Fibromyalgia is a chronic condition characterized by pain in the muscles, ligaments, and tendons; fatigue; and multiple tender points on the body. While no one knows what causes fibromyalgia, there is evidence that people with the condition may be more sensitive to pain because something is wrong with the body's usual pain perception processes. More women than men have fibromyalgia.

Fibromyalgia tends to come and go throughout life. It also tends to coexist with sleep disorders, anxiety, depression, and irritable bowel syndrome. Fibromyalgia can be debilitating for some people, but it is not degenerative or life-threatening. You can manage your symptoms and improve your quality of life with professional care and self-care.

• Widespread pain and stiffness
• Fatigue or trouble sleeping
• Paresthesia (tingling)
• Irritable bowel syndrome (IBS)
• Skin sensitivity
• Heightened sensitivity to noises, bright lights, smells
• Depression
• Headaches
• Pain after exertion
• Memory lapses or difficulty concentrating
• Restless legs syndrome (RLS)
• Dizziness
• Anxiety
• Hemorrhoids

It is not uncommon for people with fibromyalgia to have other conditions, including temporomandibular joint disorder and bladder problems.

No one knows what causes fibromyalgia. Several theories and multiple factors may bring on the condition, including:

• Changes in brain chemicals. Some people with fibromyalgia have abnormal levels of brain chemicals called neurotransmitters. Specifically, they have low levels of serotonin, which affects mood, promotes sleep, and helps reduce the perception of pain. They often have high levels of substance P, which transmits the "pain message" to the brain.
• Disregulation of the autonomic nervous system. The autonomic nervous system releases hormones that affect how you react to stress. Some doctors think people with fibromyalgia release these hormones differently when they experience stress, and the hormones affect the perception of pain.
• Sleep problems. The majority of people with fibromyalgia report sleep problems, and especially have trouble with the most restful stage of sleep in which the body repairs itself. Some doctors believe the lack of restful sleep means that the muscles of people with fibromyalgia are not able to repair the tiny tears and trauma that occur every day, leading to muscle pain and fatigue. Other doctors believe that sleep problems are a result, not a cause, of fibromyalgia.
• Injury and infection. An injury, especially to the upper spine or neck, or an infection caused by a virus or bacteria may trigger firbromyalgia.
• Genetics. The tendency to get fibromyalgia may sometimes be inherited.
• Having another rheumatic disease. You may be more likely to get fibromyalgia if you have a disease such as rheumatoid arthritis or lupus.

There is no laboratory test for fibromyalgia, but your doctor may order several tests, including blood tests and x-rays, to rule out other diseases. Your doctor may also press firmly on specific "tender points" on your head and body to see which ones are abnormally sensitive under pressure. Be sure to tell your doctor about all of your symptoms. Your doctor may refer you to a rheumatologist, who specializes in treating rheumatic conditions like fibromyalgia and arthritis.

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

Drug Therapies

Your doctor may prescribe the following drugs:

• Pregabalin (Lyrica). Is the first medication approved by the Food and Drug Administration (FDA) for the treatment of fibromyalgia.
• Low doses of tricyclic antidepressants, such as amitriptyline (Elavil), doxepin (Sinequan), and nortriptyline (Pamelor, Aventyl) may help treat sleep disturbances. Your doctor may also prescribe sleeping pills for short term use.
• Analgesics treat pain. Your doctor may recommend nonsteroidal anti-inflammatory drugs (NSAIDs), such as naproxen sodium (Aleve), ibuprofen (Advil, Motrin), or prescription NSAIDs. These drugs may lessen pain, but they are not effective for everyone. Your doctor may also prescribe tramadol (Ultram), which is often used to treat fibromyalgia pain.
• Muscle relaxants, such as cyclobenazaprine (Flexeril), can help treat muscle spasms.
• Your doctor may use a technique called "spray and stretch". A prescription spray coolant is applied to a painful muscle while the muscle is stretched.
• Doctors may treat pain in specific spots in muscles by injecting lidocaine or procaine into points where pain is greatest, or by applying capsaicin topically.
• Antidepressants, such as fluoxetine (Prozac) and sertraline (Zoloft), milnacipran (Savella), and diloxetine (Cymbalta) for depression.
• Armour Thyroid, a natural thyroid hormone medication, may be helpful if tests show abnormal thyroid function. People with fibromyalgia may want both conventional and holistically-oriented doctors to evaluate their tests because levels of thyroid hormone in the blood are often interpreted differently. Specifically, people with fibromyalgia may want to ask for an assessment of free T3 levels, a lab test that is rarely ordered by conventional doctors.
• Antipsychotics, such as quetiapine, may help alleviate depression and anxiety, while also improving sleep. This is an evolving area of research. Speak with your doctor.

