What’s the Bottom Line?

What do we know about the effectiveness of complementary health approaches for fibromyalgia?

Psychological and Physical Approaches

• Although some studies of tai chi, yoga, mindfulness meditation, and biofeedback for fibromyalgia have had promising results, the evidence is too limited to allow definite conclusions to be reached about whether these approaches are helpful.
• It’s uncertain whether acupuncture is helpful for fibromyalgia pain.
• Some preliminary research on transcranial magnetic stimulation (TMS) for fibromyalgia symptoms has had promising results.

Nutritional Approaches

• Vitamin D supplements may reduce pain in people with fibromyalgia who are deficient in this vitamin.

What do we know about the safety of complementary health approaches for fibromyalgia?

• The psychological and physical approaches discussed here generally have good safety records. However, some may need to be adapted to make them safe and comfortable for people with fibromyalgia.
• Some of the dietary supplements that have been studied for fibromyalgia may have side effects or interact with medications.
• Headaches sometimes occur as a side effect of TMS for fibromyalgia. TMS and other procedures involving magnets may not be safe for people who have metal implants or medical devices such as pacemakers in their bodies.

What Is Fibromyalgia?

Fibromyalgia is a common disorder that involves widespread pain, tenderness, fatigue, and other symptoms. It’s not a form of arthritis, but like arthritis, it can interfere with a person’s ability to perform everyday activities. An estimated 5 million American adults have fibromyalgia. Between 80 and 90 percent of people with fibromyalgia are women, but men and children can also have this condition.

More About Fibromyalgia

In addition to pain and fatigue, people with fibromyalgia may have other symptoms, such as cognitive and memory problems, sleep disturbances, morning stiffness, headaches, painful menstrual periods, numbness or tingling of the extremities, restless legs syndrome, temperature sensitivity, and sensitivity to loud noises or bright lights.

A person may have two or more coexisting chronic pain conditions. Such conditions can include chronic fatigue syndrome, endometriosis, fibromyalgia, irritable bowel syndrome, interstitial cystitis, temporomandibular joint dysfunction, and vulvodynia. It’s not known whether these disorders share a common cause.

The exact cause of fibromyalgia is unclear, but it may be related to injury, emotional distress, or viruses that change the way the brain perceives pain. There’s no diagnostic test for fibromyalgia, so health care providers diagnose it by examining the patient, evaluating symptoms, and ruling out other conditions.

The U.S. Food and Drug Administration has approved several drugs to treat fibromyalgia, but medication is just one part of conventional medical treatment. Nondrug approaches such as exercise and good sleep habits can also help manage symptoms. Research has repeatedly shown that regular exercise is one of the most effective treatments for fibromyalgia. People with fibromyalgia who have too much pain or fatigue to do vigorous exercise should begin with walking or other gentle exercise and build their endurance and intensity slowly.

What the Science Says About Complementary Health Approaches for Fibromyalgia

Complementary approaches can be classified by their primary therapeutic input (how the therapy is taken in or delivered), which may be:

• Nutritional (e.g., special diets, dietary supplements, herbs, probiotics, and microbial-based therapies).
• Psychological (e.g., meditation, hypnosis, music therapies, relaxation therapies).
• Physical (e.g., acupuncture, massage, spinal manipulation).
• Combinations such as psychological and physical (e.g., yoga, tai chi, dance therapies, some forms of art therapy) or psychological and nutritional (e.g., mindful eating).

Nutritional approaches include what the National Center for Complementary and Integrative Health (NCCIH) previously categorized as natural products, whereas psychological and/or physical approaches include what was referred to as mind and body practices.

A variety of complementary approaches have been studied for fibromyalgia. The following sections summarize the evidence on the effectiveness and safety of specific approaches.

