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
Signs and Symptoms
Pain after exertion
Restless leg syndrome
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.
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
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
Complementary and Alternative Therapies
Nutritional support, herbs, and mind-body techniques may help reduce
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
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
Zinc (30 mg per day) is essential for proper immune
Phosphatidyl choline and phosphatidyl serine (300 mg per day) may
help depression and improve memory.
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 may be useful as a supportive therapy.
Two to four cups of Epsom salts in a warm bath can soothe aching
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.
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
Massage may reduce stress and improve
Education and support groups may help you manage your
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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,
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