Evidence-Based Non-Pharmacological Therapies for Fibromyalgia

  • Mansoor M. Aman
  • R. Jason Yong
  • Alan David Kaye
  • Richard D. Urman
Other Pain (A Kaye and N Vadivelu, Section Editors)
Part of the following topical collections:
  1. Topical Collection on Other Pain


Purpose of Review

Fibromyalgia (FM) is the second most common rheumatologic pain disorder after osteoarthritis with a multisystem presentation. While the treatment of FM in a clinical setting incorporates both pharmacologic and non-pharmacologic modalities, the present investigation reviews evolving literature on cognitive behavioral and complementary medical therapies. The recent medical literature on FM was reviewed between 2012 and 2017 via MEDLINE and the Cochrane Central Registry of Controlled Trials, with an emphasis on randomized controlled trials, meta-analyses, and evidence-based treatment guidelines.

Recent Findings

Cognitive behavioral therapy continues to play a significant role in the non-medical therapy of FM. It is especially helpful in high catastrophizing patients as evidenced by recent studies that note changes in the brain on functional magnetic resonance imaging. Mindfulness meditation can be helpful in improving pain symptoms and pain perception. No particular diet is found to have a meaningful impact in FM; however, various diets including low fermentable oligo- di –monosaccharides and polyols diet, gluten free, and hypocaloric may be helpful in ameliorating gastrointestinal distress in select patient populations. Current literature does not support the routine use of acupuncture for improving pain or quality of life in FM; however, given its benign side effect profile, it should not be discouraged.


Goals for symptom management and pain control should be set early, and patient engagement remains critical in the management of this complex pain presentation. While low quality evidence exists for most non-pharmacologic treatment modalities for FM, CBT and mindfulness meditation show promise for future investigation.


Chronic pain Widespread pain Tender point Fatigue Cognitive therapy Meditation Acupuncture Diet Fibromyalgia 


Compliance with Ethical Standards

Conflict of Interest

The authors declare that they have no conflict of interest.

Human and Animal Rights and Informed Consent

This article does not contain any studies with human or animal subjects performed by any of the authors.


Papers of particular interest, published recently, have been highlighted as: • Of importance, •• Of major importance