Psychological and Physical Approaches

Acupuncture

• Acupuncture is a technique in which practitioners stimulate specific points on the body, known as acupuncture points. This is most often done using needles that penetrate the skin (manual acupuncture), but other techniques, such as using electrical current (electroacupuncture), may also be used.
• Limited evidence indicates that people with fibromyalgia who receive acupuncture have improvements in symptoms such as pain and stiffness when compared to those who don’t receive it (for example, people on a waiting list). However, acupuncture hasn’t been shown to be more effective than simulated acupuncture in relieving fibromyalgia symptoms. Electroacupuncture may produce better results than manual acupuncture.
• Acupuncture is generally considered safe when performed by an experienced practitioner using sterile needles. Improperly performed acupuncture can cause potentially serious side effects.

Biofeedback

• Biofeedback techniques measure body functions and give you information about them so that you can learn to control them.
• A small number of short-term studies of biofeedback, particularly electromyographic (EMG) biofeedback, in which people learn to control and decrease muscle tension, indicate that it may reduce fibromyalgia pain. However, the overall evidence on biofeedback is so limited that no definite conclusions can be reached about whether it’s helpful for fibromyalgia symptoms.
• In studies of EMG biofeedback for fibromyalgia, some participants reported that the procedure was stressful. No other side effects were reported.

Guided Imagery

• Guided imagery is a technique in which people are taught to focus on pleasant images to replace negative or stressful feelings. Guided imagery may be self-directed or led by a practitioner or a recording.
• Studies of guided imagery for fibromyalgia symptoms have had inconsistent results. In some studies, patients who were taught guided imagery had decreases in symptoms such as pain and fatigue, but in other studies it had no effect.
• Guided imagery is one of a group of approaches called relaxation techniques. Relaxation techniques are generally considered safe for healthy people. Occasionally, however, people report unpleasant experiences such as increased anxiety.

Magnetic Therapies

• Static (permanent) magnets are found in magnetic mattress pads, shoe inserts, bracelets, and other products. There’s not enough evidence on static magnets to allow any conclusions to be reached.
• Electromagnets are used in a type of treatment called transcranial magnetic stimulation (TMS), which influences brain activity. The U.S. Food and Drug Administration has approved certain TMS devices for treating migraine and treatment-resistant depression. A small number of preliminary studies have evaluated TMS for fibromyalgia symptoms, and some have had promising results.
• Magnets and magnetic devices may not be safe for people who have metal implants or medical devices such as pacemakers in their bodies. Headaches have been reported as a side effect in several studies of TMS for fibromyalgia.

Massage Therapy

• Massage therapy includes a variety of techniques in which practitioners manipulate the soft tissues of the body.
• Several studies have evaluated various types of massage therapy for fibromyalgia. Most indicated that massage could provide short-term relief of some fibromyalgia symptoms. However, the current evidence is too limited to be considered conclusive. Experts recommend that massage therapy for fibromyalgia should not cause pain. It may be necessary to start with very gentle massage and increase the intensity gradually over time.
• Massage therapy appears to have few risks when performed by a trained practitioner.

Mindfulness Meditation

• Mindfulness meditation is a type of meditation that involves completely focusing on experiences on a moment-to-moment basis.
• In several studies, mindfulness meditation training has led to short-term improvements in pain and quality of life in people with fibromyalgia. However, the number of studies is small, and the quality of the evidence is relatively low, so no definite conclusions can be reached. Frequent practice of mindfulness techniques may be important for good results. In a 2014 study of mindfulness for fibromyalgia, those participants who practiced mindfulness more frequently had a greater reduction in symptoms.
• Mindfulness and other forms of meditation are generally considered to be safe for healthy people. However, they may need to be modified to make them safe and comfortable for people with some health conditions.

Meditative Movement Practices (Tai Chi, Qigong, and Yoga)

• Tai chi and qigong, which originated in China, and yoga, which is of Indian origin, all involve a combination of physical postures or movements, a focus on breathing, and meditation or relaxation. Because these three practices have so many features in common, they are sometimes grouped together as meditative movement practices.
• Exercise is beneficial for people with fibromyalgia, so meditative movement practices may be helpful because of the physical activity they involve. It’s also possible that the meditative component of these practices might help too. Some individual studies of tai chi, qigong, or yoga for fibromyalgia symptoms have had promising results. However, there isn’t enough high-quality evidence on these approaches to allow definite conclusions to be reached about their effects.
• Meditative movement practices generally have good safety records when practiced under the guidance of a qualified instructor. Few side effects have been reported in studies of yoga, tai chi, or qigong. However, these practices may need to be modified to make them suitable for people with fibromyalgia.

