The Best Ways to Treat Fibromyalgia

Medically Reviewed

Imagine being told that the pain and tenderness you’re feeling throughout your body is all in your head.

That’s what many people with fibromyalgia were told by their doctors for years, until just a few decades ago when the medical community finally began recognizing fibromyalgia as a “real,” chronic condition. Today, new medications specifically approved for fibromyalgia are available.

Fibromyalgia explained

Although not considered a disease, fibromyalgia is a syndrome—a cluster of medical signs, symptoms, and problems that have no identifiable cause—and diagnosing it can be difficult. No test exists that can diagnose fibromyalgia, so doctors evaluate symptoms and rule out other conditions with similar symptoms.

The hallmark symptoms of fibromyalgia are multiple tender-to-the-touch spots (called tender points); persistent fatigue; and pain in the muscles, tendons, and ligaments. These symptoms can be accompanied by depression, anxiety, sleep disturbances, irritable bowel syndrome, headaches, difficulty concentrating, and memory problems (“fibro fog”).

Fibromyalgia overwhelmingly affects women. The condition is chronic but not progressive or life-threatening, nor will it cause inflammation, damage, or deformity to joints, muscles, and other tissues.

Researchers don’t know what causes fibromyalgia, but tests have found that people with the condition have overly sensitive pain receptors in the brain. Their brains also contain high levels of neurotransmitters that conduct pain signals.

No single treatment is right for everyone. Treatment can involve a combination of lifestyle measures, behavioral therapy, counseling, and drug therapy, with a goal toward relieving symptoms and learning how to cope with the condition. Your doctor will consider:

Your specific symptoms and whether they’re mild, moderate, or severe

Your tolerance for certain drugs and physical activities

Your age, health history, and other coexisting conditions or illnesses

Your expectations for the course of the condition

Studies have found that a major factor in successfully managing fibromyalgia is a patient’s attitude toward the condition. People who make an effort to understand their condition, take an active role in managing symptoms, and don’t “catastrophize” it tend to feel better. Cognitive behavioral therapy—which focuses on how patterns of thinking affect feelings and behavior—can teach you methods for dealing with the frustrations of living with fibromyalgia.

Drug therapy

Three drugs are approved to treat fibromyalgia:

• Pregabalin (Lyrica) is an anticonvulsant that alters neurotransmitter levels in the brain and helps relieve pain and improve sleep. Common side effects include dizziness, drowsiness, weight gain, and swollen lower legs.

• Duloxetine (Cymbalta) is a neuropathic drug that helps relieve pain and fatigue and improve well-being by elevating certain brain chemicals. It’s commonly used to treat chronic nerve pain, anxiety, and depression. Although up to 50 percent of people with fibromyalgia suffer from depression when they’re diagnosed, you don’t have to be depressed to benefit from duloxetine. Common side effects are nausea and dizziness.

• Milnacipran (Savella) is similar to duloxetine but approved only for fibromyalgia.

Your doctor may also prescribe pain relievers like acetaminophen, other antidepressants, sleep medications, muscle relaxants, anti-anxiety agents, antiseizure drugs, and drugs to control headaches.

Physical activity

Regular aerobic exercise—at least 30 minutes three times a week—is essential to easing fibromyalgia symptoms. Most people with fibromyalgia find it difficult to be physically active—muscle pain and fatigue may seem to worsen as you begin. But sticking with it will eventually improve symptoms.

Studies have shown fast walking, swimming, water aerobics, and biking to be the most effective activities. Muscle-strengthening and flexibility exercises can help, too. Consider working with a physical therapist to develop a program tailored to your symptoms.

The slower, softer movements of mind-body exercises like yoga, tai chi, and qigong may help provide long-term benefits. A recent clinical trial found that patients who practiced qigong, which emphasizes relaxed movements, mental focus, and controlled breathing, saw significant improvements in pain, sleep, fatigue, depression, and other physical and mental functions.