Complementary and Alternative Therapies

Nutritional support, exercise, herbs, and mind-body techniques may help reduce symptoms. If you are pregnant, or thinking about becoming pregnant, do not use any CAM therapies unless directed to do so by your physician.

Nutrition and Supplements

These nutritional tips may help reduce symptoms:

• Eliminate potential food allergens, including dairy, wheat (gluten), corn, soy, preservatives, and food additives. Your doctor may want to test for food sensitivities.
• Eat antioxidant foods, including fruits (such as blueberries and cherries), and vegetables (such as kale, spinach, and bell peppers).
• Avoid refined foods, such as white breads, pastas, and sugar.
• Eat fewer red meats and more lean meats, cold-water fish, tofu (soy, if no allergy) or beans for protein.
• Use healthy cooking oils, such as olive oil or coconut oil.
• Reduce or eliminate trans fatty acids, found in commercially-baked goods, such as cookies, crackers, cakes, French fries, onion rings, donuts, processed foods, and margarine.
• Avoid alcohol, tobacco, and caffeine, and limit foods that are high in sugar, salt, and fat. Avoid foods with additives such as monosodium glutamate (MSG).
• Drink 6 to 8 glasses of filtered water daily.

You can address nutritional deficiencies with the following supplements:

• Omega-3 fatty acids. To help reduce inflammation and improve immunity. Talk to your doctor before taking omega-3 supplements if you are taking blood-thinning medications, such as aspirin or warfarin (Coumadin).
• A multivitamin daily, containing the antioxidant vitamins A, C, D, E, the B-vitamins, and trace minerals, such as magnesium, calcium, zinc, and selenium.
• Vitamin C, as an antioxidant and for immune support.
• Vitamin D, for pain reduction. Vitamin D may also improve immunity.
• Alpha-lipoic acid, for antioxidant support. Alpha-lipoic acid may decrease thiamine levels. It may also interact with certain medications, particularly some medicines used in chemotherapy and in the treatment of thyroid conditions. Speak with your doctor.
• L-carnitine, for muscular support. L-carnitine may make symptoms of hypothyroidism worse, and can potentially increase the likelihood of seizure in people with a history of seizures.
• Magnesium, for symptoms of fibromyalgia. If you have kidney disease, talk to your doctor before taking magnesium. Magnesium can potentially interact with certain medications, including high blood pressure medicines and some antibiotics.
• S-adenosylmethionine (SAMe), for mental and immune support. People who have manic or bipolar disorder should not take SAMe. SAMe may potentially have negative side effects in people with Parkinson's disease. If you are taking any psychoactive medication, speak with your doctor before taking SAMe.
• Probiotic supplement (containing Lactobacillus acidophilus), for maintenance of gastrointestinal and immune health. Some acidophilus products may need refrigeration -- check labels carefully. If you are severely immune compromised, or if you take immune suppressive drugs, talk to your physician before taking probiotic supplements.
• Calcium/vitamin D supplement, for support of muscle and skeletal weakness.
• Coenzyme Q10 (CoQ10), for antioxidant, immune, and muscular support. CoQ10 can interfere with the actions of some blood-thining medications, such as warfarin (Coumadin) and others. Talk with your doctor.
• Chlorella (Chlorella pyrenoidosa), a blue-green algae, may help lessen symptoms. Participants in a clinical study took a dose of 10 g of Sun chlorella tablets and 100 ml of the liquid chlorella extract Wasaka Gold and showed significant improvement in symptoms. More studies are needed. Chlorella contains large amounts of vitamin K, a nutrient that helps the body's clotting function and may interfere with blood-clotting effects of certain medications, such as warfarin (Coumadin) and others. If you are severely immune compromised, or if you take immune suppressive drugs, talk to your physician before taking chlorella supplements.
• Nicotinamide adenine dinucleotide (NADH), for energy. People who have anxiety should start NADH at a lower dose and work up slowly.
• Melatonin, for sleep and immune support. Talk to your doctor first if you are taking antidepressants or other neurological or psychiatric medications.

