Treatment for fibromyalgia: all you need to know

23rd December, 2022 • 14 min read

If you’ve been diagnosed with fibromyalgia, it’s important to have a plan for managing pain and fatigue, both day to day and if you have a flare-up – when your symptoms feel worse. And as we don’t fully understand what causes this condition, you may need to try different things, to find out what works for you. Here’s how you and your healthcare team can work together on a plan for fibromyalgia medication, diet and self-care – to make living with fibromyalgia that little bit easier.

Living with fibromyalgia

It can feel hard to enjoy life when you’re dealing with pain and fatigue, which can sometimes flare up and catch you out. “Many people with fibromyalgia have good days and bad days, and finding ways to have more good days is key,” says Dr Ann Nainan, family doctor and Healthily expert.

“Treatment for fibromyalgia and its symptoms is still developing, so there aren’t any cures. But there are medications, proven self-care approaches and peer support, which can help you manage pain, sleep problems, fatigue and depression.”

“Even though nothing shows up on scans or X-rays, the pain is real – it’s important to stay clear about that, and to help yourself stay hopeful. That can feel hard, but we’ve got the latest tips and information to help.”

Self-care for fibromyalgia

It can sometimes feel tough to find the mental and physical energy for self-care. But getting into some regular habits can make a big difference to your wellbeing.

Natural treatment for fibromyalgia pain

These medication-free pain relief ideas are proven to help with fibromyalgia pain – try them on their own or alongside treatments from your doctor:

  • soak in a warm bath or shower – heat can ease muscular pain and morning stiffness. Soaking your hands and feet in warm water may also help ease aching
  • try soothing heat treatments – heat wrap and heat pad products are available from pharmacies or online, as well as microwavable wheat bags and hot water bottles
  • use relaxation techniques
    stress
    can make pain worse, so try to take time out to relax.
    Deep breathing
    or
    meditation techniques
    can help you unwind, or try
    yoga
  • consider
    acupuncture
    – this Chinese medicine technique involves inserting hair-thin needles into various points in the body, and has been found to be helpful for fibromyalgia

Fibromyalgia diet?

While there isn’t a definitive ‘fibro diet’, there’s some limited evidence that eating a healthy, balanced diet may improve some of your symptoms.

Diet plans

In a recent recent review of different studies, researchers found evidence that people who followed the diets below saw an improvement in their fibromyalgia symptoms, including chronic pain, anxiety, depression, cognitive function and sleep pattern:

  • vegetarian diet
  • Mediterranean diet
  • gluten-free diet
  • low-calorie diet
  • low FODMAP diet
    – about 70% of people with fibromyalgia also have
    irritable bowel syndrome (IBS)
    . The low FODMAP diet is helpful for IBS symptoms, so some experts think it may also help people with fibromyalgia. In a small study, 38 women with fibromyalgia who followed the low FODMAP diet for 4 weeks reported a significant reduction in both gastrointestinal and fibromyalgia symptoms

The review authors say that diet is a “promising complementary approach to treat fibromyalgia.” However, the studies reviewed were small, and not always of the highest quality. Some of the recorded benefits might be due to weight loss, or the fact that the diets above are often based on healthy foods. More research is needed.

Foods to help

It’s difficult to pinpoint specific foods for fibromyalgia, as diet studies usually look at a whole eating plan.

But there has been some indication in early studies that these 3 things might help:

  • extra-virgin olive oil – this contains a high concentration of antioxidants, which can protect against cell damage. In a small trial of 23 women with fibromyalgia, it was shown to protect against cell damage and improve physical function and psychological status.The authors of the study concluded that extra-virgin olive oil may be a “valuable therapeutic support in fibromyalgia”
  • ancient grains, such as Khorasan wheat – these contain higher levels of magnesium, selenium, zinc and potassium than regular wheat. In a small study of 20 people with fibromyalgia who ate either Khorasan wheat or regular wheat for 8 weeks, the Khorasan group reported improvements in sleep, widespread pain severity scores, and tiredness levels
  • cutting out artificial sweeteners and monosodium glutamate additives – studies have suggested that higher levels of the chemicals glutamate and aspartate could be involved in heightened pain sensitivity. These are present in many foods and drinks, as aspartame and monosodium glutamate. So 1 theory is that eating these might play a role in fibromyalgia. It’s been speculated that avoiding them may help improve symptoms – but more research is needed

Weight loss

Fibromyalgia symptoms have been found to be worse if you’re overweight. “It can be tough to try to lose weight when pain and fatigue makes exercise feel hard,” says Dr Ann. “So check in with your doctor, and use the tips on pacing yourself below and healthy eating to see if you can move more and reduce calories, while eating lots of helpful nutrients.”

Fibromyalgia fatigue? Pace yourself

“With fibromyalgia, it can be easy to overdo things when you have a good day, so you end up with no energy at all the day after,” says Dr Ann.

