Patient information from BMJ

Fibromyalgia: what treatments work?

Last published:Sep 29, 2022

We all get aches and pains from time to time. But if you have long-term widespread pain across your whole body, you may have a condition called fibromyalgia.

There is no cure for fibromyalgia but there are treatments that can help you cope. With treatment, most people find that their symptoms improve over time. 

Various treatments can help with fibromyalgia. These include:

• Medicines to help with pain

• Gentle exercise

• Learning how to improve your sleep

• A talking treatment called cognitive behaviour therapy, and

• A combinations of some or all of these things.

We’ve described some of the common treatments below. You can use this information to talk to your doctor about what may be best for you.

The most important thing you can do is to learn all that you can about fibromyalgia. The more you know, the better you will be able to manage your symptoms. Your doctor should be able to help you find support groups, charities, and sources of information where you live.

To learn more about the signs and symptoms of fibromyalgia, see our leaflet Fibromyalgia: what is it?

Things you can do for yourself

Exercise may be the last thing you feel like doing. But gentle aerobic exercise, such as walking or exercising in a warm swimming pool, can help you feel better overall. Exercise may also make you fitter, which may help you feel better. And it can also help you to sleep better.

Your doctor should be able to advise you how to exercise in the safest and most helpful way. Or they may refer you to a physiotherapist, who can help you to find the best approach for you.

Better sleep quality could help you feel better. For example, it can help you feel less tired, which may reduce your pain. 

There are several other ways to improve your sleep quality:

• Go to bed at the same time every day, so that your body gets into the habit of regular sleep

• Avoid napping during the daytime

• Make sure your bedroom is cool, comfortable, dark, and quiet

• Get out of bed if you can’t fall asleep or you’re not tired

• Only go to bed to sleep or have sex, not to watch television or to use a tablet or smart phone

• Don’t eat, drink, or exercise just before you go to bed

• Avoid drinking caffeine late in the day

• Don’t drink too much alcohol. It may help you get to sleep, but you’ll probably wake up again and your sleep quality won’t be as good.

Talking treatments

A treatment called cognitive behaviour therapy (CBT) aims to help you feel more positive about life, and to give you new ways of coping with your condition. If you have CBT you meet a therapist regularly to talk about your outlook on life and help you change negative ways of thinking.

Talking treatments are usually medium- to long-term treatments. And if they work for you, you can try them again, even after a break.

Many people wonder whether a talking treatment can really make a difference to physical symptoms like pain. But research suggests that CBT can help people with fibromyalgia to:

• Feel less tired

• Feel more positive about life, and

• Get on with life (for example, have a social life, enjoy hobbies, or get back to work).

We don’t know exactly how it works. But CBT seems to help some people with fibromyalgia to sleep better. Better sleep can help you to feel less tired, which may help to reduce your pain. 

Medicines

There are several medicines used to reduce fibromyalgia pain and to help people sleep. You may need to try several treatments before you find one that helps you.

For example, antidepressant medicines are usually used to treat conditions such as depression and anxiety. But doctors are learning more about the part they can play in relieving pain. They may also help you to sleep better.

Like all medicines, antidepressants can cause side effects, including dizziness and drowsiness. Ask your doctor about side effects when you’re deciding on treatment.

Medicines called gabapentinoids, which are usually used to help people with epilepsy, can also help some people with fibromyalgia, by calming down the nervous system. These medicines can cause side effects in some people, including dizziness, sleepiness, and weight gain.

Unfortunately, commonly used painkillers such as paracetamol, aspirin, and ibuprofen are not helpful for fibromyalgia symptoms. 

Alternative treatments

Biofeedback is a technique to help you feel in control of your body. It uses electrical monitoring equipment to demonstrate how fast your heart is beating (heart rate variability biofeedback) or how tense your muscles are (electromyograph biofeedback).

The monitoring equipment makes beeps, or flashes lights, to show how much electrical activity it’s picking up.

You learn to control your heart rate or relax your muscles through breathing and relaxation exercises. When you do this, the beeps or lights get slower or quieter, so you can see what effect you are having on your heart or muscles.

Treatments that combine exercise and relaxation, such as yoga and T'ai Chi, can also help with fibromyalgia symptoms.