Mind and Body Practices for Fibromyalgia

February 23, 2022 Joe Brady
Posted by Joe Brady on

What the Science Says

Fibromyalgia is a common disorder that involves widespread pain, tenderness, fatigue, and other symptoms. It’s not a form of arthritis, but like arthritis, it can interfere with a person’s ability to perform everyday activities. An estimated 5 million American adults have fibromyalgia. Between 80 and 90 percent of people with fibromyalgia are women, but men and children can also have this condition.

In addition to pain and fatigue, people with fibromyalgia may have other symptoms, such as cognitive and memory problems, sleep disturbances, morning stiffness, headaches, painful menstrual periods, numbness or tingling of the extremities, restless legs syndrome, temperature sensitivity, and sensitivity to loud noises or bright lights.

The exact cause of fibromyalgia is unclear, but it may be related to injury, emotional distress, or viruses that change the way the brain perceives pain. There’s no diagnostic test for fibromyalgia, so health care providers diagnose it by examining the patient, evaluating symptoms, and ruling out other conditions.

Exercise in general and tai chi, in particular, are excellent treatments for fibromyalgia

Research has repeatedly shown that regular exercise is one of the most effective treatments for fibromyalgia. People with fibromyalgia who have too much pain or fatigue to do vigorous exercise should begin with tai chi or walking or other gentle exercise and build their endurance and intensity slowly.

Recent systematic reviews and randomized clinical trials provide encouraging evidence that practices such as tai chi, acupuncture, mindfulness, and biofeedback may help relieve some fibromyalgia symptoms. There is insufficient evidence that any natural products can relieve fibromyalgia pain, with the possible exception of vitamin D supplementation, which may reduce pain in people with fibromyalgia who have vitamin D deficiencies. For more on the actual research and references to the scientific literature read on.

Current diagnostic criteria are available from the American College of Rheumatology. Treatment often involves an individualized approach that may include both pharmacologic therapies (prescription drugs, analgesics, and NSAIDs) sometimes these are quite useful to break the cycle of pain and inflammation. Over the long haul, though nonpharmacologic interventions help reduce symptoms while reducing the need for medications, these include treatments such as exercise, tai chi, muscle strength training, cognitive behavioral therapy, movement/body awareness practices, massage, and acupuncture.

Read more about the role of meditation, acupuncture, tai chi, and massage therapy in the treatment of fibromyalgia.

Acupuncture

Limited evidence suggests that when compared to a control, acupuncture may help improve symptoms of fibromyalgia such as pain and stiffness.

What Does the Research Show?

  • A 2020 update to a systematic review by the Agency for Healthcare Research and Quality found that acupuncture was associated with a small improvement in function compared with sham acupuncture as evaluated by the Fibromyalgia Impact Questionnaire (FIQ) Total Score at short-term and intermediate-term follow-up. (The strength of evidence was considered moderate.) The updated review also found no effect of acupuncture versus sham acupuncture on pain in the short term or intermediate term. (The strength of evidence was considered low.)
  • A 2013 Cochrane review of 9 studies involving a total of 395 participants found low-to-moderate evidence that acupuncture improves pain and stiffness in people with fibromyalgia, compared with no treatment and standard therapy. The reviewers also found moderate-level evidence that the effect of acupuncture does not differ from sham acupuncture in reducing pain or fatigue, or improving sleep or global well-being.

Safety

  • Acupuncture is generally considered safe when performed by an experienced practitioner using sterile needles. Relatively few complications from acupuncture have been reported.
  • Serious adverse events related to acupuncture are rare but include infections and punctured organs.
  • There are fewer adverse effects associated with acupuncture than with many standard drug treatments (such as anti-inflammatory medication and steroid injections) used to manage painful musculoskeletal conditions like fibromyalgia, myofascial pain, and osteoarthritis.

Mindfulness Meditation

Mindfulness mediation may provide short-term improvements in pain and quality of life in patients with fibromyalgia; however, the evidence is limited by a small number of studies with low methodological quality.

What Does the Research Show?