“Energy pacing is a way to help you have enough energy for the things you enjoy, as well as the things you feel you have to do. You’re looking to find a pattern of varied activity that you can manage on good and bad days.”

Remember to:

  • spend your energy wisely – think of your body as having a fixed amount of energy each day, and consider how you’ll spend it, even when you’re feeling good
  • make helpful choices – prioritizing tasks that are are important, and working out what you could have help with
  • delegate – or break up tasks into smaller segments
  • learn to say no – to things that you know will be too much for you
  • plan to rest after any activity – even if you don’t feel tired. It’s easier to recover and keep going if you avoid draining yourself of energy

“You could try the spoon theory to help plan your daily activities,” says Dr Ann. “Start the day with a number of ‘spoons of energy’ – which represent how much physical and mental energy it will take to complete a task.

“For example, showering and dressing may use 1 spoon each, but bigger tasks – such as cooking, cleaning or going for a walk – may be 3 or 4. If you use up too many spoons on 1 day, you may pay for it the next day and be unable to do as much. It’s about learning not to overdo it.

“Try to work out how many spoons are a good amount for you, then work within this, starting with the most important tasks – and tailor it from month to month depending on your symptoms.”

Fibromyalgia and exercise

It might be the last thing you feel like doing when you have a pain condition – and when simply taking a shower can leave you exhausted – but exercise can help with fibromyalgia symptoms, including reducing muscle pain and improving strength.

Keeping moving

If you’re finding it challenging to exercise while coping with pain and fatigue, try to do the following:

  • change positions regularly – so you’re not sitting or standing in 1 way for too long
  • stretch – at least twice an hour, do some mild stretching to avoid your muscles tightening up (but don’t overdo it). Ask your doctor or physiotherapist to recommend some suitable stretches

Aerobic exercise

  • start gradually and work up – before you start, talk to your doctor, and ask other people with fibromyalgia about what has helped them
  • aim to do 30 minutes of cardio, 3 times a week – you may have to work up to this gradually, as you may feel more tired to begin with
  • choose low-impact cardio exercise – such as fast walking, cycling, swimming or aqua aerobics

Muscle strengthening

Strength-training exercises, such as group strength-building classes or lifting weights, have been seen to reduce muscle pain and the number of painful areas, as well as improving muscle strength in people with fibromyalgia.

Tai Chi

Tai chi
is a Chinese mind/body form of exercise, which has been shown to be as effective or better than aerobic exercise for managing fibromyalgia – plus, people with fibromyalgia may be more likely to attend classes.

It’s a gentler form of exercise, so may be more suitable if you need to build up your fitness slowly.

Watch this video about how to start exercising with fibromyalgia.

Fibromyalgia and sleep

Fibromyalgia pain can stop you sleeping, while poor sleep can also be a trigger for pain and/or make your symptoms feel worse – so fibromyalgia and sleep have a complicated relationship.

This means it’s important that you prioritize getting enough sleep. Following good

sleep hygiene
can help, including:

  • sleeping in a cool, dark, quiet room
  • sticking to a routine for getting up and going to bed each day
  • avoiding overstimulation – including blue light from screens – in the evening
  • avoiding caffeine and alcohol too close to be bedtime

Getting your pain well-controlled (admittedly easier said than done) will also aid sleep, as your pain then won’t stop you dropping off, or wake you up later.

Try applying heat – with a heat wrap or electric blanket – to ease muscle pain. A warm bath or shower before bed can also help, and aid relaxation, too.

Emotional support to help you stay hopeful

It can be hard not to feel worn down by chronic pain. But there is support out there to help you stay hopeful.

And remember, fibromyalgia is a recognised medical condition – it’s definitely not “all in your head”. This can help you feel more confident in dealing with your condition, and that your self-management efforts are worthwhile, and important to prioritize.

You could try:

Fibromyalgia treatments from your doctor

Your doctor is likely to help you manage fibromyalgia with a combination of self-care measures, medication and psychological treatments.

Self-management programs

Your doctor may be able to refer you to a self-management program. These vary in what they offer, but may include:

  • education about pain management
  • psychological techniques, such as mindfulness and cognitive behavioral therapy (CBT)
  • sleep hygiene
  • advice about how to start aerobic exercise
  • stress management and relaxation

A review of studies of self-management programs found they were effective at reducing pain and improving physical function in the short and longer term. But the quality of some of the research study evidence was poor, and more research is needed.

Fibromyalgia medication

While there’s no ‘fibromyalgia pill’, there are medications your doctor can prescribe to help relieve symptoms such as pain, depression and sleep problems.

However, you might be surprised to learn this doesn’t usually include painkillers.

