Supported by multiple clinical trials and systematic reviews
Fibromyalgia
Fibromyalgia is a chronic, centralized pain condition characterized by widespread pain, fatigue, nonrestorative sleep, cognitive symptoms (“fibro fog”), and sensory hypersensitivity. Modern understanding emphasizes central sensitization—heightened pain processing in the central nervous system—along with autonomic dysregulation, stress-axis changes, and overlapping conditions (e.g., irritable bowel syndrome, migraine, temporomandibular disorders, and mood and sleep disturbances). Diagnosis is clinical, using validated symptom indices rather than tender-point counts. Management focuses on education, self-management, graded physical activity, psychological therapies, and selected medications. Strong evidence supports aerobic and resistance exercise, cognitive-behavioral therapy (CBT), and mind-body practices. Pharmacotherapy can help a subset of patients but typically yields modest benefits, and guidelines discourage long-term opioid therapy. Eastern and traditional systems frame fibromyalgia through functional patterns. In Traditional Chinese Medicine (TCM), common patterns include qi and blood stagnation, liver qi constraint, spleen qi deficiency, and kidney yang deficiency, often linked with cold, dampness, and stress. Treatment uses acupuncture (including electroacupuncture), moxibustion, cupping, tuina, and individualized herbal formulas. Evidence for acupuncture is moderate, with several trials and reviews showing short- to medium-term improvements in pain and function, particularly with electroacupuncture. Ayurvedic perspectives often attribute symptoms to vata aggravation and ama (metabolic/toxic) accumulation; therapies include Abhyanga (warm oil massage), Swedana (steam/sudation), Shirodhara, Panchakarma detoxification procedures, and adaptogenic herbs such as Ashwagandha. Clinical evidence in fibromyalgia specifically is limited, though some components (e.g., massage, stress reduction, sleep support) have broader supportive data. Mind-body practices bridge
This content is for informational purposes only and does not constitute medical advice. Always consult a qualified healthcare provider before starting, stopping, or changing any supplement or medication regimen.
Western Medicine
Diagnosis
Clinical diagnosis using 2016 revised criteria: generalized pain in at least 4 of 5 regions; symptoms present ≥3 months; Widespread Pain Index (WPI, 0–19) and Symptom Severity Scale (SSS, 0–12) thresholds met; diagnosis can be made irrespective of other conditions if criteria are satisfied (tender-point exam not required).
Treatments
- Patient education and shared decision-making focused on centralized pain and self-management
- Exercise as first-line: graded aerobic training (strong evidence)
- Progressive resistance/strength training 2–3x weekly (strong evidence)
- Flexibility/aquatic exercise as tolerated (moderate evidence)
- Cognitive behavioral therapy for pain, coping, and function (moderate-to-strong evidence)
- Sleep optimization: CBT-I, treatment of OSA/RLS/PLMD, sleep hygiene
- Multicomponent therapy (exercise + psychological ± medication)
- Physical/occupational therapy for pacing, ergonomics, graded activity
- Management of comorbid depression/anxiety, migraine, IBS
- Avoidance of long-term opioids; consider tramadol short-term only if needed
Medications
- Duloxetine (SNRI; FDA-approved)
- Milnacipran (SNRI; FDA-approved)
- Pregabalin (gabapentinoid; FDA-approved)
- Low-dose amitriptyline (off-label)
- Cyclobenzaprine (off-label, low dose at night)
- Gabapentin (off-label)
- Tramadol (conditional, short-term)
- NSAIDs/acetaminophen for comorbid nociceptive pain (limited for core FM symptoms)
Limitations
Effect sizes for medications and single-modality therapies are often modest; heterogeneity of patient phenotypes; adherence challenges for exercise and CBT; access barriers to nonpharmacologic care; limited efficacy of opioids with risk of harm; residual symptoms common, supporting need for multimodal, sustained self-management.
Sources
- Wolfe F et al. 2016 Revisions to the 2010/2011 fibromyalgia diagnostic criteria. Semin Arthritis Rheum. 2016;46(3):319-329.
- EULAR revised recommendations for the management of fibromyalgia. Ann Rheum Dis. 2017;76:318–328.
- Bidonde J et al. Aerobic exercise training for adults with fibromyalgia. Cochrane Database Syst Rev. 2017.
- Busch AJ et al. Resistance exercise training for fibromyalgia. Cochrane Database Syst Rev. 2013.
- Bernardy K et al. Psychological therapies for fibromyalgia in adults. Cochrane Database Syst Rev. 2013/2019 update.
- Skelly AC et al. AHRQ Comparative Effectiveness Review: Noninvasive Nonpharmacologic Treatments for Chronic Pain. 2020.
Eastern & Traditional Medicine
Traditional Chinese Medicine (including acupuncture)
Fibromyalgia is viewed as dysregulation of qi and blood with patterns such as liver qi stagnation, qi and blood stasis causing pain, spleen qi deficiency with dampness, and kidney yang deficiency. Stress, overexertion, and exposure to cold/damp contribute. Treatment aims to move qi and blood, dispel damp/cold, tonify deficiencies, and calm shen.
Techniques
- Acupuncture (manual and electroacupuncture) targeting points for pain modulation and stress regulation
- Moxibustion for cold/damp patterns
- Cupping and tuina (manual therapy) for myofascial tension
- Individualized herbal formulas (e.g., Xiao Yao San variants, Du Huo Ji Sheng Tang, Gui Pi Tang) adjusted to pattern
Tai chi and qigong (meditative movement)
Slow, mindful movement integrating breath and attention modulates autonomic tone, reduces stress reactivity, improves balance and strength, and downregulates central sensitization. Particularly well-suited for graded activity in FM.
