Fibromyalgia treatment

Treatment for fibromyalgia aims to ease your symptoms and help you get back to the things that matter to you. No single treatment works for everyone. Most people find that a mix of approaches works best.

In England and Wales, doctors follow guidance from NICE (the National Institute for Health and Care Excellence). NICE guideline NG193 covers long-term pain, including fibromyalgia.

Exercise and movement

Exercise may be the last thing you feel like doing, but gentle, regular activity is one of the most helpful treatments. It can reduce pain, improve sleep and lift your mood over time.

NICE recommends offering supervised group exercise programmes for long-term pain. Things that people with fibromyalgia often find helpful include:

• exercise in a warm water pool (hydrotherapy)
• walking, starting with a few minutes a day
• tai chi, yoga or Pilates, at a gentle level
• stretching to ease stiffness

The key is to start low and go slow. Do a little less than you think you can, and build up over weeks, not days. A physiotherapist can help you plan this.

Talking therapies

Living with pain affects your mood, sleep and relationships. Talking therapies do not mean your pain is "in your head". They help you cope with the effects of pain and break unhelpful cycles.

NICE recommends offering:

• acceptance and commitment therapy (ACT), which helps you live a full life alongside pain
• cognitive behavioural therapy (CBT) for pain, which helps you change patterns of thinking and doing

In England, you can refer yourself to NHS Talking Therapies without seeing a GP. In Wales, ask your GP about local services.

Pain management programmes

Some areas offer pain management programmes. These are group courses, often run by a team of physiotherapists, psychologists and nurses. They teach skills like pacing, relaxation and goal setting. Ask your GP or pain clinic if one is available near you.

Medicines

NICE says an antidepressant can be considered for adults with long-term pain like fibromyalgia, even if you are not depressed. At lower doses, some antidepressants can help with pain and sleep. The ones NICE names are:

• amitriptyline
• duloxetine
• citalopram, fluoxetine, paroxetine or sertraline

Your doctor will talk to you about the possible benefits and side effects before you start.

Medicines NICE advises against starting

For long-term pain with no other known cause, NICE advises doctors not to start these medicines, because the evidence shows they are unlikely to help and may cause harm:

• paracetamol
• anti-inflammatory painkillers, such as ibuprofen
• opioids, such as codeine, tramadol or morphine
• gabapentin and pregabalin
• benzodiazepines, such as diazepam

Acupuncture

NICE says a short course of acupuncture can be considered for long-term pain, as long as it is given by a trained health professional and within set limits. It is not available on the NHS everywhere.

Other things that can help

• Heat, such as warm baths, heat pads and hot water bottles
• Pacing, which means balancing activity and rest (see living well with fibromyalgia)
• Good sleep habits, like a regular bedtime and a dark, cool room
• Relaxation, such as breathing exercises or mindfulness
• Support groups, where you can talk to people who understand

If treatment is not helping

Tell your GP. You could ask about:

• trying a different medicine or dose
• a referral to a physiotherapist, pain clinic or pain management programme
• a referral to a talking therapy service

Next, read about living well with fibromyalgia.