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Table of Contents > Conditions > Fibromyalgia
Fibromyalgia
Signs and Symptoms
What Causes It?
What to Expect at Your Provider's Office
Treatment Options
Drug Therapies
Complementary and Alternative Therapies
Following Up
Supporting Research

Fibromyalgia syndrome (FMS) is characterized by pain in the muscles and bones, trouble sleeping (or waking up feeling tired), and multiple tender points on the body. FMS, while different for everyone who has it, tends to come and go throughout life. It is not deforming, degenerative, life-threatening, or imaginary.


Signs and Symptoms
  • Fatigue
  • Morning stiffness
  • Paresthesia (tingling)
  • Raynaud's phenomenon
  • Skin sensitivity
  • Headaches
  • Psychological disturbances
  • Pain after exertion
  • Memory lapses
  • Sleep disorders
  • Restless leg syndrome
  • Dizziness
  • Irritable bowel syndrome
  • Joint pain and swelling

What Causes It?

The tendency to get FMS may be inherited. Illness or physical trauma such as an accident often precedes FMS symptoms. Many patients report a history of psychological problems, such as depression or anxiety.


What to Expect at Your Provider's Office

Although FMS does not show up in laboratory and imaging tests, your provider must perform them to rule out other causes of your symptoms. Your provider will also perform a physical examination of your joints. Be sure to tell your provider about all of your symptoms.


Treatment Options

The goal is to help you function as well as possible on a day-to-day basis. While it is probably not possible to completely relieve all your symptoms, medication and certain complementary and alternative therapies may help reduce symptoms.


Drug Therapies

The following drugs may be prescribed.

  • Sleep disturbances are often treated successfully with low doses of tricyclic antidepressants. Benzodiazepines may also be used.
  • Psychological disturbances can be treated with tricyclic antidepressants and sedative-hypnotics.
  • Pain in the bones and muscles can be treated with lidocaine or procaine (injected into points where pain is greatest) or with capsaicin (used topically). Ibuprofen may also help briefly reduce muscle pain.

Complementary and Alternative Therapies

Nutritional support, herbs, and mind-body techniques may help reduce symptoms.


Nutrition
  • Eliminate all food allergens from the diet. Common allergenic foods are dairy, soy, citrus, peanuts, wheat, fish, eggs, corn, and tomatoes. Try an elimination trial: Remove suspected allergens from the diet for two weeks. Reintroduce one food every three days. Watch for reactions such as gastrointestinal upset, mood changes, flushing, fatigue, and worsening of symptoms. A rotation diet, in which the same food is not eaten more than once every four days, may reduce sensitivities.
  • Decrease carbohydrate intake; increase protein; fats in moderation.
  • Eliminate inflammatory foods such as refined foods, sugar, saturated fats (meat and dairy products), alcohol, and caffeine.
  • Eat whole foods such as vegetables, whole grains, fruits, protein, and essential fatty acids (cold-water fish, nuts, and seeds).
  • Vitamin C (250 to 500 mg twice per day) reduces swelling and helps your immune system function better.
  • Coenzyme Q10 (50 to 100 mg one to two times per day) improves oxygen delivery to tissues and has antioxidant activity.
  • Chromium picolinate (200 mcg with meals) may reduce reactive hypoglycemia which may make your symptoms worse.
  • Magnesium (200 mg two to three times per day) with malic acid (1,200 mg one to two times per day) relieves pain and fatigue.
  • 5-Hydroxytryptophan (100 mg three times per day) may help with depression and insomnia.
  • B vitamins help reduce the effects of stress: B-complex (50 to 100 mg per day), niacinamide (100 mg per day), and B6 (100 mg per day).
  • Melatonin (0.5 to 3 mg one time before bed) may help sleep.
  • Zinc (30 mg per day) is essential for proper immune function.
  • Phosphatidyl choline and phosphatidyl serine (300 mg per day) may help depression and improve memory.