  1. 1.
    Wolfe F, Ross K, Anderson J, Russell IJ, Hebert L. The prevalence and characteristics of fibromyalgia in the general population. Arthritis Rheum. 1995;38(1):19–28.CrossRefPubMedGoogle Scholar
  2. 2.
    Wolfe F, Smythe HA, Yunus MB, Bennett RM, Bombardier C, Goldenberg DL, et al. The American College of Rheumatology 1990 Criteria for the classification of fibromyalgia. Report of the Multicenter Criteria Committee. Arthritis Rheum. 1990;33(2):160–72.CrossRefPubMedGoogle Scholar
  3. 3.
    Wolfe F, Clauw DJ, Fitzcharles M-A, Goldenberg DL, Katz RS, Mease P, et al. The American College of Rheumatology Preliminary Diagnostic Criteria for fibromyalgia and measurement of symptom severity. Arthritis Care Res. 2010;62(5):600–10.CrossRefGoogle Scholar
  4. 4.
    Wolfe F, Brahler E, Hinz A, Hauser W. Fibromyalgia prevalence, somatic symptom reporting, and the dimensionality of polysymptomatic distress: results from a survey of the general population. Arthritis Care Res (Hoboken). 2013;65(5):777–85.CrossRefPubMedGoogle Scholar
  5. 5.
    • Wolfe F, Clauw DJ, Fitzcharles MA, Goldenberg DL, Hauser W, Katz RL, et al. Revisions to the 2010/2011 fibromyalgia diagnostic criteria. Semin Arthritis Rheum. 2016;46(3):319–29. This is an update on fibromyalgia diagnostic criteria that addresses physician and questionnaire data, diagnosis of regional pain disorders, and other modifications to the criteria. CrossRefPubMedGoogle Scholar
  6. 6.
    Queiroz LP. Worldwide epidemiology of fibromyalgia. Curr Pain Headache Rep. 2013;17(8):356.CrossRefPubMedGoogle Scholar
  7. 7.
    Vincent A, Lahr BD, Wolfe F, Clauw DJ, Whipple MO, Oh TH, et al. Prevalence of fibromyalgia: a population-based study in Olmsted County, Minnesota, utilizing the Rochester Epidemiology Project. Arthritis Care Res (Hoboken). 2013;65(5):786–92.CrossRefGoogle Scholar
  8. 8.
    Walitt B, Fitzcharles MA, Hassett AL, Katz RS, Hauser W, Wolfe F. The longitudinal outcome of fibromyalgia: a study of 1555 patients. J Rheumatol. 2011;38(10):2238–46.CrossRefPubMedGoogle Scholar
  9. 9.
    Jensen KB, Kosek E, Wicksell R, Kemani M, Olsson G, Merle JV, et al. Cognitive behavioral therapy increases pain-evoked activation of the prefrontal cortex in patients with fibromyalgia. Pain. 2012;153(7):1495–503.CrossRefPubMedGoogle Scholar
  10. 10.
    •• Lazaridou A, Kim J, Cahalan CM, Loggia ML, Franceschelli O, Berna C, et al. Effects of cognitive-behavioral therapy (CBT) on brain connectivity supporting catastrophizing in fibromyalgia. Clin J Pain. 2017;33(3):215–21. This study demonstrates changes on functional MRI in high catastrophizing individuals before and after CBT. PubMedPubMedCentralGoogle Scholar
  11. 11.
    Adler-Neal AL, Zeidan F. Mindfulness meditation for fibromyalgia: mechanistic and clinical considerations. Curr Rheumatol Rep. 2017;19(9):59.CrossRefPubMedPubMedCentralGoogle Scholar
  12. 12.
    •• Theadom A, Cropley M, Smith HE, Feigin VL, McPherson K. Mind and body therapy for fibromyalgia. Cochrane Database of System Rev. 2015(4):Cd001980. This is a systematic review that examines the effectiveness of psychological treatment options to improve physical functioning, pain, and mood for patients with fibromyalgia. Google Scholar
  13. 13.
    Cash E, Salmon P, Weissbecker I, Rebholz WN, Bayley-Veloso R, Zimmaro LA, et al. Mindfulness meditation alleviates fibromyalgia symptoms in women: results of a randomized clinical trial. Ann Behav Med : Publ Soc Behav Med. 2015;49(3):319–30.CrossRefGoogle Scholar
  14. 14.
    Shonin E, Van Gordon W. Managers’ experiences of meditation awareness training. Mindfulness. 2015;6(4):899–909.CrossRefGoogle Scholar
  15. 15.
    • Van Gordon W, Shonin E, Dunn TJ, Garcia-Campayo J, Griffiths MD. Meditation awareness training for the treatment of fibromyalgia syndrome: a randomized controlled trial. Br J Health Psychol. 2017;22(1):186–206. This study describes the positive effects of meditation awareness training on the symptoms of fibromyalgia syndrome. CrossRefPubMedGoogle Scholar
  16. 16.
    Marum AP, Moreira C, Saraiva F, Tomas-Carus P, Sousa-Guerreiro CA. low fermentable oligo-di-mono saccharides and polyols (FODMAP) diet reduced pain and improved daily life in fibromyalgia patients. Scand J Pain. 2016;13:166–72.PubMedGoogle Scholar
  17. 17.
    Slim M, Calandre EP, Garcia-Leiva JM, Rico-Villademoros F, Molina-Barea R, Rodriguez-Lopez CM, et al. The effects of a gluten-free diet versus a hypocaloric diet among patients with fibromyalgia experiencing gluten sensitivity-like symptoms: a pilot, open-label randomized clinical trial. J Clin Gastroenterol. 2017;51(6):500–7.CrossRefPubMedGoogle Scholar
  18. 18.
    •• Marum AP, Moreira C, Tomas-Carus P, Saraiva F, Guerreiro CS. A low fermentable oligo-di-mono-saccharides and polyols (FODMAP) diet is a balanced therapy for fibromyalgia with nutritional and symptomatic benefits. Nutricion Hospitalaria. 2017;34(3):667–74. Dietary modification with low FODMAP resulting in 50% improvement of distressing GI symptoms in FM patients. CrossRefPubMedGoogle Scholar
  19. 19.
    Schrepf A, Harte SE, Miller N, Fowler C, Nay C, Williams DA, et al. Improvement in the spatial distribution of pain, somatic symptoms, and depression following a weight-loss intervention. J Pain 2017.Google Scholar
  20. 20.
    Feinberg T, Lilly C, Nonvitamin IK. Nonmineral dietary supplement use among adults with fibromyalgia: United States, 2007–2012. Evid-Based Complement Altern Med : eCAM. 2017;2017:6751856.CrossRefGoogle Scholar
  21. 21.
    Nahin RL, Boineau R, Khalsa PS, Stussman BJ, Weber WJ. Evidence-based evaluation of complementary health approaches for pain management in the United States. Mayo Clin Proc. 2016;91(9):1292–306.CrossRefPubMedPubMedCentralGoogle Scholar
  22. 22.
    Goldie L, Hogg K. BET 2: acupuncture and fibromyalgia. Emerg Med J : EMJ 2016;33(10):743–744.Google Scholar
  23. 23.
    Iannuccelli C, Guzzo MP, Atzeni F, Mannocci F, Alessandri C, Gerardi MC, et al. Pain modulation in patients with fibromyalgia undergoing acupuncture treatment is associated with fluctuations in serum neuropeptide Y levels. Clinical and experimental rheumatology. 2017;35 Suppl 105(3):81–5.Google Scholar
  24. 24.
    Perry R, Leach V, Davies P, Penfold C, Ness A, Churchill R. An overview of systematic reviews of complementary and alternative therapies for fibromyalgia using both AMSTAR and ROBIS as quality assessment tools. System Rev. 2017;6(1):97.CrossRefGoogle Scholar

Copyright information

© Springer Science+Business Media, LLC, part of Springer Nature 2018

Authors and Affiliations

  • Mansoor M. Aman
    • 1
  • R. Jason Yong
    • 1
  • Alan David Kaye
    • 2
  • Richard D. Urman
    • 1
  1. 1.Division of Pain Medicine, Department of AnesthesiologyBrigham and Women’s HospitalBostonUSA
  2. 2.Department of AnesthesiologyLouisiana State University Health Sciences CenterNew OrleansUSA

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