Exercise

It may seem odd to suggest exercising when your muscles are sore and you are in pain, but a number of studies show that regular, low-intensity exercise is one of the most effective treatments for fibromyalgia. Although you may experience a slight increase in pain and soreness when you start, as you continue you will help lessen muscle tension and stiffness, improve sleep quality, and raise serotonin and endorphin levels, helping to reduce pain. Exercise programs should include multiple dimensions, including strength, endurance, flexibility, and balance. Many people with fibromyalgia find warm water aquatic exercises to be helpful. Talk to your doctor or physical therapist to design an exercise program that is right for you.

Herbs

Herbs are a way to strengthen and tone the body's systems. As with any therapy, you should work with your doctor to diagnose your problem before starting any treatment. You may use herbs as dried extracts (capsules, powders, or teas), glycerites (glycerine extracts), or tinctures (alcohol extracts). Unless otherwise indicated, make teas with 1 tsp. of herb per cup of hot water. Steep covered 5 to 10 minutes for leaf or flowers, and 10 to 20 minutes for roots. Drink 2 to 4 cups per day. You may use tinctures alone or in combination as noted.

Herbal therapies aim to reduce the symptoms of fibromyalgia, or those of common conditions associated with fibromyalgia.

• Green tea (Camelia sinensis). For antioxidant and immune effects. Use caffeine-free products. You may also prepare teas from the leaf of this herb.
• Cat's claw (Uncaria tomentosa). For inflammation, immune, and antifungal activity. Cat's claw can interfere with a variety of medications, and may worsen certain conditions, such as leukemia and some autoimmune disorders. Talk to your doctor.
• Bromelain (Ananus comosus). For pain and inflammation. Bromelain can have a blood-thinning effect and increase the effectiveness of blood-thinning medications, such as aspirin and warfarin (Coumadin). People with peptic ulcers should not take bromelain. Bromelain can affect the absorption of certain antibiotics, 5-fluoracil and vincristine, and medications that cause drowsiness, such as benzodiazepines lorazepam (Ativan) or diazepam (Valium), some antidepressants, and narcotics, such as codeine, and barbituates, such as phenobarbitol.
• Turmeric (Curcuma longa). For inflammation. Turmeric can have a blood-thinning effect and can increase the effectiveness of blood-thinning medications, such as aspirin and warfarin (Coumadin).
• Rhodiola (Rhodiola rosea). For antioxidant, anti-stress, and immune activity.
• Capsicum or capsaicin (Zostrix). As a cream applied topically (on the skin), 1 to 3 times daily.

Homeopathy

Before prescribing a remedy, homeopaths take into account a person's constitutional type, includes your physical, emotional, and intellectual makeup. An experienced homeopath assesses all of these factors when determining the most appropriate remedy for a particular individual. Some of the homeopathic remedies used for fibromyalgia include:

• Arnica. For someone who feels sore and bruised, and does not want to be touched. Laying down is difficult, and the patient is restless when trying to find a comfortable position. Soreness stays after gentle exercise.
• Bryonia. Used when the slightest movement aggravates pain. The person is usually very thirsty. Pain is worse at night and upon waking in the morning.
• Calcarea carbonica. For people who tend to move slowly, look pasty, and are always chilly. Exertion leaves them weak and breathless. They feel better when lying down. Being warm relieves symptoms.
• Rhus toxicodendron. For joint stiffness, worse when starting to move, then easing with more movement. Stiffness is worse in the morning and in cold or damp weather.
• Ruta graveolens. For sore, bruised pain in the joints and tendons that feel worse when lying on the affected area.

Mind-Body Therapies

Stress makes symptoms of fibromyalgia worse, so mind-body therapies including meditation and biofeedback can be helpful in learning relaxation techniques.

Physical Medicine

Using 2 to 4 cups of Epsom salts in a warm bath can soothe aching muscles.

Acupuncture

Acupuncturists treat people with fibromyalgia based on an individualized assessment of the excesses and deficiencies of qi located in various meridians. In fibromyalgia, a qi deficiency is usually detected in the spleen or kidney meridians. Moxibustion (a technique in which the acupuncturist burns an herb called mugwort over specific acupuncture points) is used to strengthen the entire energy system. Qualified practitioners may also advise people with fibromyalgia on lifestyle and diet, and provide recommendations on the use of herbal medicines.

