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Fibromyalgia is a long-term condition that causes pain and tenderness throughout the body, along with fatigue and trouble sleeping. There’s no cure, but the symptoms can be managed. Treatment usually combines exercise or other movement, psychological and behavioral therapy, and medicines.[1]
Good fibromyalgia pain management is about finding the mix that suits you. This guide covers what each fibromyalgia treatment can realistically do, based on NIAMS, MedlinePlus, NCCIH, the NHS and the European (EULAR) treatment recommendations, and where to start.
In brief
- Exercise has the strongest evidence of any fibromyalgia treatment. Start at a low level and build up gradually.
- Cognitive behavioral therapy (CBT), good sleep habits and pacing your day can help too. Medicines help some people, and they’re meant to be used alongside exercise and therapy, not instead of them.
- Most treatments bring modest gains, so expect to combine a few and adjust them over time with your doctor.
What fibromyalgia is
The main symptoms are chronic, widespread pain, fatigue and trouble sleeping. People often describe the pain as aching, burning or throbbing, and it’s often felt in the arms, legs, head, chest, abdomen, back and buttocks.[1] Other symptoms can include:
- muscle and joint stiffness, and tenderness to touch[1]
- numbness or tingling in the arms and legs, or in the hands and feet[1][2]
- trouble concentrating, thinking clearly or remembering, often called “fibro fog”[1]
- sensitivity to light, noise, smells and temperature[1]
- tension headaches or migraines[2]
- digestive problems such as bloating or constipation. Some people also have irritable bowel syndrome (IBS).[1][3]
- depression and anxiety[2]
Most people with fibromyalgia have at least one of fatigue, low mood or sleep problems. Many can’t get to sleep or stay asleep, and wake up tired.[2] Symptoms also change over time, and they can suddenly get better or worse.[4]
What causes it
Nobody knows exactly. People with fibromyalgia are more sensitive to pain, so they feel pain when others don’t. Brain imaging and other studies show altered signaling in the nerve pathways that send and receive pain.[1] It tends to run in families, so genes probably play a part.[1] It’s often triggered by physical or emotional stress, such as a serious injury, an infection, a major operation or emotional trauma, though sometimes there’s no obvious trigger.[5]
Who gets it
Anyone can get fibromyalgia, including children, but it’s more common in women. It usually starts in middle age, and the chance of having it rises as you get older.[1] You’re more likely to have it if you have rheumatoid arthritis, lupus, ankylosing spondylitis, osteoarthritis, depression or anxiety, chronic back pain or IBS.[1]
How it’s diagnosed
There’s no specific lab or imaging test for fibromyalgia.[6] Doctors diagnose it from your symptoms: widespread pain for at least 3 months, together with ongoing sleep problems, fatigue, or problems with thinking and memory.[2]
You may have read that you need a certain number of painful “tender points” to be diagnosed. That’s out of date. A doctor doesn’t need to find tender points to make the diagnosis, and your physical exam may be normal.[2]
Your doctor may order blood or urine tests, X-rays or other scans to rule out conditions with similar symptoms, such as rheumatoid arthritis, lupus or an underactive thyroid.[2][6][7] Finding another condition doesn’t rule fibromyalgia out, because you can have both.[7]
How fibromyalgia is treated
Treatment aims to relieve pain and other symptoms, reduce disability and help you cope.[2] No single treatment works for everyone, so you may need to try a few to find a mix that suits you.[8]
The EULAR recommendations, published in 2017, were written by a group of experts from 12 countries after assessing 107 systematic reviews and meta-analyses. They suggest a graduated approach, with you and your doctor deciding together. In outline:[9]
- Start with learning about fibromyalgia and with treatments that don’t involve drugs.
- If that isn’t enough, add treatment matched to your needs: psychological therapy for low mood or unhelpful ways of coping, medicine for severe pain or sleep problems, or a multidisciplinary rehabilitation program for severe disability.
