Skip to main content

Complementary and alternative therapies for fibromyalgia

Current Rheumatology Reports volume 3, pages 147–156 (2001)Cite this article

Abstract

Fibromyalgia (FM) is a syndrome of chronic widespread musculoskeletal pain that is accompanied by sleep disturbance and fatigue. Clinical treatment usually includes lifestyle modifications and pharmacologic interventions meant to relieve pain, improve sleep quality, and treat mood disorders. These therapies are often ineffective or have been shown in clinical studies to have only short-term effectiveness. Pharmacologic treatments have considerable side effects. Patients may have difficulty complying with exercise-based treatments. Thus, patients seek alternative therapeutic approaches and physicians are routinely asked for advice about these treatments. This article reviews nontraditional treatment alternatives, from use of nutritional and herbal supplements to acupuncture and mindbody therapy. Little is known about efficacy and tolerance of complementary and alternative therapies in FM and other chronic musculoskeletal pain syndromes. Most studies on these treatments have been performed for osteoarthritis, rheumatoid arthritis, or focal musculoskeletal conditions. Clinical trials are scarce; the quality of these trials is often criticized because of small study population size, lack of appropriate control interventions, poor compliance, or short duration of follow-up. However, because of widespread and growing use of alternative medicine, especially by persons with chronic illnesses, it is essential to review efficacy and adverse effects of complementary and alternative therapies.

This is a preview of subscription content, access via your institution.

Access options

Buy single article

Instant access to the full article PDF.

USD 39.95

Price includes VAT (USA)
Tax calculation will be finalised during checkout.

References and Recommended Reading

  1. Panush RS: American College of Rheumatology Position Statement. Complementary and Alternative Therapies for Rheumatic Disease. Rheum Dis Clin N Am 2000, 26:189–192.

    Article  Google Scholar 

  2. Ramos-Remus C, Gutierrez-Urena S, Davis P: Epidemiology of complementary and alternative practices in rheumatology. Rheum Dis Clin North Am 1999, 25:789–804.

    PubMed  Article  CAS  Google Scholar 

  3. Fitzcharles M, Esdaile J: Nonphysician practitioner treatments and fibromyalgia syndrome. J Rheumatol 1997, 24:937–940.

    PubMed  CAS  Google Scholar 

  4. Pioro-Boisset M, Esdaile JM, Fitzcharles M: Alternative medicine use in fibromyalgia syndrome. Arthritis Care Res 1996, 9:13–17. Cross-sectional survey of frequency of CAM in patients with rheumatologic disorders, including fibromyalgia.

    PubMed  Article  CAS  Google Scholar 

  5. Dimmock S, Troughton PR, Bird HA: Factors predisposing to the resort of complementary therapies in patients with fibromyalgia. Clin Rheumatol 1996, 15:478–482.

    PubMed  Article  CAS  Google Scholar 

  6. Ernst E, Chrubasik S: Phyto-anti-inflammatories: a systematic review of randomized, placebo-controlled double-blind trials. Rheum Dis Clin North Am 2000, 26:13–27.

    PubMed  Article  CAS  Google Scholar 

  7. Balderer G, Borbély AA: Effect of valerian on sleep. Psychopharmacology 1985, 87:406–409.

    PubMed  Article  CAS  Google Scholar 

  8. Donath F, Quispe S, Diefenbach K, Maurer A, Fietze I, Roots I: Critical evaluation of valerian extraction sleep structure and sleep quality. Pharmacopsychiatry 2000, 33:46–53.

    Article  Google Scholar 

  9. Wagner J, Wagner ML, Hening WA: Beyond benzodiazepines: alternative pharmacologic agents for the treatment of insomnia. Ann Pharmacotherapy 1998, 32:680–691. Good review of alternative treatments for insomnia.

    Article  CAS  Google Scholar 

  10. Thompson CA: USP moves forward in providing information on botanical products. Am J Health System Pharm 1998, 55:527–530.

    CAS  Google Scholar 

  11. Chong SKF, Oberholzer VG: Ginseng—is there a use in clinical medicine? Postgrad Med J 1988, 64:841–846.

    PubMed  CAS  Google Scholar 

  12. Banerjee U, Izquierdo JA: Antistress and antifatigue properties of Panax ginseng: comparison with piracetam. Acta Physiologica Latinoamericana 1982, 32:277–285.