According to a review of the research, compared with no treatment and standard therapy, acupuncture improves pain and stiffness in people with fibromyalgia. However, studies show acupuncture does not differ from treatment in reducing pain, or fatigue, or improving sleep and well being.

Chiropractic

Because fibromyalgia generally includes low back pain 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 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, improve circulation, and soothe sore muscles. In one study, massage therapy for 5 weeks or more improved pain, anxiety, and depression among patients with fibromyalgia. Find a massage therapist who has experience working with fibromyalgia.

Education and support groups may help you manage your condition.

Abeles M, Solitar B, Pillinger M, et al. Update on Fibromyalgia Therapy. The American Journal of Medicine. 2008;121(7).

Bartecchi CE. Fibromyalgia and complementary and alternative medicine. Mayo Clin Proc. 2005;80(6):826; author reply 826-7.

Bennett R. Clinical Manifestations and Diagnosis of Fibromyalgia. Rheumatic Diseases Clinics of North America. 2009;35(2).

Bernardy K, Füber N, Klose P, et al. Efficacy of hypnosis/guided imagery in fibromyalgia syndrome--a systematic review and meta-analysis of controlled trials. [Review]. BMC Musculoskelet Disord. 2011;12:133.

Bernstein CD, Albrecht KL, Marcus DA. Milnacipran for fibromyalgia: a useful addition to the treatment armamentarium. Expert Opin Pharmacother. 2013;14(7):905-16.

Bope ET, Kellerman RD, eds. Conn's Current Therapy 2014. 1st ed. Philadelphia, PA: Elsevier Saunders; 2013.

Bronfort G, Haas M, Evans R, et al. Effectiveness of manual therapies: the UK evidence report. Chiropr Osteopat. 2010;18:3.

Calandre EP, Rico-Villademoros F. The role of antipsychotics in the management of fibromyalgia. CNS Drugs. 2012;26(2):135-53.

Cao H, Liu J, Lewith GT. Traditional Chinese Medicine for treatment of fibromyalgia: a systematic review of randomized controlled trials. [Review]. J Altern Complement Med. 2010;16(4):397-409.

Casanueva-Fernández B, Llorca J, Rubió JB, et al. Efficacy of a multidisciplinary treatment program in patients with severe fibromyalgia. Rheumatol Int. 2011. [Epub ahead of print].

Castro-Sánchez AM, Matarán-Peñarrocha GA, Arroyo-Morales M, et al. 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):800-13.

Castro-Sánchez AM, Matarán-Peñarrocha GA, Granero-Molina J, et al. Benefits of massage-myofascial release therapy on pain, anxiety, quality of sleep, depression, and quality of life in patients with fibromyalgia. Evid Based Complement Alternat Med. 2011;2011:561753.

Chakrabarty S, Zoorob R. Fibromyalgia. Am Fam Physician. 2007;76(2):247-54.

De Silva V, El-Metwally A, Ernst E, et al. Evidence for the efficacy of complementary and alternative medicines in the management of fibromyalgia: a systematic review. [Review]. Rheumatology (Oxford). 2010;49(6):1063-8.

Deare JC, Zheng Z, Xue CC, et al. Acupuncture for treating fibromyalgia. Cochrane Database Syst Rev. 2013;5:CD007070.

Ernst E. Herbal medicine in the treatment of rheumatic diseases. [Review]. Rheum Dis Clin North Am. 2011;37(1):95-102.

Ferri FF, ed. Ferri's Clinical Advisor 2014. 1st ed. Philadelphia, PA: Elsevier Mosby; 2013.

Firestein GS, Budd RC, Gabriel SE, et al., eds. Kelly's Textbook of Rheumatology. 8th ed. Philadelphia, PA: Elsevier Saunders; 2008.

Gauffin J, Hankama T, Hannonen P, et al. Do fibromyalgia patients use active pain management strategies? A cohort study. J Rehabil Med. 2013;45(5):477-80.

Gunnarsdottir TJ, Peden-McAlpine C. Effects of reflexology on fibromyalgia symptoms: a multiple case study. Complement Ther Clin Pract. 2010;16(3):167-72.

