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Non-Drug Therapies

Managing fibromyalgia symptoms with medications is only a part of the multidisciplinary approach that is needed to address this disease. Non-drug therapies also play an important role in the overall treatment plan for fibromyalgia. Physical exercise and cognitive behavioral therapy (CBT) are the two most studied non-pharmacologic interventions for fibromyalgia.

Additional interventions that are used include yoga, tai chi, qi gong, mindfulness, acupuncture, and biofeedback.

Physical exercise has been shown to be beneficial for pain control, sleep, mood, and stress and should be used in addition to any drug treatment. Low-impact physical exercises are typically started slowly and increased gradually based on the individual. A meta-analysis of randomized clinical trials looking at the effectiveness of therapeutic exercise in fibromyalgia found evidence to suggest that muscle strengthening and aerobic exercise are most effective in reducing the pain and severity of the disease. Stretching and aerobic exercise produce the largest improvements in health- related quality of life, and combined exercise was the most effective way of reducing symptoms of depression.184

Water-based exercises are also beneficial and can decrease pain and improve strength and stamina. A 16-week randomized controlled study assessing the effects of aquatic therapy in patients with heightened fibromyalgia symptoms showed that exercise therapy three times a week in a warm pool improved most symptoms.185

Cognitive behavioral therapy focuses on understanding how thoughts and behaviors can affect pain and other symptoms.2 Cognitive behavioral therapy and related treatment, such as mindfulness, can be helpful for patients for symptom control and to lessen the pain that they experience. A Cochrane review of CBTs for fibromyalgia found that CBTs provided some benefit in reducing pain, negative mood, and disability.186 Cognitive behavior therapy has also been found to be beneficial in reducing pain catastrophizing in patients with fibromyalgia.187

Mind–Body Practices

Yoga is a mind body technique that uses physical postures in combination with breathing techniques and meditation. A meta-analysis of 3 yoga trials in 86 fibromyalgia patients showed positive effects on reducing sleep disturbances, fatigue, depression, improving quality of life, and providing pain relief.188

Tai chi is a traditional Chinese practice that combines meditation with deep breathing, relaxation, and gentle movements. A meta-analysis of 6 randomized trials in 657 patients with fibromyalgia demonstrated that tai chi had significant positive benefits for pain, sleep quality index, fatigue, depression, and quality of life as assessed by the Fibromyalgia Impact (FIQ) score.189 Tai chi could provide an alternative for the management of fibromyalgia symptoms, especially for patients who are unable to tolerate aerobic exercise.

Qi gong is a holistic type of coordinated body posture and movement, breathing, and meditation used for health in Chinese medicine. Preliminary clinical research shows that external qi gong therapy performed by a trained qi gong practitioner might decrease pain and improve functioning in women with fibromyalgia.190 Other evidence suggests that qi gong sessions three times weekly may improve pain, tender points, and symptom severity in patients with fibromyalgia.191 Since exercise is the best way to manage fibromyalgia, qi gong is a good complementary option for the management of symptoms in fibromyalgia.

Acupuncture is an ancient Chinese practice that uses needles to stimulate specific points throughout the body in an effort to improve overall function. Studies have shown inconsistent results on the effectiveness of this technique for fibromyalgia symptoms. Kim J et al.192 conducted a systematic review and meta-analysis of 8 studies comparing verum and sham acupuncture in 579 patients with fibromyalgia and found that verum acupuncture is more effective than sham acupuncture for pain relief, improving sleep quality, and general status posttreatment. A reduction in fatigue was not found.

Biofeedback is a mind body technique that gives a patient visual or auditory feedback on processes such as heart rate, pain perception, muscle tension, and blood flow. This information is then used by the patient to learn to control stress. While biofeedback has been helpful for some people with fibromyalgia, more studies are needed to confirm its effectiveness.


Fibromyalgia is a challenging disease with a complex etiology yet to be determined. While advancements are being made to understand the pathophysiology, current treatment is focused on symptom management. A multi-modal, patient-specific approach inclusive of medication, in combination with non-pharmacologic therapies, is a necessary part of the treatment plan. Opioids have proven unhelpful in this patient population and should be avoided as they can cause worsening of pain.


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