Fibromyalgia

What is Fibromyalgia?

Fibromyalgia is a chronic pain disorder marked by widespread musculoskeletal pain, usually with fatigue, cognitive problems and other symptoms. Changes in how the central nervous system processes pain, known as central sensitization, underlie many of its main features.^[1]

Common symptoms

The core symptom is diffuse pain lasting more than three months. It is often accompanied by fatigue, sleep disturbance, problems with thinking and memory, and depression or anxiety.^[1] Fibromyalgia is described as nociplastic pain, with pain more widespread or intense than the tissue findings would predict, along with fatigue, sleep, memory and mood problems.^[2]

Causes and risk factors

The cause is not fully understood. Genetic predisposition, personal experiences, emotional and cognitive factors, and the ability to cope with stress all appear to contribute.^[3] Genetic, environmental and neurobiological factors are involved.^[1]

How it is diagnosed and treated conventionally

Diagnosis is clinical and follows American College of Rheumatology criteria. Routine blood tests and imaging are usually normal and are used mainly to exclude other conditions.^[1]

Treatment combines education, exercise and psychotherapy with medicines such as duloxetine, milnacipran, pregabalin and amitriptyline, which give modest benefit. NSAIDs, acetaminophen and opioids are generally not recommended.^[1] European guidelines give exercise the only strong recommendation, and the size of effect for most treatments is modest.^[4]

Why Fibromyalgia calls for a whole-person approach

Fibromyalgia has no single cause and no single treatment. Reviewers describe many interacting factors in how it develops and persists, which is why a multi-modal approach tailored to the individual is advised.^[3]

Care that also addresses sleep, stress and activity is therefore a reasonable addition to medical treatment. The factors below are the ones most relevant here.

A sensitized nervous system

Brain imaging shows amplified responses to painful stimuli and altered connectivity in people with fibromyalgia.^[1] Nociplastic pain responds less to treatments aimed at tissue, such as anti-inflammatory drugs, opioids, surgery or injections.^[2]

Sleep

Pain can disturb sleep, and poor sleep can amplify pain. A review describes this two-way link and proposes several biological systems that may be involved.^[5] Better sleep is a sensible goal of care.

Stress and mood

Emotional and cognitive factors and the way a person copes with stress are thought to influence fibromyalgia.^[3] Depression and anxiety are common alongside it.^[1]

Movement and exercise

Exercise is the best-supported therapy in European guidelines.^[4] An overview of Cochrane reviews found that exercise may improve pain and function in chronic pain conditions including fibromyalgia, mostly with small to moderate effects.^[6]

Acupuncture for Fibromyalgia

What the research shows

The evidence for acupuncture in fibromyalgia is mixed. Some trials and reviews are positive, while others find that its effect cannot be clearly told apart from sham needling.

A 2013 Cochrane review of nine trials (395 people) found low to moderate evidence that acupuncture improved pain and stiffness compared with no treatment or standard therapy. It also found moderate evidence that acupuncture did not differ from sham acupuncture for pain, fatigue, sleep or well-being, though electroacupuncture looked better than manual acupuncture. Effects lasted about one month and were not maintained at six months.^[7] A 2010 meta-analysis of seven trials found a small pain-relieving effect that could not be clearly distinguished from bias, and did not recommend acupuncture.^[8]

More recent work is more favorable. A 2022 review of 25 trials found that acupuncture and dry needling reduced pain, fatigue, sleep problems and disability in the short term, with long-term effects still uncertain.^[9] A 2025 Chinese guideline recommended acupuncture and health education as core therapies on the basis of moderate-quality evidence.^[10]

Individual trials point in the same direction. In a trial of 164 people in Spanish primary care, 10 weekly sessions of individualized acupuncture cut pain by about 41 percent, compared with 27 percent for sham, and the difference was still present at 12 months.^[11] A small trial of 30 women found that group acupuncture improved symptom impact, pain and fatigue more than group education.^[12] In a sham-controlled trial of 76 people, pain fell with electroacupuncture and with sham laser alike, which illustrates how large the non-specific response can be.^[13]

How acupuncture may work

Researchers suggest that acupuncture acts through the nervous system, modulating the body's opioid, serotonin and stress-hormone systems.^[14] In the electroacupuncture trial above, people who had less temporal summation, a measure of pain amplification, at the start tended to improve more.^[13] These are proposed explanations, not settled facts.

What treatment involves

Treatment uses fine, sterile, single-use needles, usually left in place for about 20 to 40 minutes, with electrical stimulation in some cases. A course is usually several visits, and trials have used weekly sessions over about 10 weeks.^[11] We reassess after a short course.