Other Psychological and Physical Approaches

So little research has been done on chiropractic care and hypnosis for fibromyalgia that no conclusions can be reached about these practices.

An approach called amygdala retraining, which includes various psychological and physical practices, has been proposed as a treatment for fibromyalgia. Because almost no research has been done on this approach, its effectiveness and safety cannot be evaluated.

Nutritional Approaches

• It has been suggested that deficiencies in vitamin D might worsen fibromyalgia symptoms. In one study of women with fibromyalgia who had low vitamin D levels, 20 weeks of vitamin D supplementation led to a reduction in pain.
• Researchers are investigating whether low magnesium levels contribute to fibromyalgia and if magnesium supplements might help to reduce symptoms.
• Other substances of natural origin that have been studied for fibromyalgia include dietary supplements such as soy,S-adenosyl-L-methionine (SAMe), and creatine. There’s not enough evidence to determine whether these products are helpful.
• “Natural” doesn’t necessarily mean “safe.” Products of natural origin can have side effects, and some may interact with medications. Even vitamins and minerals (including vitamin D and magnesium) can be harmful if taken in excessive amounts.

Other Complementary Approaches

Balneotherapy

• Balneotherapy is the technique of bathing in tap or mineral water for health purposes; it also includes related practices such as mud packs. Although some research has been done on balneotherapy for fibromyalgia, there’s not enough evidence to reach definite conclusions on whether it relieves symptoms.
• Balneotherapy has a good safety record.

Homeopathy

• Homeopathy is a medical system based on the unconventional idea that a disease can be cured by highly diluted solutions of a substance that causes similar symptoms in healthy people. Studies of homeopathy have not demonstrated that it is beneficial for fibromyalgia.
• Highly diluted homeopathic remedies are generally safe. However, not all products labeled as homeopathic are highly dilute; some may contain substantial amounts of ingredients and therefore could cause side effects.

Reiki

• Reiki is a complementary health approach in which practitioners place their hands lightly on or just above a person, with the goal of facilitating the person’s own healing response. An NCCIH-funded study examined the use of Reiki for fibromyalgia-related pain. The study showed no effect of Reiki on pain or any of the other outcomes measured in the study (physical and mental functioning, medication use, and visits to health care providers).
• Reiki appears to be generally safe.

Topical Herbal Products

• Topical products containing capsaicin (the substance that gives chili peppers their heat) have been studied for fibromyalgia. There's not enough evidence to determine whether these products are helpful.

Limited evidence suggests that when compared to a control, acupuncture may help improve symptoms of fibromyalgia such as pain and stiffness.

What Does the Research Show?

• A 2020 update to a systematic review by the Agency for Healthcare Research and Quality found that acupuncture was associated with a small improvement in function compared with sham acupuncture as evaluated by the Fibromyalgia Impact Questionnaire (FIQ) Total Score at short-term and intermediate-term follow-up. (The strength of evidence was considered moderate.) The updated review also found no effect of acupuncture versus sham acupuncture on pain in the short term or intermediate term. (The strength of evidence was considered low.)
• A 2013 Cochrane review of 9 studies involving a total of 395 participants found low-to-moderate evidence that acupuncture improves pain and stiffness in people with fibromyalgia, compared with no treatment and standard therapy. The reviewers also found moderate-level evidence that the effect of acupuncture does not differ from sham acupuncture in reducing pain or fatigue, or improving sleep or global well-being.

Safety

• Acupuncture is generally considered safe when performed by an experienced practitioner using sterile needles. Relatively few complications from acupuncture have been reported.
• Serious adverse events related to acupuncture are rare but include infections and punctured organs.
• There are fewer adverse effects associated with acupuncture than with many standard drug treatments (such as anti-inflammatory medication and steroid injections) used to manage painful musculoskeletal conditions like fibromyalgia, myofascial pain, and osteoarthritis.