Häuser W, Klose P, Langhorst J, et al. Efficacy of different types of aerobic exercise in fibromyalgia syndrome: a systematic review and meta-analysis of randomised controlled trials. [Review]. Arthritis Res Ther. 2010;12(3):R79.

Hsu MC, Schubiner H, Lumley MA, et al. Sustained pain reduction through affective self-awareness in fibromyalgia: a randomized controlled trial. J Gen Intern Med. 2010;25(10):1064-70.

Itoh K, Kitakoji H. Effects of acupuncture to treat fibromyalgia: a preliminary randomised controlled trial. Chin Med. 2010;5:11.

Kalichman L. Massage therapy for fibromyalgia symptoms. [Review]. Rheumatol Int. 2010;30(9):1151-7.

Kengen Traska T, Rutledge DN, Mouttapa M, et al. Strategies used for managing symptoms by women with fibromyalgia. J Clin Nurs. 2012;21(5-6)626-35.

Kibar S, Yildiz HE, Ay S, et al. New Approach in Fibromyalgia Exercise Program: A Preliminary Study Regarding the Effectiveness of Balance Training. Arch Phys Med Rehabil. 2015;96(9):1576-82.

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(4):778-88.

Li YH, Wang FY, Feng CQ, et al. Massage therapy for fibromyalgia: a systematic review and meta-analysis of randomized controlled trials. PLoS One. 2014;9(2):e89304.

McBeth J, Jones K. Epidemiology of chronic musculoskeletal pain. Best Pract Res Clin Rheumatol. 2007;21(3):403-25.

Müller W, Schneider EM, Stratz T. The classification of fibromyalgia syndrome. Rheumatol Int. 2007;27(11):1005-10.

Napadow V, Harris RE. What has functional connectivity and chemical neuroimaging in fibromyalgia taught us about the mechanisms and management of 'centralized' pain? Arthritis Res Ther. 2014;16(5):425.

Perry R, Terry R, Ernst E. A systematic review of homoeopathy for the treatment of fibromyalgia. [Review]. Clin Rheumatol. 2010;29(5):457-64.

Porter NS, Jason LA, Boulton A, et al. Alternative medical interventions used in the treatment and management of myalgic encephalomyelitis/chronic fatigue syndrome and fibromyalgia. [Review]. J Altern Complement Med. 2010;16(3):235-49.

Reiter RJ, Acuna-Castroviejo D, Tan DX. Melatonin therapy in fibromyalgia. Curr Pain Headache Rep. 2007;11(5):339-42.

Schmidt S, Grossman P, Schwarzer B, et al. Treating fibromyalgia with mindfulness-based stress reduction: results from a 3-armed randomized controlled trial. Pain. 2011;152(2):361-9.

Staud R. Treatment of fibromyalgia and its symptoms. Expert Opin Pharmacother. 2007;8(11):1629-42.

Targino RA, Imamura M, Kaziyama HH, et al. A randomized controlled trial of acupuncture added to usual treatment for fibromyalgia. J Rehabil Med. 2008;40(7):582-8.

Terhorst L, Schneider MJ, Kim KH, et al. Complementary and alternative medicine in the treatment of pain in fibromyalgia: a systematic review of randomized controlled trials. [Review]. J Manipulative Physiol Ther. 2011;34(7):483-96.

Terry R, Perry R, Ernst E. An overview of systematic reviews of complementary and alternative medicine for fibromyalgia. Clin Rheumatol. 2012;31(1):55-66.

Vas J, Modesto M, Aguilar I, et al. Effects of acupuncture on patients with fibromyalgia: study protocol of a multicentre randomized controlled trial. Trials. 2011;12:59.

Wang C. Tai chi and rheumatic diseases. [Review]. Rheum Dis Clin North Am. 2011;37(1):19-32.

Wepner F, Scheuer R, Schuetz-Wieser B, et al. Effects of vitamin D on patients with fibromyalgia syndrome: a randomized placebo-controlled trial. Pain. 2014;155(2):261-8.

Wierwille L. Fibromyalgia: diagnosing and managing a complex syndrome. J Am Acad Nurse Pract. 2012;24(4):184-92.

Zoppi M, Maresca M. Symptoms accompanying fibromyalgia. Reumatismo. 2008;60(3):217-20.