Exercise was the only treatment EULAR strongly recommended. The second-step treatments were all rated “weak for” (a weak recommendation in favor), and the authors note that most treatments have relatively modest effects.[9]
Treatment evidence at a glance
| Treatment | What the sources say | Evidence | Source |
|---|---|---|---|
| Exercise | Helps reduce pain, and even modest amounts help. The only treatment EULAR recommends strongly. | Strong (EULAR) | [6][9] |
| CBT and ACT | Can help, especially combined with other treatment. ACT has been shown to improve sleep and reduce pain. | Weak (EULAR) | [6][8][9] |
| Medicines | Some ease pain and improve sleep. Three are FDA-approved for fibromyalgia. | Weak (EULAR) | [2][6][9] |
| Tai chi, qigong, yoga | NIAMS lists them as helpful movement options. NCCIH says the evidence is too limited for firm conclusions. | Limited | [6][10] |
| Mindfulness | Short-term gains in pain and quality of life in a small number of studies. | Limited | [10] |
| Acupuncture | Better than no acupuncture in some studies, but no better than simulated acupuncture. | Uncertain | [10] |
| Massage | Short-term relief of some symptoms. Evidence too limited to be conclusive. | Limited | [10] |
| Opioids | No evidence they work for fibromyalgia, and possible harms. | Avoid | [2] |
Exercise: where to start
Exercise is a key part of fibromyalgia treatment. Pain and fatigue can make it hard, but NIAMS says regular exercise is one of the most useful ways to combat fibromyalgia, and even modest levels help. Aerobic activity can also improve sleep and ease anxiety and depression.[6] The NHS adds that regular exercise has been shown to help reduce pain and improve quality of life.[8]
What the sources advise:
- Check with your doctor before you start a new exercise routine.[6]
- Start at a low level and build up gradually.[6] If pain or fatigue makes vigorous exercise too much, begin with walking or other gentle exercise and build up how long and how hard you go slowly.[10]
- Low-impact aerobic activities are especially helpful, such as walking, biking, swimming and water exercise. Mind-body activities such as yoga and tai chi also help.[6]
- Choose something you enjoy and can keep doing long term.[8]
- A physical therapist or exercise physiologist can prescribe a program and support you as you build up.[6]
Pace yourself on busy days as well. You may not be able to do everything you once did, or not as quickly. NIAMS advises not using up all your energy each day, because doing too much can make symptoms worse.[6] For more on working with a therapist, see our guide to physical therapy for fibromyalgia.
Talk therapy and mind-body approaches
Cognitive behavioral therapy (CBT)
CBT aims to change the way you think about pain. You can do it one-on-one or in a group, and it can be especially helpful combined with other treatment.[6] A counselor trained in CBT can teach you skills and techniques to better control the pain.[6] MedlinePlus calls CBT an important part of fibromyalgia treatment and says it helps you learn to:[2]
- deal with negative thoughts
- keep a diary of your pain and symptoms
- recognize what makes your symptoms worse
- seek out activities you enjoy
- set limits
Acceptance and commitment therapy (ACT)
ACT teaches you to accept what’s outside your control and commit to changes that improve your life. The NHS says it has been shown to improve sleep quality, reduce pain and help with negative thoughts and feelings.[8] If emotional problems come up, NIAMS recommends seeing a mental health professional.[6] Our guide to the psychology of pain explains more about how thoughts and stress affect pain.
Tai chi, qigong and yoga
These meditative movement practices combine postures or movements with a focus on breathing and relaxation. Because exercise helps fibromyalgia, they may help through the movement alone, and the meditative part may add to that. Some studies have had promising results, but NCCIH says there isn’t yet enough high-quality evidence to reach firm conclusions.[10]
They have good safety records when taught by a qualified instructor, but may need adapting for people with fibromyalgia, so look for a teacher who can modify the moves for you.[10]
Mindfulness and relaxation
In several small studies, mindfulness meditation training led to short-term improvements in pain and quality of life. Practicing often may matter: in a 2014 study, people who practiced mindfulness more frequently had a bigger drop in symptoms. The quality of the evidence is still relatively low.[10]
Results for guided imagery have been mixed. Relaxation techniques are generally considered safe for healthy people, though a few people report feeling more anxious while doing them.[10]
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Medicines for fibromyalgia
Several types of medicine can help relieve pain and improve sleep, and your doctor may prescribe more than one at the same time:[6]
- Antidepressants. These can help fibromyalgia even if you aren’t depressed.
- Anti-seizure medicines. These can lessen pain and improve sleep by interfering with pain signals on their way to the brain.
- Pain relievers, for people who need extra relief.
Three medicines are approved by the US Food and Drug Administration (FDA) specifically for treating fibromyalgia: duloxetine, pregabalin and milnacipran. Your doctor may suggest other medicines too.[2]
A few things worth knowing before you start:
- Medicine should be used along with exercise and behavioral therapy, not instead of them.[2]
- Anti-inflammatory painkillers usually don’t help fibromyalgia itself, because it doesn’t cause tissue inflammation. They may help with other painful conditions you have.[6]
- There’s no evidence that opioids work for fibromyalgia, and studies suggest possible harms. MedlinePlus says they should be avoided.[2]
- Finding the right medicine, combination or dose can take time, and improvement is often gradual.[6] Before prescribing an antidepressant, your doctor should talk through its pros and cons with you.[8]
Sleep and fatigue
Persistent fatigue is one of the most troubling symptoms of fibromyalgia.[6] You may wake up tired even after plenty of sleep, because the condition can stop you sleeping deeply enough to feel refreshed.[3] NIAMS suggests these habits to sleep better and feel more rested:[6]
- Go to sleep and get up at the same time every day.
