According to an article compiling the results of 49 studies, the optimal treatment of fibromyalgia integrates non-pharmacological treatments (especially exercise and cognitive behavioral therapy) with the usual medication, which helps you sleep better and relieve pain⁵. Increasingly, some of these approaches are being taught in rehabilitation schools for people with fibromyalgia. According to a meta-analysis published in 2010, cognitive behavioral therapy is the most effective psychological approach to reduce pain. Relaxation techniques and biofeedback are particularly effective against sleep disorders associated with the disease.⁶⁵.

 “Body-mind” approaches or mindbody

Among the complementary treatments, body-mind approaches (such as biofeedback, hypnotherapy, relaxation with mental imagery, etc.) are the most used by people with fibromyalgia – more than acupuncture and manipulative therapy. , such as massage therapy and chiropractic¹¹. According to proponents of these approaches, body and mind are two inseparable aspects of one and the same reality, rather than separate, interrelated elements. See our Body-Mind Approaches fact sheet for more information.

According to the results of a meta-analysis of 802 people with fibromyalgia, body-mind approaches help tolearn to live better with the disease, despite its impact¹². This aspect should not be neglected since the way of envisioning the future would have direct consequences on the perception of pain and involvement in the therapeutic strategy.

Here are some approaches that have been studied.

Cognitive-behavioral therapy. It is non-drug therapy, with aerobic, most recommended by the different fibromyalgia guidelines^23,67. This individual psychotherapy aims to help people to better know and understand their disease, and to better manage their states of anxiety, their emotions and their pains. One of the goals is to replace negative thoughts and perceptions, which can make symptoms worse, with more positive ones. It may require certain changes in daily life. In 2010, a meta-analysis of 14 trials and more than 900 people with fibromyalgia confirmed the usefulness of cognitive and behavioral therapy to improve pain management and reduce depressive disorders.¹⁷.

biofeedback. The goal of biofeedback is to learn how to control muscle tension or a respiratory rate using devices that make these physiological parameters visible. A review of the scientific literature mentions that biofeedback can bring positive results in case of fibromyalgia⁵⁷. Several trials report an increase in physical activity, some reduction in morning stiffness, a decrease in the number of tender points associated with fibromyalgia and certain other symptoms, such as pain and psychological distress.^13,14,66.

Hypnotherapy. In a controlled study¹⁵ The effectiveness of hypnotherapy was compared to that of massage, which was combined with the learning of a muscle relaxation technique, in 40 people whose fibromyalgia had resisted medical treatment. People in the group treated with hypnotherapy saw their general condition improve much more than those in the other group, particularly with regard to morning fatigue, the muscle aches and the quality of sleep. Hypnotherapy seems even more effective when combined with cognitive behavioral psychotherapy¹⁶.

Relaxation techniques. Several clinical trials have shown the effectiveness of relaxation in reducing pain associated with fibromyalgia⁶⁷. Effective techniques include mindfulness meditation, autogenic training, visualization and mental imagery, and progressive muscle relaxation which relaxes muscles all over the body and prevents muscle tension.

 balneotherapy. Several studies have evaluated the value of balneotherapy (spa) in people with fibromylagia⁶⁷. A recent review analyzing 10 studies shows that balneotherapy is effective in reducing diffuse pain And the number of points painful²². See the hydrotherapy sheet.

 5-HTP (5-hydroxytryptophane). 5-HTP is a precursor to serotonin in the brain. It is mostly used to treat depression, but it may also provide relief for people with fibromyalgia, as several studies in the 1990s suggested.^33,34,35. In 1998, a review of studies highlighted the link between low serotonin levels and fibromyalgia, which could explain the beneficial action of 5-HTP³⁶. However, this has not been confirmed since.

Dosage

A total of 300 mg per day, taken in 3 doses of 100 mg.

Notes. The use of 5-HTP for self-medication is controversial. See our file on this subject.

 Sound resonance intervention technique. This technique, also called the Psycho Physio method, consists of using vibro-acoustic stimulation to stimulate the recall of memories possibly linked to psychological trauma. These past traumas may have created neurological and behavioral imprints that lead to fibromyalgia. Sensory stimulation is accompanied by psychotherapeutic follow-up. Preliminary study indicates that this technique improves symptoms in 90% of cases⁵⁶. However, this treatment costs between $ 4 and $ 000 and is not available everywhere. For more information, see the blog Fibromyalgia outside the box.

 Acupuncture. Clinical trials published before the year 2000 suggest that acupuncture may relieve symptoms fibromyalgia. However, their methodological quality leaves much to be desired.^27,28. Between 2005 and 2006, 5 new tests were carried out^29-32 , giving contradictory results (3 positive and 2 negative studies). Among these studies, the 2 which have the best methodology show an effectiveness of acupuncture with a follow-up at 6 months⁶⁰. However, other trials would be necessary to conclude that there is real efficacy against fibromyalgia.