Serious problems are rare. In prospective studies, about 9 in 100 patients had a minor reaction such as bleeding, soreness or redness at a needle site, and serious events occurred in about 1 in 10,000 patients.^[15] Because pain sensitivity is high in fibromyalgia, tell us if needling is uncomfortable. Tell the practitioner first if you have a bleeding disorder, take blood thinners, are pregnant, or have a pacemaker (relevant to electroacupuncture).

Ayurvedic medicine for Fibromyalgia

The Ayurvedic view

Ayurveda has no exact equivalent of fibromyalgia. Widespread aching, stiffness, fatigue and disturbed sleep are traditionally understood as Vata imbalance, sometimes with Ama, a term for poorly processed material that is said to cause heaviness and fatigue. These are traditional categories used to choose treatment, not biomedical diagnoses.

Therapies that may be used

Care is chosen for the individual and traditionally combines:

• Diet and daily routine intended to calm Vata, such as warm, regular meals and steady sleep hours
• Warm oil massage and gentle local heat
• Herbs traditionally used for pain, stress and sleep, prescribed individually
• A herbal preparation applied to the skin, as part of our transdermal medication therapy

Panchakarma is not appropriate during pregnancy, acute illness or frailty, and strong cleansing therapies are generally unsuitable for someone who is already exhausted.

What the research shows

We found no clinical trials or systematic reviews of Ayurvedic treatment, herbs or Panchakarma for fibromyalgia. Yoga, which comes from the same Indian tradition, has been reviewed for fibromyalgia, but the review noted that definitive conclusions about a clear clinical effect have not been established.^[16] Because Ayurveda has not been tested in fibromyalgia, we describe it as supportive and do not claim it treats the condition.

Ayurvedic products also carry a safety concern. One study found that about one fifth of Ayurvedic medicines bought online contained detectable lead, mercury or arsenic.^[17]

Herbal medicine for Fibromyalgia

Herbs and formulas that have been studied

Herbal research in fibromyalgia is sparse. We found one randomized trial of the mushroom Ganoderma lucidum, which is used in traditional Chinese medicine, in 64 women with fibromyalgia.^[18] A Chinese guideline notes that nutritional supplements show promise but need further research because the certainty of evidence is low.^[10]

What the research shows

The evidence is very limited. In the Ganoderma trial, 6 weeks of treatment improved some physical fitness measures such as aerobic endurance and flexibility compared with a comparison supplement, but the trial did not measure pain as its main outcome and was small.^[18] We found no systematic review of Chinese or Ayurvedic herbal formulas for fibromyalgia.

Safety and herb-drug interactions

Herbs are active substances and can interact with medicines. Many people with fibromyalgia take antidepressants, pregabalin or other medicines. A review of herb-drug interactions describes St John's wort causing serotonin syndrome when combined with SSRI antidepressants, and several herbs interacting with sedatives and other drugs.^[19] A practitioner needs your full medicine list before prescribing any herb.

Herbal and dietary supplements are a recognized cause of liver injury.^[20] Herbs should come from tested sources and be prescribed individually. Tell us if you are pregnant or breastfeeding, have liver or kidney disease, or have surgery planned.

Translating traditional medicine into modern biological language

The links drawn here are interpretation, not equivalence. Chinese medicine describes widespread pain and fatigue as qi and blood stagnation with deficiency. Researchers studying acupuncture look at things that loosely parallel this picture, such as the body's pain-modulating systems and how the brain amplifies pain signals.^{[2, 14]}

Ayurveda's Vata imbalance describes pain, stiffness and disturbed sleep together, which loosely parallels the finding that pain and sleep affect each other.^[5] No study has shown that a dosha or a channel corresponds to a specific biological process.

How this care fits with your medical care

Integrative care for fibromyalgia is complementary. Keep your physician, rheumatologist or pain specialist, and do not stop or change prescribed medicines without your prescriber. Exercise and education are the best-supported parts of care, and we encourage you to keep them up.^[4] We do not diagnose fibromyalgia, and new symptoms should be medically evaluated because other conditions can mimic it.^[1]

Please bring your diagnosis, recent test results, and a full list of medicines and supplements.

When to seek urgent medical care

Other conditions can mimic or accompany fibromyalgia, so some symptoms should not be put down to it and need prompt medical evaluation.^[1]

• New weakness, numbness or loss of bladder or bowel control
• Fever, unexplained weight loss, or night sweats with pain
• A hot, red, swollen joint
• Sudden severe headache, chest pain or shortness of breath
• Thoughts of harming yourself (call or text 988, the Suicide and Crisis Lifeline)

If any of these occur, call 911 or go to the nearest emergency department.