Herbs

Herbs may be used as dried extracts (capsules, powders, teas), glycerites (glycerine extracts), or tinctures (alcohol extracts). Teas should be made with 1 tsp. herb per cup of hot water. Steep covered 5 to 10 minutes for leaf or flowers, 10 to 20 minutes for roots. Drink 2 to 4 cups per day.

The following herbs may help increase resistance to stress and strengthen the immune system. Siberian ginseng (Eleutherococcus senticosus), schizandra berry (Schizandra chinensis), ashwaganda root (Withania somnifera), gotu kola (Centella asiatica), and astragalus root (Astragalus membranaceus). Use ginseng alone or with equal parts of two to three herbs. Take 20 to 30 drops two to three times per day. These may need to be taken for four to six months for maximum benefit.

Herbs that alleviate pain and nervous tension include the following: black cohosh (Cimicifuga racemosa), kava kava (Piper methysticum), skullcap (Scutellaria lateriflora), passionflower (Passiflora incarnata), lavender (Lavandula angustifolia), and valerian (Valeriana officinalis). Combine equal parts and take as a tincture 20 to 30 drops two to three times per day.

Essential oils of jasmine, lemon balm, rosemary, and clary sage relieve nervous exhaustion and may be used in aromatherapy. Place several drops in a warm bath or atomizer, or on a cotton ball, and inhale.


Homeopathy

Homeopathy may be useful as a supportive therapy.


Physical Medicine

Two to four cups of Epsom salts in a warm bath can soothe aching muscles.


Acupuncture

There are a few well-designed studies showing that acupuncture can help improve fibromyalgia symptoms and the National Institutes of Health recommend acupuncture as a treatment for this condition. Acupuncturists treat people with fibromyalgia based on an individualized assessment of the excesses and deficiencies of qi located in various meridians. In the case of fibromyalgia, a qi deficiency is usually detected in the spleen and/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 persons with fibromyalgia on lifestyle and diet, and provide recommendations on the use of herbal medicines.


Chiropractic

Because fibromyalgia generally includes low back pain and/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 that they experienced 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

Massage may reduce stress and improve circulation.


Following Up

Education and support groups may help you manage your condition.


Supporting Research

Abraham GE, Flechas JG. Management of fibromyalgia: rationale for the use of magnesium and malic acid. J Nutr Med. 1992;3:49-59.

Berman BM, Ezzo J, Hadhazy V, Swyers JP. Is acupuncture effective in the treatment of fibromyalgia? J Fam Pract. 1999;48(3):213-218.

Bigos S, Bowyer O, Braen G et al. Acute lower back problems in adults. Clinical Practice Guideline, Quick Reference Guide Number 14. Rockville, MD: U.S. Department of Health and Human Services, Public Health Service, Agency for Health Care Policy and Research, AHCPR Pub. No. 95-0643. December 1994.

Carr AC, Frei B. Toward a new recommended dietary allowance for vitamin C based on antioxidant and health effects in humans. Am J Clin Nutr. 1999;69(6):1086-1107.

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.

Chaitow L. Fibromyalgia: the muscle pain epidemic. Part I. Available at: http://www.healthy.net/asp/templates/article.asp?PageType=Article&ID=587.

Deluze C, Bosia L, Zirbs A, Chantraine A, Vischer TL. Electroacupuncture in fibromyalgia: results of a controlled trial. BMJ. 1992;305:1249-1252.

Fauci AS, Braunwald E, Isselbacher KJ, et al., eds. Harrison's Principles of Internal Medicine. 14th ed. New York, NY: McGraw-Hill; 1998:1955-1957.

Hains G, Hains F. Combined Ischemic compression and spinal manipulation in the treatment of fibromyalgia: a preliminary estimate of dose and efficacy. J Manipulative Physiol Ther. 2000;23:225-230.

Holland NW, Gonzalez EB. Soft tissue problems in older adults. Clin Geriatr Med. 1998;14:601-603.

JAMA Patient Page. How much vitamin C do you need? JAMA. 1999;281(15):1460.