There is some limited evidence that suggests that balneotherapy (hydrotherapy) may provide small improvement in pain and health-related quality of life for patients with fibromyalgia.

What Does the Research Show?

• A 2021 systematic review and meta-analysis of 11 randomized controlled trials involving 672 participants concluded that there is very low-to-moderate evidence that balneotherapy can benefit fibromyalgia symptoms in pain and quality-of-life improvement, whereas tenderness and depression improvement varies at time phases. The reviewers also noted that established balneotherapy regimens with a large sample size and longer observation are needed.
• A 2018 prospective, randomized, controlled, double-blind trial of 100 participants with a 6-month follow-up found that there was a significant improvement of Visual Analogue Scale (VAS) and FIQ-Total at the end of the treatment that persisted until 6 months, while no significant differences were found in the control group.

Safety

• Balneotherapy is generally considered safe. A few mild side effects (i.e., slight flushing) have been reported.

There is some low-quality evidence that biofeedback, compared to usual care, has an effect on physical functioning, pain, and mood in patients with fibromyalgia; however, due to the lack of quality evidence, it is unknown if biofeedback has any therapeutic effect on these outcomes.

What Does the Research Show?

• A 2015 Cochrane review found very low-quality evidence that biofeedback in comparison to usual care controls had an effect on physical functioning, pain, and mood post-treatment. However, because of the lack of quality evidence the reviewers noted that they cannot be certain that biofeedback has little or no effect on these outcomes.

Safety

• In studies of electromyograhic biofeedback for fibromyalgia, some participants reported that the procedure was stressful. No other side effects were reported.

Studies on the effects of guided imagery for fibromyalgia symptoms have had inconsistent results.

What Does the Research Show?

• A 2014 randomized controlled trial of 65 participants with fibromyalgia syndrome found no therapeutic effects of guided imagery on fibromyalgia symptoms.
• A 2014 randomized trial involving 72 women with fibromyalgia found that after 10 weeks of daily guided imagery use, participants reported statistically significant increases in self-efficacy and statistically significant decreases in stress, fatigue, pain, and depression, compared to usual care controls. No statistically significant changes were seen in participants’ biomarker levels between groups. Although there were no statistically significant changes over time in C-reactive protein levels, this systemic inflammation biomarker was elevated at all measurement time points before and during treatment, which supports the hypothesis that there may be an inflammatory component to fibromyalgia.
• A 2018 randomized controlled trial involving 56 women aged 35 to 65 years found some preliminary evidence for the benefit of Group Music and Imagery intervention to improve well-being and reduce anxiety in women with fibromyalgia. Findings from the trial also suggest that Group Music and Imagery intervention may help diminish pain intensity, state depression, and the impact of fibromyalgia on functional capacity and health, but further studies are needed to establish efficacy.

Safety

• Guided imagery is generally considered safe for healthy people. Occasionally, however, people report unpleasant experiences such as increased anxiety.

There is limited evidence that massage can provide modest improvement in some fibromyalgia symptoms.

What Does the Research Show?

• A 2020 review found that massage or myofascial release yields a small improvement in fibromyalgia symptoms.
• A 2020 update to a systematic review by the Agency for Healthcare Research and Quality found that at intermediate term, there was functional improvement with myofascial release; however, the strength of evidence was considered low.
• A 2014 systematic review and meta-analysis of 9 randomized controlled trials involving 404 participants with fibromyalgia syndrome found that massage therapy with a duration of 5 weeks or longer had beneficial immediate effects on improving pain, anxiety, and depression.

Safety

• Massage therapy appears to have few risks when performed by a trained practitioner. However, massage therapists should take precautions with certain health conditions.

Mindfulness mediation may provide short-term improvements in pain and quality of life in patients with fibromyalgia; however, the evidence is limited by a small number of studies with low methodological quality.

What Does the Research Show?