 Cayenne (Capsicum frutescens). Creams, lotions or ointments containing capsaicin, the active compound in cayenne, have been shown to be effective in relieving rheumatic pain. Furthermore, Commission E recognizes the external use of cayenne to relieve muscle pain in the shoulders, arms and spine. The effect of capsaicin preparations in people with fibromyalgia is not yet well known and the evidence for its effectiveness remains insufficient.³⁷. A preliminary study involving 45 subjects aged 18 to 70 years, however, showed that the application of a cream (concentrated at 0,025% in capsaicin), 4 times a day, relieved the muscle tension more effectively than a placebo⁴³. Capsaicin would exert its pain-relieving effect by depleting the reserves of substance P.

 Chiropractic. Several studies in a small number of patients have evaluated the effect of chiropractic on fibromyalgia⁶⁷. In one of them, carried out in 2000, a reduction in the intensity of pain and an improvement in quality of sleep and the degree of fatigue were observed after 30 chiropractic sessions²⁵. However, other trials have found no benefit⁶⁹. A meta-analysis conducted in 2009 lamented the poor quality of the studies and found insufficient evidence to conclude that chiropractic was effective in fibromyalgia pain.²⁴.

 Massage therapy. Although many people with fibromyalgia use massage therapy, very few studies have been done to assess its effects.^18,19. According to a review of randomized clinical trials published in 2003¹⁹, a massage can be very painful for a person with fibromyalgia, but could reduce the pain in the medium term. A summary of studies published in 2010 underlines the poor methodological quality of the studies and specifies that the scientific evidence on the effectiveness of messages on pain related to fibromyalgia remains insufficient.²⁰. The authors stress that massages should not be painful.

 SAM-e (S-adenosylmethionine). Mainly used for the treatment of depression and osteoarthritis, SAM-e may be of benefit in fibromyalgia. In 4 trials evaluating the efficacy of SAM-e given by intravenous injection rather than orally, the product resulted in greater symptom reduction than placebo in 3 of the 4 trials³⁸. However, the quality of these trials is questionable and there is no convincing evidence to recommend this supplement.³⁷.

 Tai-chi. In 2010, a study of 66 people with fibromyalgia showed that tai chi would improve symptom management and increase quality of life.¹⁰. The randomized trial was conducted over 12 weeks.

 Vegetarianism. A vegetarian diet could help reduce pain muscle as well as stiffness to the joints, as indicated by the results of 3 studies^44-46 . So far, the effect of this diet has been tested on a small number of subjects. The longest study lasted 7 months. Note that another study concluded that vegetarianism had no noticeable effect on this disease.⁴⁷. The authors of a review published in 2010 suggest that the possibly beneficial effects of vegetarianism are linked to the increased intake of antioxidants, but also to better weight control.²¹. Many fibromyalgia patients are indeed overweight, which worsens the pain.

 Chinese Pharmacopoeia. Le Xiao Yao Wan Said “Free Walk Powder” is used in Traditional Chinese Medicine to relieve fibromyalgia pain. See our sheet on this product in the Chinese Pharmacopoeia section.

 Dietary recommendations. Some experts say fibromyalgia symptoms could be made worse by unhealthy eating⁴⁰. Here are the recommendations of D^r Andrew Weil, renowned physician and naturopath⁵³ :

• Eliminate hydrogenated vegetable oils from your diet (such as shortening and some margarines that remain solid at room temperature) and foods with high trans fatty acid content (such as fried foods, pastries and cookies).
• Increase your intake of omega-3 fatty acids, a fatty acid essential for the proper functioning of the body, which collaborates in anti-inflammatory reactions. Seeds and flaxseed oil and fish oils (found in wild fatty fish like mackerel and salmon) are important sources.
• Eat enough fruits and vegetables (5 to 10 servings, according to Canada’s Food Guide).
• Incorporate more ginger and turmeric into your meals.

It seems that the fibromyalgia is accompanied by an excess of free radicals, wastes produced by the body when it burns nutrients for energy^49-51 . A surplus of free radicals (or a lack of antioxidants, which fight them) could therefore play a role in the pathophysiology of the disease. This is why it would be particularly important to consume foods rich in antioxidants, such as fruits and vegetables.

Finally, another renowned naturopath, JE Pizzorno, believes that it is important to ensure that the diet does not cause strong variations in blood sugar.⁵². According to him, marked deviations from the normal increase the sensitivity to pain. For advice on how to better control your blood sugar, see our Customized Diet: Diabetes, Customized Diet: Hypoglycemia and Customized Diet: Glucose Intolerance fact sheets. See also Glycemic Index and Glycemic Load.