  • A 2015 Cochrane review of 61 trials involving 4,234 participants examined mind and body therapies for fibromyalgia. The review found no advantage observed for mindfulness compared to usual care (control) for physical functioning, pain, mood, or participant withdrawals post-intervention. However, the quality of the evidence was very low for pain and moderate for mood and number of withdrawals.
  • A 2019 randomized controlled trial involving 70 female participants found that mindfulness training was efficacious in reducing clinical severity of patients with fibromyalgia. The results of the trial also suggest that mindfulness-based stress reduction (MBSR) has significant immune regulatory effects in patients with fibromyalgia, while immune-inflammatory pathways may in part predict the clinical efficacy of MBSR.

Safety

  • Mindfulness and other forms of meditation are generally considered to be safe for healthy people. However, they may need to be modified to make them safe and comfortable for people with some health conditions.

Tai Chi

Findings from some randomized controlled trials suggest that meditative movement therapies, such as tai chi, may provide modest relief of some fibromyalgia symptoms.

What Does the Research Show?

  • A 2018 prospective, randomized, 52-week, single-blind comparative effectiveness trial involving 226 participants found that tai chi resulted in similar or greater improvement in fibromyalgia symptoms than aerobic exercise. Longer duration of tai chi showed greater improvement.
  • A 2019 review concluded that tai chi is a cost-effective and efficacious method of symptom reduction and is a promising therapy that may result in being added to the first-line recommendations for patients with fibromyalgia pending further research.
  • A 2020 update to a systematic review by the Agency for Healthcare Research and Quality concluded that compared with exercise, tai chi conferred improvement in function in the short and intermediate-term; however, the strength of evidence was considered low.
  • A 2013 systematic review and meta-analysis of 7 studies involving 362 participants found evidence that meditative movement therapies such as tai chi, qigong, and yoga resulted in modest improvements in sleep disturbances, fatigue, depressed mood, and health-related quality of life at the conclusion of the study treatment period. The investigators also found evidence of continued improvement in sleep disturbances and health-related quality of life 3 to 6 months later. The investigators concluded that high-quality studies with larger sample sizes are needed to confirm these results.

Safety

  • Tai chi and qigong are generally regarded as safe practices. However, people who are pregnant, or who have a hernia, joint problems, back pain, fractures, or severe osteoporosis should use caution and consult their health care provider.
  • Yoga is generally considered to be safe in healthy people when practiced appropriately. However, people with certain conditions such as high blood pressure, glaucoma, or sciatica, and women who are pregnant should modify or avoid some yoga poses.

Massage

There is limited evidence that massage can provide modest improvement in some fibromyalgia symptoms.

What Does the Research Show?

  • A 2020 review found that massage or myofascial release yields a small improvement in fibromyalgia symptoms.
  • A 2020 update to a systematic review by the Agency for Healthcare Research and Quality found that at intermediate term, there was functional improvement with myofascial release; however, the strength of evidence was considered low.
  • A 2014 systematic review and meta-analysis of 9 randomized controlled trials involving 404 participants with fibromyalgia syndrome found that massage therapy with a duration of 5 weeks or longer had beneficial immediate effects on improving pain, anxiety, and depression.

Safety

  • Massage therapy appears to have few risks when performed by a trained practitioner. However, massage therapists should take precautions with certain health conditions.

For more information about fibromyalgia, visit the National Institute of Arthritis and Musculoskeletal and Skin Diseases website.

References

NCCIH Clinical Digest is a service of the National Center for Complementary and Integrative Health, NIH, DHHS. NCCIH Clinical Digest, a monthly e-newsletter, offers evidence-based information on complementary health approaches, including scientific literature searches, summaries of NCCIH-funded research, fact sheets for patients, and more.

The National Center for Complementary and Integrative Health is dedicated to exploring complementary health products and practices in the context of rigorous science, training complementary health researchers, and disseminating authoritative information to the public and professionals. For additional information, call NCCIH’s Clearinghouse toll-free at 1-888-644-6226, or visit the NCCIH website at nccih.nih.gov. NCCIH is 1 of 27 institutes and centers at the National Institutes of Health, the Federal focal point for medical research in the United States.

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