Larchmt). 2004;13:187-194.
43. Jones KD, Adams D, Winters-Stone K, Burckhardt CS. A comprehensive review of 46 exercise treatment studies in fibromyalgia (1988-2005). Health Qual Life Outcomes. 2006;4:67. Available at: http://www.hqlo.com/content/pdf/1477-7525-4-67.pdf. Accessed October 2, 2006.
44. K, Lammi K, Hypen M, et al. Vegan diet alleviates fibromyalgia symptoms. Scand J Rheumatol. 2000;29:308-313.
46. Bach GL, Clement DB. Efficacy of Farabloc as an analgesic in primary fibromyalgia. Clin Rheumatol. 2007 Jan 11. [Epub ahead of print]
47. Ko GD, Hum A, Traitses G, Berbrayer D. Effects of topical O24 essential oils on patients with fibromyalgia syndrome: a randomized, placebo controlled pilot study. J Musculoskelet Pain. 2007;15:11-19.
48. Massey PB. Reduction of fibromyalgia symptoms through intravenous nutrient therapy: results of a pilot clinical trial. Altern Ther Health Med. 2007;13:32-34.
49. Fioravanti A, Perpignano G, Tirri G, et al. Effects of mud-bath treatment on fibromyalgia patients: a randomized clinical trial. Rheumatol Int. 2007 May 23. [Epub ahead of print]
50. Donmez A, Karagulle MZ, Tercan N, et al. SPA therapy in fibromyalgia: a randomised controlled clinic study. Rheumatol Int. 2005;26:168-172.
51. 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;25:182-188.
52. Busch AJ, Schachter CL, Overend TJ, et al. Exercise for fibromyalgia: a systematic review. J Rheumatol. 2008 May 1.
53. Brosseau L, Wells GA, Tugwell P, et al. Ottawa panel evidence-based clinical practice guidelines for aerobic fitness exercises in the management of fibromyalgia: part 1. Phys Ther. 2008 May 22.
54. Brosseau L, Wells GA, Tugwell P, et al. Ottawa panel evidence-based clinical practice guidelines for aerobic fitness exercises in the management of fibromyalgia: part 2. Phys Ther. 2008 May 22.
55. McVeigh JG, McGaughey H, Hall M, et al. The effectiveness of hydrotherapy in the management of fibromyalgia syndrome: a systematic review. Rheumatol Int. 2008 Aug 27.
56. Assefi N, Bogart A, Goldberg J, et al. Reiki for the treatment of fibromyalgia: a randomized controlled trial. J Altern Complement Med. 2008;14:1115-1122.
57. Ali A, Njike VY, Northrup V, et al. Intravenous micronutrient therapy (Myers' Cocktail) for fibromyalgia: a placebo-controlled pilot study. J Altern Complement Med. 2009;15:247-257.
58. Langhorst J, Klose P, Musial F, et al. Efficacy of acupuncture in fibromyalgia syndrome--a systematic review with a meta-analysis of controlled clinical trials. Rheumatology (Oxford). 2010;49:778.
59. Wang C, Schmid C, Rones R, et al. A randomized trial of Tai Chi for fibromyalgia. N Engl J Med. 2010;363(8):743.
60. Carson JW, Carson KM, Jones KD, Bennett RM, Wright CL, Mist SD. A pilot randomized controlled trial of the Yoga of Awareness program in the management of fibromyalgia. Pain. 2010;151(2):530-539.
61. Castro-Sánchez AM, Matarán-Peñarrocha GA, Sánchez-Labraca N, et al. A randomized controlled trial investigating the effects of craniosacral therapy on pain and heart rate variability in fibromyalgia patients. Clin Rehabil. 2011;25(1):25-35.
62. Mendonca ME, Santana MB, Baptista AF, et al. Transcranial DC stimulation in fibromyalgia: optimized cortical target supported by high-resolution computational models. J Pain. 2011;12(5):610-617.
63. Castro-Sánchez AM, Matarán-Peñarrocha GA, Arroyo-Morales M, Saavedra-Hernández M, Fernández-Sola C, Moreno-Lorenzo C. Effects of myofascial release techniques on pain, physical function, and postural stability in patients with fibromyalgia: a randomized controlled trial. Clin Rehabil. 2011;25(9):800-813.
64. Hargrove JB, Bennett RM, Simons DG, et al. A randomized placebo-controlled study of noninvasive cortical electrostimulation in the treatment of fibromyalgia patients. Pain Med. 2012;13(1):115-124.
65. Meeus M, Nijs J, 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. Clin Rehabil. 2014 Sep 8 [Epub ahead of print].
66. Mendonca ME, Santana MB, Baptista AF. Transcranial DC stimulation in fibromyalgia: optimized cortical target supported by high-resolution computational models. J Pain. 2011;12(5):610-317.
67. Villamar MF, Wivatvongvana P, Patumanond J. Focal modulation of the primary motor cortex in fibromyalgia using 4×1-ring high-definition transcranial direct current stimulation (HD-tDCS): immediate and delayed analgesic effects of cathodal and anodal stimulation. J Pain. 2013;14(4):371-383.
68. Fagerlund AJ, Hansen OA, Aslaksen PM. Transcranial direct current stimulation as a treatment for patients with fibromyalgia: A randomized controlled trial. Pain. 2015;156(1):62-71.
69. Vas J, Santos-Rey K, Navarro-Pablo R, et al. Acupuncture for fibromyalgia in primary care: a randomised controlled trial. Acupunct Med. 2016;34(4):257-266.
Last reviewed December 2015 by EBSCO CAM Review Board Last Updated: 2/21/2017