Because examination of a particular method is included in this
review, it should not be taken as a recommendation for its use.
This discussion is an exercise in reporting what is being claimed
in what appear to be responsible publications, by a wide range of
therapists and practitioners, however there is no absolute ‘quality
control’ or ability to adequately compare the accuracy of the
reports on which these discussions are based.
Cardiovascular exercise is stated to be helpful in rehabilitation
The guidelines most commonly given involve the patient
performing active aerobic exercise three times weekly (some say
four times) for at least 20 (some say 15) minutes during which
time they are required to achieve between 60 and 85% of their
maximum predicted heart rate. The methods of exercise best
suited to Fibromyalgia patients are said to be cycling (static
cycle) walking or swimming.
Appropriate warmup and warmdown periods are suggested and a
slow incremental program is needed to reach the prescribed
length and frequency of exercising. The release of hormone-like
substances (endogenous endorphins) during aerobic exercise is
thought to offer the means whereby pain relief and well-being
are enhanced, along with the obvious increased self-esteem and
psychological boost which comes with increased fitness.
A study involving 34 patients with fibromyalgia had some of the
patients perform aerobic exercise (cycle exercise which was
designed to achieve a heart rate of 150 per minute) or flexibility
exercises (achieving no more than 115 beats per minute) three
times a week for 20 weeks. At the end of this period those
patients doing the aerobic routines achieved far greater reduction
in pain than the flexibility group. People with CFS (ME) may be unable to do any exercise at all in
some stages of their illness.
See the discussion below on cognitive/behavioral treatment in
which tasks and routines (which have been agreed and
negotiated between the CFS patient and the therapist) are
performed daily with slight increments over time, whatever the
patient feels (and whether they are having a good day or a bad
day) always staying without strain.
Acupuncture in general and electroacupuncture in particular has an excellent track record in treatment of pain.
One of the leading experts in use of acupuncture in pain relief is
Dr. P. Baldry after asserting categorically that acupuncture is
certainly the treatment of choice for dealing with Myofascial Pain
Syndrome or trigger point problems states:
“The pain in Fibromyalgia, which would seem to be due to some
as yet unidentified noxious substance in the circulation giving
rise to neural hyperactivity at tender points and trigger points
takes a protracted course and it is only possible by means of
acupuncture to suppress this neural hyperactivity for short
As is clear there are other ways, however if acupuncture is used
for Fibromyalgia Baldry believes that it is necessary to repeat
treatment every 2 to 3 weeks for months or even years, which
he regards as unsatisfactory, “but nevertheless some patients
insist that it improves the quality of their lives.”
Relief from pain for weeks on end and an enhanced quality of life
would seem quite a desirable objective, perhaps helping ease the
pain burden while more fundamental approaches are dealing with
constitutional and causative issues. A Swiss research team in
Geneva has examined the effectiveness of electro-acupuncture in
treating Fibromyalgia. 70 patients (54 women) who all met the
American College of Rheumatology criteria for Fibromyalgia
received either sham acupuncture (‘wrong’ points used) or the real thing. Various methods were used for patients to record their
level of symptom activity and the amount of medication they
used before and after treatment. Sleep quality, morning stiffness
and pain were all monitored.
Over a three week period the electroacupuncture treatment was
administered with only the doctor giving the treatment knowing
whether or not the needles were being placed correctly and
whether the amount and type of electrical current being passed
through the needles was correct. Seven out of the eight
measurements showed that only the acupuncture group and not
the placebo (dummy acupuncture) group had benefits (as in all
such studies a few minor improvements are always noted in the
dummy or placebo group, but these were only slight).
The acupuncture group, after treatment, required far more
pressure on tender points to produce pain while use of pain
killing medication was virtually halved as was these patient’s
assessment of regional pain levels. There was also a significant
increase in quality of sleep. The length of time morning stiffness
was experienced only improved a small amount.
