Nondrug Treatments
Even if you are taking medications, they won’t provide enough relief or the side effects will be intolerable. You need to consider alternative therapies to get your fibromyalgia under control. For approaches that specifically target the painful knots in your muscles, see our section on Muscle Pain Relief. This section includes all the other nondrug treatments for fibromyalgia.
Massage
Patients rate professional massage as their top nondrug therapy for easing the discomfort of fibromyalgia. Massage relieves pain, anxiety and depression in people with fibromyalgia, while promoting better quality sleep, according to multiple studies.1
Keep in mind there are many forms of massage. In addition, there are two main drawbacks of this alternative therapy for fibromyalgia. First, you need to find a therapist experienced in treating this condition. Second, the cost for multiple sessions adds up because massage is not covered by insurance.
Pros & Cons
| Massage Pros: #1 nondrug therapy endorsed by patients Cons: Cost, finding a therapist |
| Heat Wraps Pros: Cheap, easy, no side effects Cons: Targets only one area |
| Spa Therapy/ Balneotherapy Pros: Inexpensive DIY approach Cons: Prescription therapy best but not offered in the US |
| Acupuncture Pros: Helps 1/3 of Patients Cons: Cost; takes 7-8 sessions |
| TENS Pros: Cheap & often helpful Cons: Can build up tolerance |
| Brain Stimulation Pros: Mild side effects Cons: Cost, needs more research |
| Occupational Therapy Pros: A few sessions can benefit you lifelong Cons: Cost may need a referral |
| Cognitive Behavioral therapy Pros: Once learned, the benefits persist Cons: Cost, finding a therapist |
Rather than going for full-body treatments, find a therapist who will give you 15-minute sessions at a reduced rate. Ask them to focus on your neck region using medium pressure. Applying this approach in fibromyalgia patients demonstrated improvements in pain, sleep, fatigue, and mood.2 Once you know how you respond, your therapist can increase the pressure, if needed.
If you want to try massage, start with one or two sessions per week. Most patients notice improvements within 2-3 treatments. If you opt for 30-minute sessions, ask your therapist to treat your shoulders and back (in addition to your neck).
Theoretically, massage reduces muscle tension and improves blood flow (which is impaired in fibromyalgia). This can lead to the release of pain-sensitizing chemicals that are trapped in your knotted muscles. For best results, drink plenty of water after your massage to flush out the chemicals. If you notice increased pain following the session, take a hot show or bath to soothe sore muscles.
Despite its potential for providing relief, the cost can be a deal-breaker. Inexpensive alternatives include using a hand-held massager or asking your significant other for help. Learning a self-massage is another option. If you occasionally visit a therapist, they can give you tips for a home program to use between visits.
Heat Wraps
Heat relaxes the muscles and relieves pain, thus it’s an easy-to-use nondrug treatment for fibromyalgia. You can make a microwaveable heat wrap by filling up a large sock with rice (not the instant type) and tying off the end. Or you can purchase a Bed Buddy Neck and Shoulder wrap from Amazon for $30. Although a hot bath or shower often provide instant pain relief, heat wraps are more convenient.
Heat may be soothing to the area it’s applied, but you have pain everywhere and you can’t live in a hot tub. So, if you are curious whether a regional heat wrap can tone down your body-wide pain, read more.
Spa Therapy or Balneotherapy
A prescription for three to four weeks of spa therapy is common for painful disorders in European countries. Balneotherapy is a form of spa treatment that makes use of natural mineral waters, such as the Dead Sea. Both nondrug treatments (spas and balneotherapy) show favorable results in people with fibromyalgia.
Full-body submersion in warm water (often with minerals) is much more effective than applying a heat wrap to one area. In fact, daily spa therapy effectively reduces pain, such that patients can increase exercise levels without incurring more pain. Other aspects of these programs may include mud packs, massage, and education about fibromyalgia. However, the key seems to be the application of whole-body heat. Why? Because these “add-on” approaches are not as effective when performed as a solo treatment.
If you are concerned that you don’t have the money for a hot tub with jets, don’t be. A study in fibromyalgia patients shows that the fancy jets are not as important submersing the body in warm water. In fact, warm water appears to reduce the strain on chest wall muscles and significantly improves lung function. If you feel out of breadth all the time, read more.
Most patients achieve significant improvements in function and fatigue, in addition to the reductions in pain. Better yet, the benefits tend to last up to six months after the last spa session. If you are curious about how spa therapy works and steps you can take to set up a “do it yourself” spa therapy home program, read more.
Acupuncture
This alternative therapy for fibromyalgia involves the insertion of tiny needles into specific locations to improve the body’s energy flow. Traditional Chinese Medicine protocol involving 12 acupuncture points offers a significant improvement in pain, function, and fatigue in about 40 percent of patients.3 Acupuncture exerts a systemic impact because body regions that are not treated with needles still show a reduction in pain.