- Keep your bed for sleeping. Watching TV, reading or using a phone or laptop in bed can keep you awake.
- Keep your bedroom dark, quiet and cool.
- Avoid caffeine and nicotine, and limit alcohol.
- Wind down before bed with something relaxing, such as soft music, meditation or a warm bath, and avoid working or exercising close to bedtime.
Your doctor may also suggest a sleep study to check for sleep apnea. If you have it, a CPAP machine may be prescribed.[2] Our article on chronic pain and sleep has more on how the two affect each other.
Other treatments people try
NIAMS notes that therapies such as acupuncture, massage and hypnosis haven’t been well tested in people with fibromyalgia, so talk to your doctor before you try them.[6] Here’s what NCCIH found:[10]
- Acupuncture: some improvement in pain and stiffness compared with no acupuncture, but no better than simulated acupuncture. The NHS adds that for long-term pain, its benefits have only been shown to last up to 3 months.[8]
- Massage: short-term relief of some symptoms in several studies, though the evidence is too limited to be conclusive. Massage for fibromyalgia shouldn’t hurt, so it may need to start very gently and build up over time.
- Biofeedback: a few short studies suggest it may reduce pain, but there’s too little evidence to say whether it helps.
- Vitamin D: in one study of women with fibromyalgia and low vitamin D, 20 weeks of supplements reduced pain. Even vitamins can be harmful in excessive amounts.
- Reiki and homeopathy: one study of Reiki found no effect on fibromyalgia pain, and studies of homeopathy haven’t shown a benefit.
Tell all your health care providers about any complementary approach or supplement you use. Some supplements can have side effects or interact with medicines.[10]
Everyday self-care
MedlinePlus lists these steps you can take for yourself:[2]
- Eat a well-balanced diet.
- Avoid caffeine.
- Keep a good sleep routine.
- Exercise regularly, starting at a low level.
Learning as much as you can about fibromyalgia and joining an online or in-person support group can help you through difficult times.[6] A referral to a clinic with special expertise in diagnosing and treating fibromyalgia may also help.[2]
When to see a doctor
See a doctor if you think you might have fibromyalgia.[2][4] Other conditions can cause similar symptoms, so it’s worth getting checked rather than assuming.[7] Also talk to your doctor if:
- you feel low or hopeless most of the time, or you’ve lost interest in things you usually enjoy, which can be signs of depression[3]
- your joints are swollen, which can point to arthritis rather than fibromyalgia[7]
If emotional problems are building up, see a mental health professional.[6]
Common questions
Can fibromyalgia be cured?
Not at the moment. Treatment can ease some symptoms, though they’re unlikely to disappear completely.[4] Fibromyalgia is long term. Sometimes the symptoms improve, and at other times the pain can get worse and last for months or years.[2]
Does fibromyalgia damage your joints?
No. Fibromyalgia isn’t a form of arthritis.[10] The pain can feel as if it’s coming from the joints, but the joints aren’t affected or damaged and look normal.[2] It doesn’t cause tissue inflammation either.[6]
Why does fibromyalgia pain flare up?
Pain may get worse with physical activity, cold or damp weather, and anxiety or stress.[2] The NHS lists stress levels, changes in the weather and how active you are as factors that can make symptoms better or worse.[3] That’s one reason NIAMS advises building up exercise gradually and not using up all your energy each day.[6]
What kind of doctor treats fibromyalgia?
Most people are treated by their primary care provider. A rheumatologist may be involved too, along with others such as a physical therapist, exercise physiologist, mental health professional, pain management specialist or sleep specialist.[6]
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How we checked this article
Medical review: pending. A clinician hasn’t reviewed this article yet. We last checked it against the sources below on November 3, 2026.
Sources
- NIAMS (National Institute of Arthritis and Musculoskeletal and Skin Diseases). Fibromyalgia: overview, symptoms and causes. Last reviewed May 2024.
- MedlinePlus Medical Encyclopedia. Fibromyalgia. Review date January 28, 2025.
- NHS. Fibromyalgia: symptoms. Page last reviewed October 12, 2022.
- NHS. Fibromyalgia. Page last reviewed October 12, 2022.
- NHS. Fibromyalgia: causes. Page last reviewed October 12, 2022.
- NIAMS. Fibromyalgia: diagnosis, treatment, and steps to take. Last reviewed May 2024.
- NHS. Fibromyalgia: diagnosis. Page last reviewed October 12, 2022.
- NHS. Fibromyalgia: treatment. Page last reviewed October 12, 2022.
- Macfarlane GJ, Kronisch C, Dean LE, et al. EULAR revised recommendations for the management of fibromyalgia. Annals of the Rheumatic Diseases. 2017;76(2):318-328. PubMed 27377815
- NCCIH (National Center for Complementary and Integrative Health). Fibromyalgia: In Depth. Last updated May 2016.