Around 25% of the treated group did not improve significantly
while all the others showed a remarkable amount of
improvement with some having almost complete relief of all
The duration of the improvement was noted to be ‘several weeks’
in most patients which seems to be in line with Dr. Baldry’s
observation of it being necessary to repeat treatment every few
The fact that there are virtually no side effects from
electroacupuncture make it attractive when compared with pain
killing and/or antidepressant medication.
Dry Needling and Injection into Trigger Points
There have been few clinical trials involving bodywork in treating
fibromyalgia however there is abundant evidence of the
successful use of various methods for treating trigger points including injection of saline of procaine or even of simply ‘dry
needling’ the trigger points. In one study 46% of those people
with MPS treated found that this approach offered them the
longest lasting relief of symptoms compared with other forms of
treatment they had received. 69% required less medication for
some time afterwards.
There is a mass of anecdotal reporting of benefit from use of
chiropractic in treatment of Fibromyalgia and CFS (ME). Few
clinical studies support these claims but since the manipulative
methodology of osteopathy and chiropractic have become ever
closer, and since the methods of osteopathy which focus on
muscles notably Strain Counterstrain and Muscle Energy
Technique are now widely used by massage therapists, and since
there are indeed clinical studies involving osteopathic
manipulative therapy (OMT) and massage, see below, it is safe to
assume that the anecdotal claims are accurate.
Those forms of chiropractic which focus on muscles, such as
Morter Bio Energetic Synchronization Technique (BEST) are more
likely to be helpful in Fibromyalgia cases than the more active
adjustment methods although these do have their place when
joint restrictions are a feature.
It is generally agreed that the difference between CFS (ME) and
Fibromyalgia are marginal at best and that many, probably most,
patients in each category could just as easily be diagnosed as
having the other condition/diagnosis.
One model of these conditions suggests that whatever the trigger
(trauma, viral infection, toxicity etc) there need also to be
perpetuating factors such as emotional stress, inadequate rest
patterns, concurrent depression etc. The treatment approach
suggested would tackle the behavioral and cognitive aspects,
using agreed (between therapist and patient) targets for
changing the behavior pattern which has become established by
the illness. Careful planning and preparation are required with a lot of
attention to engaging the patient in the process of recovery. The
patient is not led to believe that this is all there is to treatment
but is encouraged to see that while underlying factors (viral or
yeast infection etc) are being dealt with the perpetuating factors
can begin to be modified. A gradual increase in activity is the aim
with equally gradual reduction in rest periods and time.
The key to success is not to do too much too soon, staying within
what is a manageable level for the patient. A structured schedule
evolves via negotiation and discussion over 20 to 30 sessions.
The same degree of activity is suggested on good and bad days,
with perhaps no increase in activity initially but a structured
pattern emerging. Very gradually activity increases and
responsibility for what happens is transferred fully to the patient.
Does it work? Some claim it does but it takes dedication on
There have been no clinical trials involving herbal treatment of
Fibromyalgia however at least one very well researched herb is
being used clinically to help circulation to the brain: Ginkgo
biloba (see above).
In addition leading herbalists are on record as claiming benefits
from an approach which tries to ‘support the nervous system
with herbal nerve tonics and adaptogens’ (substances which help
the body cope with stress).
Additionally herbal methods try to help the defense mechanisms
by using known immune system enhancers such as echinacea,
astragalus and ginseng. Various nervine herbs would also be
included in a combination aimed at helping normalize sleep
A herbal combination formula is suggested which consists of:
· 2 parts Panax quinquefolium (American Ginseng) · 2 parts Astragalus mongolicus
· 2 parts Angelica sinensis (Dong quai)
· 1 part Ginkgo biloba
· 1 part Cimicifuga racemosa (Black cohosh)
· 1/2 part passiflora incarnata (Passion flower)
· 1/2 part Betonica officinalis (Wood betony)
· 1/2 part Matricaria chamomila (Chamomile)
· 1/2 part Zizyphus sativa (Jujube red dates)
This formulation is claimed to be a tonic which will support
people with chronic weakness, anxiety, headaches, sleep
disturbances and general fatigue as well as diminished blood flow
to the extremities. The person who needs this will probably have
a weak pulse, weak digestive system, have headaches and will
be fatigued. A dose of between half and one teaspoon (infusion)
two or three times daily taken between meals is suggested.