Painkillers – some can make fibromyalgia worse

“It may sound strange, but the usual painkillers often don’t work for fibromyalgia, because the condition isn’t about the usual kinds of pain,” says Dr Ann. “You’ll need to work with your doctor to try to find other treatments that work for you, alongside self-care.”

For example, the American College of Rheumatology strongly recommends avoiding opioids. This is because they’re not helpful for most people with fibromyalgia, and may actually cause greater pain sensitivity or make pain persist. The opioid tramadol may be used in the short term if a painkiller is needed, but it’s not a long-term solution, and can lead to addiction.

Some doctors may still prescribe painkillers, such as acetaminophen (

paracetamol
),
non-steroidal anti-inflammatory drugs (NSAIDs)
, pregabalin, and opioid drugs. You might want to talk to your doctor about what the American College of Rheumatology says, and discuss if there are alternatives.

Antidepressants

Certain

antidepressants
are uses for fibromyalgia, including:

  • tricyclic antidepressants – these are used to treat fibromyalgia pain, but they can also improve emotional health and overall quality of life. Amitriptyline is the most commonly prescribed; in trials, it’s been shown to improve symptoms in between 25% and 45% of people with fibromyalgia
  • serotonin-norepinephrine reuptake inhibitors (SNRIs) – both duloxetine and milnacipran are approved by the Food and Drug Administration (FDA) to treat fibromyalgia

Anticonvulsants

Anticonvulsants include gabapentin and pregabalin, and pregabalin is approved by the FDA to treat fibromyalgia.

Originally developed to treat

epilepsy
, they work by blocking the overactivity of nerve cells involved in pain transmission, and have been shown to be effective for fibromyalgia pain.

Specialist help

In the longer term, and if the treatments above don’t help you, your doctor may refer you to a specialist for additional help.

This can include a physical therapist, rheumatologist, pain-management specialist, sleep doctor or psychologist.

Cognitive behavioral therapy (CBT)

Cognitive behavioral therapy (CBT)
or similar mind/body therapies such as
mindfulness
stress reduction are sometimes included as part of treatment for fibromyalgia.

Therapy can be helpful because people with fibromyalgia can often feel hopeless, and worry that because there’s no ‘cure’ and their condition isn’t well understood, they’ll never get better. This spiral of worry and thinking about the worst-case scenario is known by psychologists as ‘catastrophizing’. It can have a big effect on your pain and how well you do.

But CBT and mindfulness can teach you to think differently and get some perspective, as well as techniques for dealing with negative thoughts.

Treating a fibromyalgia flare-up

“Fibromyalgia symptoms can come and go,” says Dr Ann. “You might find you have a lower level of pain that’s there all the time, then have bouts of more intense symptoms, or ‘flare-ups’.

“When your symptoms get worse, it’s important to look after yourself and not push yourself too hard. Coping with pain can be exhausting. You can try to tailor your routine so that it’s in line with your symptoms.

“You may also be able to identify ‘triggers’ that set off your flare-ups and learn to avoid them – although some people find they don’t have trigger patterns for attacks.”

Here are the other tips for managing fibromyalgia flares:

Ask your doctor for a medication review

They may be able to change your medicines, or help you find a routine for a different dose during a flare-up.

Self-care

You can use self-care methods to help relieve your symptoms, such as soothing heat treatments.

“Ask for help doing tasks, use relaxation techniques, and try to set aside racing thoughts and worries,” advises Dr Ann.

Acetaminophen

Although regular painkillers, such as acetaminophen, don’t work for long-term pain, they’re sometimes used to treat short-term pain – though experts say the effects are limited.

If you want to try them, check with your pharmacist that they’re safe for you, and don’t exceed the recommended dose.

NSAIDs such as

ibuprofen
aren’t helpful, as fibromyalgia doesn’t cause inflammation.

Ones to watch

Supplements for fibromyalgia are a controversial subject. But a recent review concluded that clinical trials showed promising results for certain supplements. These included:

  • vitamin D
    – about 40% of people with fibromyalgia have been reported to have vitamin D deficiency, and some studies have suggested supplements may have a role in managing the condition. Low levels of vitamin D have been associated with chronic pain and depression in fibromyalgia patients
  • magnesium
    – several studies have shown low levels of magnesium in people with fibromyalgia. Magnesium deficiencies were associated with muscle weakness and abnormal skin sensations
  • probiotics
    – increasing evidence suggests that people with fibromyalgia may have altered gut bacteria. In a small study, 40 people with fibromyalgia who were given a multi-probiotic supplement for 7 weeks showed improvements in their cognition, particularly in choice- and decision-making
  • cannabidiol (CBD)
    – derived from the cannabis plant, cannabidiol has been anecdotally reported as helpful for people with fibromyalgia, but we don’t have enough evidence yet to know whether it’s effective or safe

Important: Our website provides useful information but is not a substitute for medical advice. You should always seek the advice of your doctor when making decisions about your health.