Fibromyalgia syndrome (FMS) is characterized by pain in the muscles and bones, trouble sleeping (or waking up feeling tired), and multiple tender points on the body. FMS, while different for everyone who has it, tends to come and go throughout life. It is not deforming, degenerative, life-threatening, or imaginary.

• Fatigue
• Morning stiffness
• Paresthesia (tingling)
• Raynaud's phenomenon
• Skin sensitivity
• Headaches
• Psychological disturbances
• Pain after exertion
• Memory lapses
• Sleep disorders
• Restless leg syndrome
• Dizziness
• Irritable bowel syndrome
• Joint pain and swelling

The tendency to get FMS may be inherited. Illness or physical trauma such as an accident often precedes FMS symptoms. Many patients report a history of psychological problems, such as depression or anxiety.

Although FMS does not show up in laboratory and imaging tests, your provider must perform them to rule out other causes of your symptoms. Your provider will also perform a physical examination of your joints. Be sure to tell your provider about all of your symptoms.

The goal is to help you function as well as possible on a day-to-day basis. While it is probably not possible to completely relieve all your symptoms, medication and certain complementary and alternative therapies may help reduce symptoms.

The following drugs may be prescribed.

• Sleep disturbances are often treated successfully with low doses of tricyclic antidepressants. Benzodiazepines may also be used.
• Psychological disturbances can be treated with tricyclic antidepressants and sedative-hypnotics.
• Pain in the bones and muscles can be treated with lidocaine or procaine (injected into points where pain is greatest) or with capsaicin (used topically). Ibuprofen may also help briefly reduce muscle pain.

Nutritional support, herbs, and mind-body techniques may help reduce symptoms.

• Eliminate all food allergens from the diet. Common allergenic foods are dairy, soy, citrus, peanuts, wheat, fish, eggs, corn, and tomatoes. Try an elimination trial: Remove suspected allergens from the diet for two weeks. Reintroduce one food every three days. Watch for reactions such as gastrointestinal upset, mood changes, flushing, fatigue, and worsening of symptoms. A rotation diet, in which the same food is not eaten more than once every four days, may reduce sensitivities.
• Decrease carbohydrate intake; increase protein; fats in moderation.
• Eliminate inflammatory foods such as refined foods, sugar, saturated fats (meat and dairy products), alcohol, and caffeine.
• Eat whole foods such as vegetables, whole grains, fruits, protein, and essential fatty acids (cold-water fish, nuts, and seeds).
• Vitamin C (250 to 500 mg twice per day) reduces swelling and helps your immune system function better.
• Coenzyme Q10 (50 to 100 mg one to two times per day) improves oxygen delivery to tissues and has antioxidant activity.
• Chromium picolinate (200 mcg with meals) may reduce reactive hypoglycemia which may make your symptoms worse.
• Magnesium (200 mg two to three times per day) with malic acid (1,200 mg one to two times per day) relieves pain and fatigue.
• 5-Hydroxytryptophan (100 mg three times per day) may help with depression and insomnia.
• B vitamins help reduce the effects of stress: B-complex (50 to 100 mg per day), niacinamide (100 mg per day), and B6 (100 mg per day).
• Melatonin (0.5 to 3 mg one time before bed) may help sleep.
• Zinc (30 mg per day) is essential for proper immune function.
• Phosphatidyl choline and phosphatidyl serine (300 mg per day) may help depression and improve memory.

Herbs may be used as dried extracts (capsules, powders, teas), glycerites (glycerine extracts), or tinctures (alcohol extracts). Teas should be made with 1 tsp. herb per cup of hot water. Steep covered 5 to 10 minutes for leaf or flowers, 10 to 20 minutes for roots. Drink 2 to 4 cups per day.

The following herbs may help increase resistance to stress and strengthen the immune system. Siberian ginseng (Eleutherococcus senticosus), schizandra berry (Schizandra chinensis), ashwaganda root (Withania somnifera), gotu kola (Centella asiatica), and astragalus root (Astragalus membranaceus). Use ginseng alone or with equal parts of two to three herbs. Take 20 to 30 drops two to three times per day. These may need to be taken for four to six months for maximum benefit.

Herbs that alleviate pain and nervous tension include the following: black cohosh (Cimicifuga racemosa), kava kava (Piper methysticum), skullcap (Scutellaria lateriflora), passionflower (Passiflora incarnata), lavender (Lavandula angustifolia), and valerian (Valeriana officinalis). Combine equal parts and take as a tincture 20 to 30 drops two to three times per day.

Essential oils of jasmine, lemon balm, rosemary, and clary sage relieve nervous exhaustion and may be used in aromatherapy. Place several drops in a warm bath or atomizer, or on a cotton ball, and inhale.

Homeopathy may be useful as a supportive therapy.

Two to four cups of Epsom salts in a warm bath can soothe aching muscles.

There are a few well-designed studies showing that acupuncture can help improve fibromyalgia symptoms and the National Institutes of Health recommend acupuncture as a treatment for this condition. Acupuncturists treat people with fibromyalgia based on an individualized assessment of the excesses and deficiencies of qi located in various meridians. In the case of fibromyalgia, a qi deficiency is usually detected in the spleen and/or kidney meridians. Moxibustion (a technique in which the herb mugwort is burned over specific acupuncture points) is used to strengthen the entire energy system. Qualified practitioners may also advise persons with fibromyalgia on lifestyle and diet, and provide recommendations on the use of herbal medicines.

Because fibromyalgia generally includes low back pain and/or neck pain (for which spinal manipulation is beneficial), chiropractors commonly treat people who have this condition. In one small study, women with fibromyalgia reported that they experienced a 77% reduction in pain intensity, 63% improvement in sleep quality, and 75% improvement in fatigue level after receiving 30 chiropractic treatments. Symptom relief continued for 1 month after treatment ended.

Massage may reduce stress and improve circulation.

Education and support groups may help you manage your condition.

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