Several studies have looked at the effects of a specific
homoeopathic remedy Rhus Tox in treating Fibromyalgia and
‘fibrositis’ with varying results.
Although treatment of painful rheumatic conditions by
homeopathy often involves the use of Rhus tox it is therefore not
suitable for all people with such conditions, but only those with
the profile of the medicine.
The ideal person for using Rhus tox is: Restless, continually
changing position, having a great deal of apprehension especially
at night and finds it difficult to stay in bed. The head will feel
heavy, and the jaws may be noisy, creaking, with TMJ pain. The tongue tends to be coated except for a red triangular area
near the tip and there is a frequently bitter taste in the mouth
and a desire for milky drinks. There is often a drowsy feeling
There may be a nagging dry cough and a sense of palpitation
most noticeable when sitting still. The back tends be stiff and
normally feels better for moving about; limbs are stiff and any
exposure to cold makes the skin feel sensitive or painful.
Cold, wet weather makes symptoms worse as does sleep and
resting. What helps most as far as symptoms are concerned is
warm, dry weather, movement, rubbing the uncomfortable
areas, warm applications and stretching. The remedy is Rhus tox
in the 6C potency.
Trials – In Britain a study found that using the 6C dilution of Rhus
Tox was effective in moderating the symptoms of patients with
Fibromyalgia whereas a trial in the Australia, involving just three
patients who fitted all the criteria including the profile for Rhus
tox, there was no benefit when a 6X dilution was used.
The difference between 6X and 6C may seem unimportant, but
the dilution difference if enormous.
With one study using Rhus tox 6C and claiming marked benefits
for Fibromyalgia patients and one using Rhus tox 6X showing no
benefit, the jury is still out. However since there is absolutely no
chance of side effects with homeopathy there is little to be lost in
trying, but try the 6C first.
In controlled trials it has been found that hypnotherapy helps
more than physical therapy in those patients who do not seem to
respond well to most other forms of treatment. Pain is reduced,
fatigue and stiffness on waking is improved and general feeling of
The most widespread treatment approach to Fibromyalgia
involves the use of various pharmacological agents and it is
useful to evaluate the results of studies as to their efficacy.
Tricyclic antidepressant medications increases the amount of
serotonin in the central nervous system and increases the deltawave sleep stage and is found to consistently improve the
symptoms of fibromyalgia, though not by acting as an antidepressant and not in all patients treated.
Studies involving various forms of antidepressant medication
tend to support use of Amitripyline (25 to 50mg daily) with pain
scores, stiffness, sleep and fatigue all improving on average but
by no means in all patients.
In one study 77% of Fibromyalgia patients receiving Amitripyline
reported general improvement after 5 weeks as against only
43% of those receiving placebo medication. Side effects from the
antidepressant were however measurable with a selection of
drowsiness, confusion, seizure, agitation, nightmares, blurred
vision, hallucinations, uneven heartbeat, gastrointestinal upsets,
low blood pressure, constipation, urinary retention, impotence
and mouth dryness all being observed or reported.
When combined with osteopathic manipulative methods (mainly
soft tissue techniques – see below) anti-depressant medication
offered greater relief.
A study involving the use of systemic corticosteroids (prednisone
15mg daily) showed that there were no measurable
improvements, and since side effects with such medication is
usual this approach is clearly not desirable. Indeed if it were to
produce an improvement it would be sensible to question
whether fibromyalgia was indeed the correct diagnosis. Some
other rheumatic condition is a more likely to improve
symptomatically with its use.