Techniques
- Yang-style or Chen-style tai chi, 1–2 sessions/week with home practice (8–24 weeks)
- Qigong sets emphasizing gentle flow and breath regulation
Yoga therapy
Combines postures, breathwork, relaxation, and mindfulness to improve flexibility, strength, interoception, and stress coping. Gentle, modified practices reduce kinesiophobia and enhance self-efficacy.
Techniques
- Gentle hatha/restorative yoga tailored for FM
- Breath regulation (pranayama) and guided relaxation/meditation
- 8–12 week programs with home practice
Mindfulness-based interventions (e.g., MBSR)
Trains nonjudgmental awareness of sensations, thoughts, and emotions, reducing catastrophizing and improving pain acceptance, mood, and sleep—key drivers of centralized pain.
Techniques
- Mindfulness-Based Stress Reduction (8-week group program)
- Mindfulness meditation, body scan, gentle mindful movement
- Ongoing daily practice (e.g., 20–30 minutes)
Sources
- Deare JC et al. Acupuncture for fibromyalgia. Cochrane Database Syst Rev. 2013.
- Zheng Z et al. Acupuncture for fibromyalgia: systematic review and meta-analysis. J Pain. 2019;20(5):473-490.
- Vickers AJ et al. Acupuncture for chronic pain: individual patient data meta-analysis. Arch Intern Med. 2012 (supports analgesic effects across chronic pain conditions).
- Wang C et al. A randomized trial of tai chi for fibromyalgia. N Engl J Med. 2010;363:743–754.
- Wang C et al. Effect of tai chi versus aerobic exercise for fibromyalgia. BMJ. 2018;360:k851.
- Lynch M et al. Qigong as a treatment for fibromyalgia. Arthritis Res Ther. 2012;14(4):R178.
- Carson JW et al. A yoga intervention for fibromyalgia. Pain. 2010;151:530–539.
- Cramer H et al. Yoga for fibromyalgia: systematic review and meta-analysis. Clin Rehabil. 2013;27(5):401–413.
- Skelly AC et al. AHRQ 2020 Review: Noninvasive Nonpharmacologic Treatments for Chronic Pain (includes fibromyalgia; supports MBSR, yoga, tai chi).
- Cash E et al. Mindfulness meditation for fibromyalgia: randomized controlled trial. Ann Behav Med. 2015;49(3):319–330.
- Lauche R et al. Mindfulness- and acceptance-based interventions for chronic pain: systematic reviews/meta-analyses (supporting evidence across centralized pain).
Integrative Perspective
For fibromyalgia, the strongest and most durable benefits arise from multimodal care that targets central sensitization, autonomic dysregulation, sleep, mood, and physical deconditioning together. Combine first-line graded aerobic and resistance exercise with a mind-body program (tai chi has high-quality RCTs; MBSR and yoga have consistent benefits) and add CBT for pain coping and sleep (CBT-I) when available. Use medications as symptom adjuncts rather than stand-alone solutions, prioritizing SNRIs or pregabalin when indicated. Consider a trial of acupuncture—particularly electroacupuncture—for pain and sleep support, recognizing moderate evidence and good safety. TCM or Ayurvedic frameworks can aid individualized lifestyle, diet, and stress management, but herbal/panchakarma components have limited FM-specific evidence and should be integrated cautiously, with attention to quality and interactions. Regular outcome tracking (e.g., FIQR, pain interference, PSQI, PHQ-9/GAD-7) helps tailor the plan. This condition’s biopsychosocial nature makes combined conventional and complementary therapies especially appropriate, aligning with EULAR’s emphasis on nonpharmacologic first-line strategies and stepped, patient-centered care.
Sources
- Wolfe F et al. 2016 Revisions to the 2010/2011 fibromyalgia diagnostic criteria. Semin Arthritis Rheum. 2016;46(3):319-329.
- Macfarlane GJ et al. EULAR revised recommendations for the management of fibromyalgia. Ann Rheum Dis. 2017;76:318–328.
- Bidonde J et al. Aerobic exercise for fibromyalgia. Cochrane Database Syst Rev. 2017.
- Busch AJ et al. Resistance exercise for fibromyalgia. Cochrane Database Syst Rev. 2013.
- Bernardy K et al. Psychological therapies for fibromyalgia. Cochrane Database Syst Rev. 2013/2019.
- Skelly AC et al. AHRQ 2020 Noninvasive Nonpharmacologic Treatments for Chronic Pain.
- Wang C et al. Tai chi for fibromyalgia. N Engl J Med. 2010;363:743–754.
- Wang C et al. Tai chi vs aerobic exercise for fibromyalgia. BMJ. 2018;360:k851.
- Deare JC et al. Acupuncture for fibromyalgia. Cochrane Database Syst Rev. 2013.
- Zheng Z et al. Acupuncture for fibromyalgia: systematic review and meta-analysis. J Pain. 2019.
- Carson JW et al. Yoga of Awareness for fibromyalgia. Pain. 2010;151:530–539.
- Cramer H et al. Yoga for fibromyalgia: systematic review and meta-analysis. Clin Rehabil. 2013.
Health Disclaimer
This content is for informational purposes only and does not constitute medical advice. Always consult a qualified healthcare provider before starting, stopping, or changing any supplement or medication regimen.