Johnston CS. Recommendations for vitamin C intake. JAMA. 1999;282(22):2118-2119.

Kelley WN, ed. Textbook of Rheumatology. 5th ed. Philadelphia, Pa: WB Saunders Co; 1997:511-518.

Koopman WJ. Arthritis and Allied Conditions: A Textbook of Rheumatology. 13th ed. Baltimore, Md: Williams & Wilkins; 1993:1619-1635.

Leventhal, LJ. Management of fibromyalgia. Ann Intern Med. 1999;131:850-858.

Levine M, Rumsey SC, Daruwala R, Park JB, Wang Y. Criteria and recommendations for vitamin C intake. JAMA. 1999;281(15):1415-1453.

Nicolodi M, Sicuteri F. Fibromyalgia and migraine, two faces of the same mechanism. Serotonin as the common clue for pathogenesis and therapy. Adv Exp Med Biol. 1996;398:373-379.

NIH Consensus Statement: Acupuncture. National Institutes of Health, Office of the Director. 1997;15(5):1-34. Accessed at http://odp.od.nih.gov/consensus/cons/107/107_statement.htm on September 24, 2001.

Romano TJ, Stiller JW. Magnesium deficiency in fibromyalgia syndrome. J Nutr Med. 1994;4:165-167.

Russell IJ. Fibromyalgia syndrome: formulating a strategy for relief. J Musculoskel Med. 1998;November:4-21.

Starlanyl D, Copeland M. Fibromyalgia and Chronic Myofascial Pain Syndrome: A Survival Manual. Oakland, Calif: New Harbinger Publications Inc; 1996:215-224, 227-235.

Tyler VE. Herbs of Choice: The Therapeutic Use of Phytomedicinals. Binghamton: Pharmaceutical Products Press; 1994.

Wolfe F, Smyth HA, Yunus MB, et al. American College of Rheumatology 1990 Criteria for the Classification of Fibromyalgia: report of the Multicenter Criteria Committee. Arthritis Rheum. 1990;33:160-172.


Review Date: August 1999
Reviewed By: Participants in the review process include: Lawrence J. Cheskin, MD, FACP, Director, The Johns Hopkins Weight Management Center, Lutherville, MD; Gary Guebert, DC, DACBR, (Chiropractic section October 2001) Login Chiropractic College, Maryland Heights, MO; Joseph Trainor, DC, (Chiropractic section October 2001) Integrative Therapeutics, Inc., Natick, MA; Marcellus Walker, MD, LAc, (Acupuncture section October 2001) St. Vincent's Catholic Medical Center, New York, NY; Leonard Wisneski, MD, FACP, George Washington University, Rockville, MD; Elizabeth Wotton, ND, private practice, Sausalito, CA; Ira Zunin, MD, MPH, MBA, (Acupuncture section October 2001) President and Chairman, Hawaii State Consortium for Integrative Medicine, Honolulu, HI.

Copyright © 2004 A.D.A.M., Inc

The publisher does not accept any responsibility for the accuracy of the information or the consequences arising from the application, use, or misuse of any of the information contained herein, including any injury and/or damage to any person or property as a matter of product liability, negligence, or otherwise. No warranty, expressed or implied, is made in regard to the contents of this material. No claims or endorsements are made for any drugs or compounds currently marketed or in investigative use. This material is not intended as a guide to self-medication. The reader is advised to discuss the information provided here with a doctor, pharmacist, nurse, or other authorized healthcare practitioner and to check product information (including package inserts) regarding dosage, precautions, warnings, interactions, and contraindications before administering any drug, herb, or supplement discussed herein.

 
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  Drugs
Antidepressant Medications
Benzodiazepines
Sedatives
  Herbs
Black Cohosh
Kava Kava
Lavender
Lemon Balm
Passionflower
Rosemary
Siberian Ginseng
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Valerian
  Supplements
5-Hydroxytryptophan (5-HTP)
Chromium
Coenzyme Q10
Magnesium
Melatonin
Vitamin B1 (Thiamine)
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