When muscle relaxants were tested in Fibromyalgia patients
most were found to be useless but cyclobenzaprine was found to
improve pain levels, sleep and tender point count (10 to 40 mg
daily given at night to prevent daytime drowsiness) and this is
thought to be because it has a chemical similarity to Amitripyline. Many other drugs are currently being researched and tried in
treatment of Fibromyalgia ranging from antiviral agents to
substances which modulate the immune system. Various
cocktails of antidepressant and sedative medications are being
tried out as well. Even aspirin has been tried and is said to be
Osteopathic medicine, from which both SCS
(Strain/Counterstrain) and Muscle Energy Technique (MET)
derive, has conducted many studies involving Fibromyalgia,
1. Doctors at Chicago College of Osteopathic Medicine let by
Drs. A. Stotz and R. Keppler measured the effects of osteopathic
manipulative therapy (OMT – which includes SCS and MET) on
the intensity of pain felt in the diagnostic tender points in 18
patients who met all the criteria for Fibromyalgia.
Each had six visits/treatments and it was found over a one year
period that 12 of the patients responded well in that there tender
points became less sensitive (14% reduction in intensity as
against a 34% increase in the six patients who did not respond
well) Most of the patients, the responders and the nonresponders to OMT, showed that there tender points were more
symmetrically spread after the course (using thermographic
imaging) than before. Activities of daily living were significantly
improved and general pain symptoms decreased overall.
2. Doctors at Texas College of Osteopathic Medicine selected
three groups of Fibromyalgia patients, one of which received
OMT, another had OMT plus self-teaching (learning about the
condition and self-help measures) and a third group received
only moist-heat treatment. The group with the least reported
pain after six months of care was that receiving OMT, although
some benefit was noted in the self-teaching group.
3. Another group of doctors from Texas tested the difference
in results involving 37 patients with Fibromyalgia of using a/ drugs only (ibuprofen, alprazolam) or b/ OMT plus medication c/
a dummy medication (placebo) plus OMT or d/ a placebo only.
The results showed that drug therapy alone resulted in
significantly less tenderness being reported than did drugs and
manipulation or the use of placebo and OMT or placebo alone.
Patients receiving placebo plus manipulation reported
significantly less fatigue than the other groups. The group
receiving medication and OMT showed the greatest improvement
in their quality of life.
4. 19 patients with all the criteria of Fibromyalgia were treated
once a week for four weeks at Kirksville, Missouri College of
Osteopathic Medicine using OMT. 84.2% showed improved sleep
patterns, 94.7% reported less pain and most patients had fewer
tender points on palpation.
Magnesium is often found to be deficient in people with
Fibromyalgia/CFS (ME). In a study 15 patients with Fibromyalgia
were supplemented with 300 to 600mg daily of magnesium and
1200 to 1400mg per day of malic acid.
Pain levels were greatly reduced. Benefits took some weeks or
even months to be noticed.
This study replicates a previous study which showed that
magnesium deficiency was a feature of many patients with
Additional supplementation strategies which are recommended
after clinical study include use of vitamin B3 and B6 which
together with magnesium and tryptophan (obtainable from a
good protein meal) are needed to manufacture serotonin.
The amino acids ornithine and arginine can be used to promote
Growth Hormone production. Calcium and zinc supplementation
is commonly found to help sleep patterns return to normal. General nutritional status support can usefully include
supplementation with B-complex and vitamin C as well as
essential fatty acids derived from flaxseeds or evening primrose.