    CAS  Google Scholar 

  13. Fugh-Berman A: Complementary and alternative therapies in primary care: clinical trials of herbs. Clin Office Pract 1997, 24:889–903. Review of clinical trials involving herbal treatments.

    Article  CAS  Google Scholar 

  14. Mehta U: Potentially serious drug interactions between St. John’s wort and other medicines. South African Med J 2000, 90:698.

    CAS  Google Scholar 

  15. Arendt J: Melatonin, circadian rhythms, and sleep. N Engl J Med 2000, 343:1114–1116.

    PubMed  Article  CAS  Google Scholar 

  16. Korszun A, Sackett-Lundeen L, Papadopoulos E, et al.: Melatonin levels in women with fibromyalgia and chronic fatigue syndrome. J Rheumatol 1999, 26:2675–2680.

    PubMed  CAS  Google Scholar 

  17. Webb SM: Fibromyalgia and melatonin: are they related? Clin Endocrinol 1998, 49:161–162.

    Article  CAS  Google Scholar 

  18. Citera G, Arias A, Maldonado-Cocco JA, et al.: The effect of melatonin in patients with fibromyalgia: a pilot study. Clin Rheumatol 2000, 19:9–13.

    PubMed  Article  CAS  Google Scholar 

  19. Matsumoto M: The hypnotic effects of melatonin treatment on diurnal sleep in humans. Psychiatry Clin Neurosci 1999, 53:243–245.

    PubMed  Article  CAS  Google Scholar 

  20. Ellis CM: Melatonin and insomnia. J Sleep Res 1996, 5:61–65.

    PubMed  Article  CAS  Google Scholar 

  21. Attenburrow ME, Cowen PJ, Sharpley AL: Low dose melatonin improves sleep in healthy middle aged subjects. Psychopharmacology 1996, 126:179–181.

    PubMed  Article  CAS  Google Scholar 

  22. Abraham G, Flechas J: Management of fibromyalgia: rationale for use of magnesium and malic acid. J Nutritional Med 1992, 3:49–59.

    Google Scholar 

  23. Clague JE, Edwards RHT, Jackson MJ: Intravenous magnesium loading in chronic fatigue syndrome. Lancet 1992, 340:124–125.

    PubMed  Article  CAS  Google Scholar 

  24. Hinds G, Bell NP, McMaster D, et al.: Normal red cell magnesium concentrations and magnesium loading tests in patients with chronic fatigue syndrome. Ann Clin Biochem 1994, 31:459–461.

    PubMed  Google Scholar 

  25. Swanink CM, Vercoulen JH, Bleijenberg G, et al.: Chronic fatigue syndrome: a clinical and laboratory study with a well-matched control group. J Intern Med 1995, 237:499–506.

    PubMed  CAS  Article  Google Scholar 

  26. Russell IJ, Michalek JE, Flechas JD, et al.: Treatment of fibromyalgia syndrome with Super Malic: a randomized, double blind placebo controlled crossover pilot study. J Rheumatol 1995, 22:953–958.

    PubMed  CAS  Google Scholar 

  27. Cox IM, Campbell MJ, Dowson D: Red blood cell magnesium and chronic fatigue syndrome. Lancet 1991, 337:757–760.

    PubMed  Article  CAS  Google Scholar 

  28. Eisinger J, Plantamura A, Marie PA, et al.: Selenium and magnesium states in fibromyalgia. Magnesium Res 1994, 7:385–388.

    Google Scholar 

  29. Demitrack M, Dale J, Straus S, et al.: Evidence for impaired activation of the hypothalamic-pituitary-adrenal axis in patients with chronic fatigue syndrome. BMJ 1991, 73:1224–1234.

    CAS  Google Scholar 

  30. Dessein PH, Shipton EA, Joffe BI, et al.: Hyposecretion of adrenal androgens and the relation of serum adrenal steroids, serotonin, and insulin-like growth factor-1 to clinical features in women with fibromyalgia. Pain 1999, 83:313–319.

    PubMed  Article  CAS  Google Scholar 

  31. vanVollenhoven RF, Morabito LM, Engleman EG, et al.: Treatment of systemic lupus erythematosus with dehydroepiandrosterone: 50 patients treated up to 12 months. J Rheumatol 1998, 25:285–289.

