If you’re experiencing fibromyalgia symptoms, you may feel like you’ll try anything to get relief. You may have tried lots of recommendations but can’t pinpoint what helps.
The difficulty with fibromyalgia symptoms is that they can vary from day to day, as if you’re turning a volume control knob up or down. At one point in time, the pain might not be so bad, but when that volume dial turns up, the fibromyalgia pain can become intense. This has probably left you thinking, what can I turn to during these flareups that actually helps?
In this post, we’re separating fact from fiction. We’ll look at common remedies and the clinical evidence behind them to see what helps fibromyalgia pain, so you can be aware of how to help the pain when symptoms arise.
A Note on Multimodal Treatment for Fibromyalgia
In a broad sense, research suggests that both medications and non-medication techniques (such as psychological therapy, exercise and diet) may help with fibromyalgia pain. However, there is no single most effective treatment for fibromyalgia. The things that help with fibromyalgia pain and flare-ups vary from person to person.
Instead of isolated techniques and treatments to help with fibromyalgia, research reviewing multiple studies shows that a multidisciplinary or “multimodal” approach works best. This simply means combining different approaches and disciplines to help with a problem. So, if you’re left scratching your head about fibromyalgia help, the evidence tells us a combination of treatments is often best.
Now, let’s look at some of the elements that may help with fibromyalgia pain as part of a treatment plan.
Movement
Evidence: Strong
You may have been recommended exercise by a doctor; while the word “exercise” can be triggering when you’re experiencing chronic pain, movement in general is recommended for fibromyalgia treatment, and there’s a wide base of research that backs it up.
A recent research paper reviewed 18 different randomized controlled trials (which tend to be the ‘gold standard’ within research) that looked at the effects between movement and fibromyalgia. They found aerobic exercise, stretching, and resistance exercises all decreased pain perception in individuals with fibromyalgia and improved quality of life. Another paper concluded that aerobic activity and strength training helped reduce fibromyalgia symptoms.
It can be scary to think about movement when you’re in pain, and these papers also identified recommendations for those who are concerned about getting started with movement. If you’re going to take part in aerobic exercise, the papers suggest starting below your actual capacity and then gradually increasing this to moderate intensity. This can help ensure you don’t make your fibromyalgia symptoms worse when initially exercising. The goal would be to, over time, try and get to 30-60 minutes of activity per day.
For stretching, starting once or twice a week in pain-free muscle groups is shown to be beneficial. You can then build up the frequency of stretches each week, up to five times per week.
Body Work, Massage & Acupuncture
Evidence: Moderate
Does massage help fibromyalgia? The short answer is, it may help. The clinical evidence suggests that massage therapy and body work like Swedish massage or connective tissue massage, for five weeks or more, can reduce pain, anxiety and depression in fibromyalgia.
Keep in mind, though, that there aren’t many studies exploring this link between massages and fibromyalgia. If you do get a massage, be open with the massage therapist about your sensitivity to pain, so they’re aware too and it can help adjust their treatment or support you as needed.
Acupuncture is another growing area of research for fibromyalgia treatment. Acupuncture has been found to improve pain severity, quality of life and sleep in individuals with fibromyalgia. But, many of the clinical studies within this area tend to be low- to medium-quality, meaning the research may have been conducted poorly. There are also studies which don’t show any effect of acupuncture on fibromyalgia, so take this recommendation with a pinch of salt.
Diet
Evidence: Low
Tracking your diet and seeing how it affects your fibromyalgia symptoms can be a good idea. Studies have shown that foods like sugar, refined carbs, and fried foods can make symptoms worse.
You might be thinking: Are there any foods that help fibromyalgia? Unfortunately, because diet-related studies are difficult to run due to many competing factors, the evidence base is mixed. A small study found a ‘raw vegetarian’ diet such as consuming lots of fresh fruit, vegetables, whole grains and seeds has been shown to help some people with fibromyalgia, but with a low sample size, it’s hard to extend the results to a recommendation.
If you’re interested in seeing the impact of diet on fibromyalgia, a good place to start is to track the foods you eat to see if they impact your symptoms. Always talk to a dietitian or healthcare professional before making major dietary changes, or for personalized advice.
Heat Therapy
Evidence: Moderate (with more research underway)
Heat has been shown to be effective in reducing pain in fibromyalgia. For example, exposing the body to heat through the use of the sauna can be effective in decreasing pain and fibromyalgia symptoms, with the positive effects being sustained for six months. However, this study also involved people doing underwater physical exercises, which may have helped with alleviating pain.
Why would heat therapy help fibromyalgia? Heat can help the body relax and improve blood flow to muscles and affected areas, which ultimately may reduce pain. People with fibromyalgia regularly report that heat treatments like hot baths or heating pads are some of the most effective ways for managing pain; in a survey of over 2,500 people with fibro, heat was the second-most effective self-reported treatment, after rest and before prescription medications.
However, more clinical research is necessary to give this recommendation more of an evidence base. A trial run by Dr. Andrea Chadwick has recently been completed to assess the impact of heat in a research setting and the results will soon be published.
CBD
Evidence: Moderate (with more research needed)
CBD treatments are becoming more accessible due to legalization (as long as the CBD comes from hemp). Therefore, there is a growing interest in CBD and the benefits it may have. So, does CBD help fibromyalgia?