• A 2015 Cochrane review of 61 trials involving 4,234 participants examined mind and body therapies for fibromyalgia. The review found no advantage observed for mindfulness compared to usual care (control) for physical functioning, pain, mood, or participant withdrawals post-intervention. However, the quality of the evidence was very low for pain and moderate for mood and number of withdrawals.
• A 2019 randomized controlled trial involving 70 female participants found that mindfulness training was efficacious in reducing clinical severity of patients with fibromyalgia. The results of the trial also suggest that mindfulness-based stress reduction (MBSR) has significant immune regulatory effects in patients with fibromyalgia, while immune-inflammatory pathways may in part predict the clinical efficacy of MBSR.

Safety

• Mindfulness and other forms of meditation are generally considered to be safe for healthy people. However, they may need to be modified to make them safe and comfortable for people with some health conditions.

Findings from some randomized controlled trials suggest that meditative movement therapies, such as tai chi, may provide modest relief of some fibromyalgia symptoms.

What Does the Research Show?

• A 2018 prospective, randomized, 52-week, single-blind comparative effectiveness trial involving 226 participants found that tai chi resulted in similar or greater improvement in fibromyalgia symptoms than aerobic exercise. Longer duration of tai chi showed greater improvement.
• A 2019 review concluded that tai chi is a cost-effective and efficacious method of symptom reduction and is a promising therapy that may result in being added to the first-line recommendations for patients with fibromyalgia pending further research.
• A 2020 update to a systematic review by the Agency for Healthcare Research and Quality concluded that compared with exercise, tai chi conferred improvement in function in the short and intermediate term; however, the strength of evidence was considered low.
• A 2013 systematic review and meta-analysis of 7 studies involving 362 participants found evidence that meditative movement therapies such as tai chi, qigong, and yoga resulted in modest improvements in sleep disturbances, fatigue, depressed mood, and health-related quality of life at the conclusion of the study treatment period. The investigators also found evidence of continued improvement in sleep disturbances and health-related quality of life 3 to 6 months later. The investigators concluded that high-quality studies with larger sample sizes are needed to confirm these results.

Safety

• Tai chi and qigong are generally regarded as safe practices. However, people who are pregnant, or who have a hernia, joint problems, back pain, fractures, or severe osteoporosis should use caution and consult their health care provider.
• Yoga is generally considered to be safe in healthy people when practiced appropriately. However, people with certain conditions such as high blood pressure, glaucoma, or sciatica, and women who are pregnant should modify or avoid some yoga poses.

Fibromyalgia syndrome is a chronic disorder involving widespread pain and tenderness, fatigue, and other symptoms that can interfere with a person’s ability to carry out daily activities. It is estimated that fibromyalgia affects 4 million American adults. Fibromyalgia can affect people of all ages, including children. However, most people are diagnosed during middle age. Women are twice as likely to have fibromyalgia as men.

Treatment of fibromyalgia often involves an individualized approach that may include both medicines and nondrug therapies.

Here are 7 things you should know about what the science says about complementary health approaches for fibromyalgia:

1. In general, research on complementary health approaches for fibromyalgia is preliminary. However, the evidence for some approaches is encouraging.

2. With one possible exception, there is insufficient evidence that any dietary supplements can relieve fibromyalgia pain. The possible exception is vitamin D supplements, which may reduce pain in people with fibromyalgia who have vitamin D deficiencies.

3. Meditative movement therapies, such as tai chi, may provide modest relief of some fibromyalgia symptoms. Some randomized controlled trials have had promising results.

4. There is limited evidence that massage can be helpful. Massage therapy or a type of manual therapy called myofascial release, which is directed at connective tissue (fascia), may lead to a small improvement in fibromyalgia symptoms.

5. Mindfulness meditation may provide short-term improvements in pain and quality of life in people with fibromyalgia. However, only a small number of studies have been done, and their quality is low.

6. Biofeedback may have effects on physical functioning, pain, and mood in people with fibromyalgia. However, the quality of the evidence is low.

7. Psychological and physical approaches such as tai chi, mindfulness, massage, and biofeedback generally have good safety records when done properly by a trained professional or taught by a well-qualified instructor. Your medical conditions may affect the safety of a practice. Talk with your health care providers and the practitioner or teacher about your individual needs.