Fibromyalgia is managed by a combination of medical treatments and lifestyle management that is tailored to the individual and is guided by their treatment outcomes.

Fibromyalgia symptoms can be diverse but most commonly include widespread pain, fatigue and sleep disturbances. Symptoms can be made worse by hormones, stress, temperature changes and alterations to diet or sleep schedule.

This paper is a summary of the information in a review article published in 2019.

Current Treatment

Therapies for Fibromyalgia are complex and treatment is most effective when tailored to the individual and guided by their treatment outcomes.

Treatment primarily focuses on symptom management and improving patient quality of life. Exercise can significantly improve pain and function, specifically, cardiovascular training is recommended. If exercise and education are insufficient, medications may be required. However, medications may have variable or limited efficacy or only short-term effectiveness.

Complementary and Alternative Medicine (CAM)

Many patients report complementary and alternative medicines and therapies are helpful in managing their pain and other symptoms and improve their quality of life.

More extensive research regarding long-term effectiveness and safety of these treatments is necessary to allow doctors to incorporate beneficial therapies into standard care and eliminate harmful practices.

Some of the available useful interventions identified include:

Acupuncture

A 2013 trial concluded acupuncture improved stiffness and pain in Fibromyalgia. Interestingly, the same study concluded that placebo acupuncture treatment got the same result. Importantly acupuncture was found to be safe with little risk of adverse effects.

Massage

Massage has been suggested as a safe therapy for Fibromyalgia.

Types of massage:

• Myofascial release
• Swedish
• Shiatsu
• Manual lymphatic drainage
• Connective tissue

Biofeedback

Biofeedback is a procedure where monitors are placed on your muscles so you can see where they are tightest and practice relaxing them. No benefit for Fibromyalgia reported (from a small study).

Meditation

Meditation and other relaxation techniques seem to be promising therapies that may improve Fibromyalgia symptoms.

Tai Chi, Probiotics and Nutrition

A 2012 meta-analysis of Tai Chi, probiotics, and nutrition improvements found considerable symptom improvement, especially in patients doing qi gong, Tai Chi and yoga.

A 2018 study compared the effectiveness of Tai Chi versus aerobic exercise, which is a current core standard treatment for Fibromyalgia. Tai Chi treatment resulted in similar or greater improvement in symptoms than aerobic exercise and was very cost effective.

Medical Cannabis

Medical cannabis is an emerging treatment. Medical cannabis is legal in 33 US states. In a small 2018 study of 26 Fibromyalgia patients, all patients reported that cannabis use improved their symptoms. Half the patients stopped taking any other pain medication and only 8 experienced very mild adverse effects.

Patients in South Australia can access medicinal cannabis medicines as a result of federal legislative changes which came into effect in November 2016 and the development of a patient access pathway.

Currently, South Australians can access medicinal cannabis on prescription from their authorised medical practitioner and dispensed by a pharmacist.

Future Directions

As the article states, given the current opioid epidemic, the role of complementary methods for pain and symptom control in Fibromyalgia is more important than ever.

Other emerging treatments showing promise based on small studies are:

• Hyperbaric oxygen therapy
• Transdermal magnesium
• Low-level light laser therapy

Conclusions

• Many of the above complementary treatments show promise but larger and longer trials are needed to further support their use.
• These are relatively low risk treatments so should be considered if symptoms remain uncontrolled.
• More research is required into non-drug approaches to symptom management to help mitigate the use of opioids.

What patients can do 

• Keep records of treatments you have tried and the results
• Try to avoid opioids.
• Pace yourself and ‘start low, go slow’.
• Many of the above complementary treatments are available in the South Australian community sector. If you decide to incorporate these treatments into your treatment please discuss with your healthcare team. Also check with your doctor so they can be included in your care plan.

Reference: ‘The Role of Complementary and Alternative Medicine Treatments in Fibromyalgia: a Comprehensive Review’ Current Rheumatology Reports 21(5)·May 2019