There is growing evidence supporting the role of CBD in managing fibromyalgia pain and symptoms. One recent study found CBD resulted in significant reductions in widespread pain in individuals with fibromyalgia. But, it’s important to say that just under 50% of the people in this study stopped taking CBD because of side effects such as mental confusion, nausea and dizziness.
A 2020 research paper which reviewed multiple studies on CBD and fibromyalgia pain and other outcomes concluded that although there is evidence to support the use of CBD in reducing pain and improving quality of life in people with fibromyalgia, the clinical evidence level is still not high. This simply means that there is not enough research out there yet to show a clear link, and the quality of this research is often poor.
FDA-Approved Medications
Evidence: Moderate (with side effects)
We’ve spoken a lot about different treatments but what about medication itself? The FDA has approved three main medications for fibromyalgia:
- Duloxetine
- Milnacipran
- Pregabalin
Duloxetine and milnacipran are antidepressant medications. They both work by blocking the removal of two key chemical messengers, serotonin and norepinephrine, increasing the amount of them in the central nervous system, which can help reduce pain.
Pregabalin is an anti-epileptic medication. Pregabalin helps prevent sensitive nerves from sending many pain signals to the brain. If there are fewer pain signals sent to the brain, this can ultimately help reduce pain.
A review in 2014 found the efficacy for these medications for fibromyalgia to be ‘modest’. From reviewing studies, only a minority of individuals taking these medications reported benefits and many stopped their medication due to side effects and a lack of efficacy. However, a 2017 review found eight studies supported the use of pregabalin for the treatment of fibromyalgia as it had superior pain relief when compared to placebo. Also, a 2018 review exploring duloxetine and milnacipran found they do not provide clinically relevant benefits over placebo in the frequency of pain relief of 50% or greater. Therefore, the evidence for these medications is mixed.
There are also common side effects that can occur from these medications including dry mouth, dizziness, feeling sleepy, and more.
Always speak to a doctor before taking or stopping any medication and if you need support with coping with side effects.
Cognitive Behavioral Therapy
Evidence: Strong
Cognitive behavioral therapy (CBT) is a psychological treatment which is based on the idea that our thoughts, feelings, physical sensations and behaviors are interconnected. CBT suggests the way we interpret events around us can have a negative impact, and can create distress and even affect physical functioning.
It’s important to note that using techniques like CBT doesn’t mean that the pain is “all in your head.” Instead, understanding the connection between thoughts, feelings, physical sensations and behaviors can demonstrably help manage symptoms. When someone is experiencing chronic widespread pain, which can increase in intensity, it’s completely natural to have difficult, upsetting thoughts such as “My pain will never get better” or “I can’t do the things I enjoy”. It’s the actual experience of this pain which can result in these thoughts, which naturally will make anyone feel low (feelings), can make the pain worse (physical sensations) and can make you not want to do anything (behaviors).
CBT tries to explore the actual feeling of pain and to connect what difficult thoughts, feelings and behaviors can arise from it. By doing so, it can help people develop alternative thoughts to impact the way they feel and their actions, with the overall goal to improve quality of life. This is the ‘cognitive’ aspect of CBT.
CBT has many behavioral interventions that can help with fibromyalgia such as learning helpful relaxation techniques, mindfulness exercises, graded activation (which could involve gradually increasing your activity levels whilst managing the pain you experience) and more. The idea with CBT is that you will learn a variety of skills and techniques to help you make more meaningful changes in your life to help with fibromyalgia.
Research reviewing a variety of studies on CBT’s effect on fibromyalgia found it to be effective in reducing pain, negative mood and disability. CBT has been found to be effective long term by reducing visits to the doctor for pain. It has also been found to have an improvement in mood, anxiety, sleep quality, exercise quality and improved mental and physical functioning.
Acceptance and Commitment Therapy
Acceptance and Commitment Therapy (ACT) is another type of psychological treatment which is known as a ‘third wave’ CBT model. Its idea is that we don’t need to “fix” or “change” our negative thoughts and emotions. Instead, it encourages acceptance of and moving towards our hardships. By doing so, it promotes psychological flexibility which can help stop people avoid their negative thoughts and emotions.
ACT may help with fibromyalgia pain because it can help people accept and live with their pain and by learning to live alongside it, it reduces the control pain exerts over one’s life. It can enable you to realize that you can still function and don’t have to be afraid of your pain and other symptoms.
Clinical evidence for ACT is building quickly. Studies have shown that ACT for fibromyalgia can result in reduced pain, depression, anxiety and can minimize the impact fibromyalgia has on one’s life. ACT has also shown to be effective when being delivered digitally, like through apps or online.
Getting Help for Fibromyalgia Pain
There are a variety of methods and techniques that can help with your fibromyalgia pain, and using a multidisciplinary approach of perhaps medications, psychological treatment and other holistic techniques such as exercise and movement can help.
If you’re looking to get help for your fibromyalgia pain, it can be best to start by consulting with your doctor to talk through the options. You can bring these ideas to your doctor and see what their recommendations are.
Wondering what doctors treat fibromyalgia? Here’s a list.
Medically Reviewed by Dr. Andrea Chadwick, Medical Director, Swing Care
