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Fibromyalgia Basics

Nondrug Treatments

Even if you are taking two to four different medications to treat your fibromyalgia symptoms, they won’t provide enough relief or the side effects will be intolerable. You need to consider other options to get your fibromyalgia under control. Therapies that specifically target your tight, knotted muscles (trigger points) are addressed in Muscle Pain Relief, while this section addresses other nondrug treatments.

Massage: Patients rate professional massage as their top nondrug therapy for treating the discomfort of fibromyalgia. You need to find a therapist who has experience with treating this condition. The first session should only be 30 minutes long with low to medium pressure applied to the neck, shoulder, and upper back regions. Once you know how you respond, your therapist can slowly increase the pressure, if needed.

Theoretically, massage should reduce muscle tension and improve blood flow (which is impaired in fibromyalgia). This can lead to the release of pain-sensitizing chemicals that are trapped in your knotted muscles. For best results, drink plenty of water after your massage to flush out the chemicals. If you notice increased pain following the session, take a hot show or bath to soothe sore muscles.

Massage relieves pain, anxiety and depression in people with fibromyalgia, while promoting better quality sleep, according to multiple studies.1 You should have a massage one to two times per week, and you will usually notice improvements within a week or two. Cost can be a limiting factor with massage therapy. If you find a therapist who will give you a 15-minute session for a reduced rate, give it a try. A hand-held massager, as well as a significant other, may help too.

Heat Wraps: Heat relaxes the muscles and relieves pain, so it is no surprise that this nondrug treatment is highly endorsed by fibromyalgia patients. You can make a microwaveable heat wrap by filling up a large sock with rice (not the instant type) and tying off the end. Or you can purchase a Bed Buddy Neck and Shoulder wrap from Amazon for $30. Although a hot bath or shower may help with pain, the advantage of heat wraps is that they can be used throughout your day.

Heat may be soothing to the area it’s applied, but you have pain everywhere and you can’t live in a hot tub. If you are curious whether a heat wrap applied to your most painful area can tone down your body-wide pain and help with sleep, read more.

Spa Therapy or Balneotherapy: A prescription for three to four weeks of spa therapy is common for painful disorders in many European countries. Balneotherapy is a form of spa treatment that makes use of natural mineral waters, such as the Dead Sea, and both approaches have shown favorable results in people with fibromyalgia.

Full-body submersion in warm water (often with minerals) is much more effective than applying a heat wrap to one area. In fact, the rapid ability of daily spa therapy to cut pain levels in half enables clinicians to add exercise to each session without increasing the pain. Other aspects of these programs may include mud packs, massage, and education about fibromyalgia … but the key seems to be the application of whole-body heat. Why? Because these “add-on” approaches are not as effective when performed as a solo treatment.

If you are concerned that you don’t have the money for a hot tub with jets, don’t be. A study in fibromyalgia patients showed that the fancy jets were not nearly as important for pain as simply submersing the body in warm water. In fact, the researchers found that the warm water reduced the strain on chest wall muscles to significantly improve lung function. If you feel out of breadth all the time, read more.

Most patients achieve significant improvements in function and fatigue, in addition to the reductions in pain. Better yet, the benefits tend to last up to six months after the last spa session. If you are curious about how spa therapy works and steps you can take to set up a “do it yourself” spa therapy home program, read more.

Acupuncture: This alternative therapy involves the insertion of tiny needles into specific locations to improve the body’s energy flow. Using Traditional Chinese Medicine protocol involving 12 acupuncture points, fibromyalgia patients will generally see a significant improvement in pain, function, and fatigue.2 Acupuncture appears to have a systemic impact because body regions that are not treated with needles still show a reduction in pain.

There are many theories about how and why acupuncture relieves the symptoms of fibromyalgia. For starters, it raises the blood levels of pain-relieving substances while it reduces the levels of those that amplify pain. In addition, brain imaging shows it may work by improving the pain control system in the brain.