Dr. Travell(17) has confirmed that a variety of factors can all
help to maintain and enhance trigger point activity: nutritional
deficiency especially vitamins C, B-complex and iron; hormonal
imbalances (low thyroid hormone production, menopausal or
premenstrual situations); infections (bacteria, viruses or yeast);
allergies (wheat and dairy in particular); low oxygenation of
tissues (aggravated by tension, stress, inactivity, poor
Vibrational Therapy (Massage/Percussion Analgesia)
Rapid low level vibration has been shown to provide a speedy,
safe and effective method for easing pain. A hand held vibrator is
suitable for this purpose and may require firm pressure contact
of the vibrator for up to half an hour before relief is strongly
noticed. Vibration (100 to 200 cycles per second) should continue
for 45 minutes at least. Relief of even chronic pain can last for
many hours and in some instances for days. A high frequency
works best (100Hz) if applied near to or below the area of pain
(or according to Richard van Why to an antagonistic muscle or
directly to a trigger point or reference zone).(18)
Manually applied vibration or rhythmic rocking (‘Harmonic
Technique’19) is extremely soothing and helpful in chronic pain
conditions with a tradition going back to the American Civil War
where the method was used to help the pain of amputees.
Research at the University of California, Irvine, has shown that
when a range of physical methods were tested in treatment of
myofascial pain including placebo ultrasound, spray and stretch,
hydrocollator, real ultrasound and massage (ischemic
compression/NMT) it was massage which came out ahead in
providing immediate relief. (20)
1. McCain G Role of physical fitness training in
fibrositis/fibromyalgia syndrome American Journal of Medicine
1986 (supplement 3A)pp73-77
2. Dr. P. Baldry Acupuncture, Trigger Points and Musculoskeletal
Pain (Churchill Livingstone, Edinburgh, 1993
3. DeLuze C et al Electroacupuncture in fibromyalgia British
Medical Journal 21 October 1992 pp1249-1252
4. Sandford Kiser R et al Acupuncture relief of chronic pain
syndrome correlates with increased plasma metenkephalin
concentrations Lancet 1983;ii:1394-1396
5. Beck A et al Cognitive therapy in depression Guildford press
New York 1979
6. Deale A Wessley S Cognitive-behavioral approach to CFS The
Therapist 2(1)1994 pp11-14
7. Kacera W Fibromyalgia and chronic fatigue – a different strain
of the same disease? Canadian Journal of Herbalism October
1993 Vol.XlV no lV pp20-29
8. Fisher P et al Effect of homoeopathic treatment of fibrositis
(primary fibromyalgia) British Medical Journal 32pp365-366 1989
9. Gemmell H et al Homoeopathic Rhus Toxicodendron in
treatment of Fibromyalgia Chiropractic Journal of Australia Vol.21
No1 March 1991pp2-6
10.Haanen H et al Controlled trial of hypnotherapy in treatment
of refractory fibromyalgia Journal of Rheumatology 18pp72-75
11. Goldenberg D et al Randomized, controlled trial of
Amitripyline anproxine in treatment of patients with fibromyalgia
12. Clark S et al Double blind crossover trial of prednisone in
treatment of fibrositis J Rheumatol 1985;12(5)pp980-983 13. Campbell S et al A double blind study of cyclobenzaprine in
patients with primary fibromyalgia Arthritis Rhem 1985;28:S40
14. Carette S et al Evaluation of Amitripyline in primary fibrositis
Arthritis Rhem 1986:29pp655-659
15a. Stoltz A Effects of OMT on the tender points f Fibromyalgia
Report in Journal of American Osteopathic Association 93(8)p866
15b. Jiminez C et al Treatment of Fibromyalgia with OMT and
self-learned techniques Report in Journal of American
Osteopathic Association 93(8)p870 August 1993
15c. Rubin B et al Treatment options in fibromyalgia syndrome
Report in Journal of American Osteopathic Association
90(9)September 1990 pp844-5
16. Abraham G et al Management of Fibromyalgia – rationale for
the use of magnesium and malic acid Journal of Nutritional
Medicine 3:49-59 1992
17. Travell J Simons D as cited previously.
18. van Why R ‘Fibromyalgia and Massage’ symposium notes
19. Lederman E DO Harmonic Tecnique Arnica House London
20. Hong C-Z et al Immediate effects of various physical
medicine modalities on pain threshold of active myofascial trigger
points. J Musculoskeletal Pain 1(2)pp37-53 1993
©1995 Leon Chaitow N.D., D.O., MRO.