    CAS  Google Scholar 

  32. vanVollenhoven RF, Park JL, Genovese MC, et al.: A doubleblind, placebo-controlled, clinical trial of dehydroepiandrosterone in severe systemic lupus erythematosus. Lupus 1999, 8:181–187.

    Article  CAS  Google Scholar 

  33. vanVollenhoven RF: Dehydroepiandrosterone in systemic lupus erythematosus. Rheum Dis Clin North Am 2000, 26:349–362.

    Article  CAS  Google Scholar 

  34. Petri M, Lahita R, McGuire J, et al.: Results of the GL701 (DHEA) multicenter steroid-sparing SLE study. Arthritis Rheum 1997, 40(suppl):

  35. vanVollenhoven RF: Dehydroepiandrosterone in the treatment of systemic lupus erythematosus. Rheumatology 2000, 39:929–930.

    Article  CAS  Google Scholar 

  36. Forsyth LM, Preus HG, MacDowell AL, et al.: Therapeutic effects of oral NADH on the symptoms of patients with chronic fatigue syndrome. Ann Allergy Asthma Immunol 1999, 82:185–191.

    PubMed  CAS  Article  Google Scholar 

  37. Behan PO, Behan WMH, Horrobin D: Effect of high doses of essential fatty acids on the postviral fatigue syndrome. Acta Neurol Scand 1990, 82:209–216.

    PubMed  CAS  Google Scholar 

  38. Henderson CJ, Panush RS: Diets, dietary supplements and nutritional therapies in rheumatic diseases. Rheum Dis Clin North Am 1999, 25:937–968. Review of nutritional supplements for rheumatic diseases.

    PubMed  Article  CAS  Google Scholar 

  39. Ammer K, Melnizky P: Medicinal baths for treatment of generalized fibromyalgia [in German]. Forschende Komplementarmedizin 1999, 6:80–85.

    PubMed  Article  CAS  Google Scholar 

  40. Dykman KD, Tone CM, Dykman RA: Analysis of retrospective survey on the effects of nutritional supplements on chronic fatigue syndrome and/or fibromyalgia. JAMA 1997, Suppl:28–31.

  41. Dykman KD, Tone CM, Ford C, et al.: The effects of nutritional supplements on the symptoms of fibromyalgia and chronic fatigue syndrome. Integrative Physiological Behav Sci 1998, 33:61–71.

    CAS  Google Scholar 

  42. Edwards AM, Blackburn L, Christie S, et al.: Food supplements in the treatment of primary fibromyalgia: a double-blind, crossover trial of anthocyanidins and placebo. J Nutrition Environ Med 2000, 10:189–199.

    Article  CAS  Google Scholar 

  43. Vickers A, Zollman C: ABC of complementary medicine: homoeopathy. BMJ 1999, 319:1115–1118.

    PubMed  CAS  Google Scholar 

  44. Jonas WB, Linde K, Ramirez G: Homeopathy and rheumatic disease. Rheum Dis Clin North Am 2000, 26:117–123.

    PubMed  Article  CAS  Google Scholar 

  45. Kramer N: Why I would not recommend complementary or alternative therapies: a physician’s perspective. Rheum Dis Clin North Am 1999, 25:833–843.

    PubMed  Article  CAS  Google Scholar 

  46. Gemmell H, Jacobson BH, Banfield K: Homoeopathic Rhus Toxicodendron in treatment of Fibromyalgia. Chiropractic J Aust 1991, 21:2–6.

    Google Scholar 

  47. Broderick JE: Mind-body medicine in rheumatologic disease. Rheum Dis Clin North Am 2000, 26:161–174.

    PubMed  Article  CAS  Google Scholar 

  48. Schuck JR, Chappell LT, Kindness G: Causal modeling and alternative medicine. Alt Ther 1997, 3:40–46.

    CAS  Google Scholar 

  49. Bennett RM, Burckhardt CS, Clark SR, et al.: Group treatment of fibromyalgia: a 6 month outpatient program. J Rheumatol 1996, 23:521–528.

    PubMed  CAS  Google Scholar 

  50. Nielson WR, Walker C, McCain GA: Cognitive behavioral treatment of fibromyalgia syndrome: preliminary findings. J Rheumatol 1992, 19:98–103.

    PubMed  CAS  Google Scholar 

  51. Goldenberg DL, Kaplan KH, Nadeau MG, et al.: A controlled study of a stress-reduction, cognitive-behavioral treatment program in fibromyalgia. J Musculoskel Pain 1994, 2:53.