There are many theories about how and why acupuncture relieves the symptoms of fibromyalgia. For starters, it raises the blood levels of pain-relieving substances while it reduces the levels of those that amplify pain. In addition, brain imaging shows it improves how the pain control system in the brain works.
It takes about eight weekly, 30-minute treatment sessions to reap a 30 percent reduction in pain.4 Only 40 percent of fibromyalgia patients respond to this therapy but most insurance companies cover acupuncture. Treatments can be halted for three-month periods to save money, but pain relief drops in half during this time. If you are interested in trying acupuncture, read more.
Transcutaneous Electrical Nerve Stimulation (TENS)
Small hand-held TENS units deliver an electrical current through electrode pads attached to the skin (a mild adhesive is used). The electrical current stimulates the nerves beneath the skin to increase endorphin (e.g., opioid) production to relieve pain. The cost is $40 to $80. The pads can be reused several times (new ones are inexpensive).
Roughly four out of ten fibromyalgia patients respond favorably to this nondrug treatment with a 30 percent drop in pain.5 The unit shown is an Auvon Dual Channel, it’s rated well and costs only $40. If you are interested in giving TENS a try, read more.
Brain Stimulation
While TENS units use an electrical current to reduce the pain you feel in your muscles, more sophisticated devices work at the level of the brain.
Some of your brain areas are overly active, while others are underperforming. It’s this lack of coordinated effort between brain centers that contributes to your symptoms. For details, see the article Chaos in the Brain. If only you could tune your brain like tuning a musical instrument. The net result would be less pain, improved ability to think, and a reduction in other symptoms. These are the goals of brain stimulation therapies, but most are only available in a research setting.
Most forms of brain stimulation therapies are undergoing design improvements and require patients to attend a research facility for treatment. On the other hand, cranial electrical stimulation or CES uses a device that you purchase and use at home. To read about its potential benefits and drawbacks, read more.
Occupational Therapy (OT)
How you move your body impacts your pain and fatigue levels. It’s easy to fall prey to using the same set of muscles for doing tasks, but this over-taxes them and leads to more pain. Occupational therapy (OT) teaches you how to move more ergonomically without straining your muscles. Therapists can also help you identify ways to conserve energy so that you don’t feel drained before noon!
This type of alternative therapy requires only a few visits to a therapist. If your insurance company does not cover OT, enquire about getting help from a physical therapist (PT). If insurance coverage is not an option, many OTs and PTs give discounts to patients who pay with cash.
Not convinced that OT can benefit you? Research shows that contacting shoulder muscles in fibromyalgia patients also leads to increased pain in the legs. In other words, over-using one muscle group spreads the pain to others. Read more to understand why and learn what steps you can take to manage your fibromyalgia pain. In a separate study, patients were asked to lift a few light-weight canisters. The repetitive action led to enhanced body-wide pain. Read more.
Cognitive Behavioral Therapy (CBT)
Behavioral therapy implies you are doing something to cause your symptoms. Not true! A better term would be Pain and Stress Management, because the end goal is to get a handle on your pain and identify stressors that make you feel worse.
Much of what goes wrong in fibromyalgia occurs in the brain’s pain processing centers. Brain imaging studies show that stress, anxiety, and depressed mood all feed into these brain centers to magnify your symptoms. CBT helps you learn ways to minimize the negative impact your emotions have on your health. Once you master the skills of CBT, the benefits remain. It’s not like a drug that tends to lose effectiveness over time.
How much improvement in pain can you expect from a series of CBT sessions? An analysis of several studies involving this nondrug treatment in fibromyalgia patients shows the average improvement is 10 percent.6 CBT may work by reducing the body’s stress responses, leading to less interruption of sleep.7 In addition, brain imaging in fibromyalgia patients shows CBT reduces activity of areas that magnify your perceptions of pain.8 As a result, you may not be as bothered by your pain.
Five to six weekly sessions are usually required. Group sessions are ideal because they cut the cost and you can learn from others in the class. The CBT course does not have to be specific for fibromyalgia; the focus can be for people with chronic, painful conditions. Contact organizations and hospitals in your community to ask if they offer CBT classes.
Another option is The University of Michigan’s online program called PainGuide. It’s free, and you can go through it at your own pace.
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References for Fibromyalgia Alternative Therapies
- Li YH, et al. PLOS One 9(2):e89304, 2014. Free Report
- Nadal-Nicolas Y, et al. Int J Environ Res Public Health 17(12):4611, 2020. Free Report
- Di Carlo M, et al. Evidence-Based CAAM Article ID 9991144, 2021. Free Report
- Di Carlo M, et al. Clin Exp Rheumatol 41:1254-1261, 2023. Free Report
- Dailey DL, at al. J Pain 7(7):1268-1281, 2022. Abstract
- Bernardy K, et al. Cochrane Database Syst Rev 13(9):CD009796, 2013. Free Report
- Prados G, et al. Brain Sci 12:947, 2022. Free Report
- Lee J, et al. Arthritis Rheumatol 76(1):130-140, 2024. Abstract