It takes about eight weekly, 30-minute treatment sessions to reap a 40 percent reduction in pain.3 Treatments can be halted for three-month periods to save money, but pain relief will drop in half. If you are interested in trying acupuncture, read more.

Transcutaneous Electrical Nerve Stimulation (TENS): Small hand-held TENS units deliver an electrical current through electrode pads attached to the skin (a mild adhesive is used). The electrical current is supposed to stimulate the nerves beneath the skin to increase endorphin (e.g., opioid) production to relieve pain. Cost is $40 to $80. The pads can be reused several times and new ones are inexpensive.

Roughly four out of ten fibromyalgia patients will respond favorably to TENS with a 30 percent drop in their overall pain levels.4 The unit shown is an Auvon Dual Channel, it’s rated well and costs only $40. If you are interested in giving TENS a try, read more

Occupational Therapy (OT): How you move your body will impact your pain and fatigue levels. It’s easy to fall prey to using the same set of muscles for doing tasks, but this over-taxes them and leads to more pain. An occupational therapist (OT) can teach you how to move more ergonomically without straining your muscles. They can also help you identify ways to conserve energy so that you don’t feel drained before noon!

This type of nondrug intervention requires only a few visits to a therapist. If your insurance company does not cover OT, they may foot the bill for a few sessions to a physical therapist (PT) who may also be able to help in this area. If insurance coverage is not an option, many OTs and PTs will give a significant discount if you pay with cash.  

Not convinced that OT can benefit you? Research shows that when fibromyalgia patients repeatedly contracted their shoulder muscles, it led to increased pain in the legs as well as the shoulders. Read more to understand why. In a separate study, fibromyalgia patients were asked to lift a few light-weight canisters. The repetitive action led to enhanced body-wide pain. Read more.

Cognitive Behavioral Therapy (CBT): Behavioral therapy implies you need to change your ways or that you are intentionally doing something to cause your symptoms. Not true! A better term would be Pain and Stress Management, because the end goal is to get a handle on your pain and identify stressors that make you feel worse. Admittedly, CBT is a lousy term but this form of therapy can provide meaningful reductions in your symptoms that remain after you have graduated from CBT school.

Much of what goes wrong in fibromyalgia occurs in the brain’s pain processing centers. Brain imaging studies show that stress, anxiety, and depressed mood all feed into these brain centers to magnify your pain and other symptoms. CBT helps you learn ways to minimize the negative impact your emotions and outlook have on your health. Once you master the skills of CBT, the benefits remain. It’s not like a drug that tends to lose effectiveness over time.

How much improvement in pain can you expect from a series of CBT sessions? An analysis of several studies involving CBT treatment in fibromyalgia patients shows the average patient will receive a 10 percent improvement in pain, mood, and function.5 However, some patients will reap greater benefits, while others get less. CBT may work by reducing the body’s stress responses, leading to less interruption of sleep.6 In addition, brain imaging fibromyalgia patients before and after CBT shows improvements in areas that magnify one’s perceptions of pain. So, CBT may not have a significant effect on pain, per se, but you may not be as bothered by the pain.

Five to six weekly sessions, each one hour long, is usually all that is required. Group sessions are ideal because they cut the cost and you can learn from others in the class. The CBT course does not have to be specific for fibromyalgia; the focus can be for people with chronic, painful conditions. Contact organizations and hospitals in your community to ask if they offer CBT classes.

An alternative to in-person therapy would be an online self-help program. The University of Michigan offers a course called PainGuide to help patients learn how to live with fibromyalgia. It’s free, and you can go through it at your own pace. To log onto the site, go to: PainGuide  

  1. Li YH, et al. PLOS One 9(2):e89304, 2014.
  2. Di Carlo M, et al. Evidence-Based CAAM Article ID 9991144, 2021.
  3. Di Carlo M, et al. Clin Exp Rheumatol 41:1254-1261, 2023.
  4. Dailey DL, at al. J Pain 7(7):1268-1281, 2022.
  5. Prados G, et al. Brain Sci 12:947, 2022.
  6. Lee J, et al. Arthritis Rheumatol 76(1):130-140, 2024.