    Article  Google Scholar 

  52. Loitman JE: Pain management:bBeyond pharmacology to acupuncture and hypnosis. JAMA 2000, 283:118–119.

    PubMed  Article  CAS  Google Scholar 

  53. Simms RW: Controlled trials of therapy in fibromyalgia syndrome. Bailliere Clin Rheum 1994, 8:917–934. Excellent review of complementary and alternative medicine specific to fibromyalgia.

    Article  CAS  Google Scholar 

  54. Leventhal LJ: Management of fibromyalgia. Ann Intern Med 1999, 131:850–858.

    PubMed  CAS  Google Scholar 

  55. Berman BM, Swyers JP, Ezzo J: The evidence for acupuncture as a treatment for rheumatologic conditions. Rheum Dis Clin North Am 2000, 26:103–115.

    PubMed  Article  CAS  Google Scholar 

  56. Sprott H, Franke S, Kluge H, et al.: Pain treatment of fibromyalgia by acupuncture. Rheumatology Int 1998, 18:35–36.

    Article  CAS  Google Scholar 

  57. Sandberg T, Lundeberg T, Gerdle B: Manual acupuncture in fibromyalgia: a long-term pilot study. J Musculoskel Pain 1999, 7:39–58.

    Article  Google Scholar 

  58. Deluze C, Bosia L, Zirbs A, et al.: Electroacupuncture in fibromyalgia: results if a controlled trial. BMJ 1992, 305:1249–1252.

    PubMed  CAS  Article  Google Scholar 

  59. Vickers A, Zollman C: ABC of complementary medicine: acupuncture. BMJ 1999, 319:973–976.

    PubMed  CAS  Google Scholar 

  60. Yamashita H, Tsukayama H, Tanno Y, et al.: Adverse events related to acupuncture. JAMA 1998, 280:1563–1564.

    PubMed  Article  CAS  Google Scholar 

  61. Fiechtner JJ, Brodeur RR: Manual and manipulation techniques for rheumatic diseases. Rheum Dis Clin North Am 2000, 26:83–96. Review of manipulative therapies for rheumatic diseases.

    PubMed  Article  CAS  Google Scholar 

  62. Blunt KL, Rajwani MH, Guerriero RC: The effectiveness of chiropractic management of fibromyalgia patients: a pilot study. J Manipulative Physiological Ther 1997, 20:389–399.

    CAS  Google Scholar 

  63. Ferraccioli G, Ghirelli L, Scita F, et al.: EMG-biofeedback training in fibromyalgia syndrome. J Rheum Dis 1987, 14:820–825.

    CAS  Google Scholar 

  64. Buckelew SP, Conway R, Parker J, et al.: Biofeedback/relaxation training and exercise interventions for fibromyalgia: a prospective trial. Arthritis Care Res 1998, 11:196–209.

    PubMed  Article  CAS  Google Scholar 

  65. Trock DH: Electromagnetic fields and magnets: investigational treatment for musculoskeletal disorders. Rheum Dis Clin North Am 2000, 26:51–62.

    PubMed  Article  CAS  Google Scholar 

  66. McCain GA: Controversies in fibromyalgia and related conditions: a cost-effective approach to the diagnosis and treatment of fibromyalgia. Rheum Dis Clin North Am 1996, 22:323–340.

    PubMed  Article  CAS  Google Scholar 

Download references

Author information

Authors and Affiliations

  1. University of Michigan, 1150 West Medical Center Drive, 48109-0680, Ann Arbor, MI, USA

    Leslie J. Crofford MD & Brent E. Appleton MD

Authors
  1. Leslie J. Crofford MD
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. Brent E. Appleton MD
    View author publications

    You can also search for this author in PubMed Google Scholar

Rights and permissions

Reprints and Permissions

About this article

Cite this article

Crofford, L.J., Appleton, B.E. Complementary and alternative therapies for fibromyalgia. Curr Rheumatol Rep 3, 147–156 (2001). https://doi.org/10.1007/s11926-001-0010-9

Download citation

  • Issue Date:

  • DOI: https://doi.org/10.1007/s11926-001-0010-9

Keywords

  • Systemic Lupus Erythematosus
  • Melatonin
  • Fibromyalgia
  • Chronic Fatigue Syndrome
  • DHEA