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Fibromyalgia

Long-lasting pain all over the body, with fatigue, poor sleep and trouble thinking clearly. Fibromyalgia is real — the nervous system turns up pain signals — and while there is no cure, gentle, steady movement and a good care plan help many people feel and function better.

New symptoms that don’t fit fibromyalgia need checking. Fibromyalgia does not cause tissue inflammation (NIAMS), and swollen joints may point to arthritis instead (NHS), so don’t put everything down to it. Ask for an urgent appointment if a joint is swollen and the skin around it feels hot, or if joint pain comes with a high temperature or feeling generally unwell (NHS). See your provider if you keep losing weight without changing what you eat or how active you are (NHS). Numbness and tingling can be part of fibromyalgia (NIAMS), but call 911 right away for sudden numbness or weakness in the face, arm or leg (especially on one side), sudden trouble seeing, speaking or walking, or sudden confusion — these can be signs of a stroke (CDC).

If you are thinking about suicide, call or text 988 to reach the 988 Suicide & Crisis Lifeline — free, confidential and open 24/7 (988 Lifeline). CDC lists serious illness such as chronic pain among the things that can raise suicide risk (CDC). Living with pain every day is hard, and you deserve support.

What is fibromyalgia?

Fibromyalgia is a chronic (long-lasting) disorder that causes pain and tenderness throughout the body, along with fatigue and trouble sleeping (NIAMS). It is not an inflammatory or autoimmune disease, and it doesn’t show up on x-rays or blood tests (ACR). There is no cure, but treatment can relieve symptoms (MedlinePlus). Fibromyalgia can reduce quality of life and make everyday activities hard (CDC, NIAMS).

Symptoms

It is real — not “all in your head”

People with fibromyalgia have an increased sensitivity to pain, so they feel pain when others do not. Brain imaging studies and other research have found altered signaling in the nerve pathways that send and receive pain, and these changes may also add to the fatigue, sleep troubles and fibro fog (NIAMS). CDC calls this “abnormal pain perception processing” (CDC). CDC’s 2022 pain guideline gives fibromyalgia as an example of “nociplastic” pain, a suggested category in which the central nervous system’s processing of pain and other sensations is heightened (CDC, 2022). Some researchers describe this as central sensitization (systematic review, Pain Physician, 2020). The ACR adds that brain chemicals such as serotonin and norepinephrine may be off balance (ACR).

Normal test results don’t mean nothing is wrong: fibromyalgia doesn’t cause any abnormalities on x-rays or blood tests (ACR). Not all providers are familiar with it, so it helps to find one who treats it (MedlinePlus).

How common is it, and who gets it?

Millions of people in the United States have fibromyalgia. It affects people of all ages, including children, but is most common in adults (CDC). More women get it than men; it usually starts in middle age, the chance of having it rises with age, and it occurs in people of all racial and ethnic backgrounds (NIAMS). People aged 30 to 50 and people with a family history of it are also more likely to develop it (CDC).

What causes it?

The cause is not known (NIAMS). Fibromyalgia tends to run in families, so genes likely play a part, but it also occurs in people with no family history. Researchers believe environmental triggers matter too — for example, having a disease that causes pain, such as rheumatoid arthritis, or mental health problems such as anxiety or depression (NIAMS). CDC lists possible risk factors or triggers including stressful or traumatic events, accidents or injuries, repeated injuries such as joint stress from sports or physical jobs, and illnesses including viral infections (CDC).

How it is diagnosed

There are no specific laboratory or imaging tests for fibromyalgia. Diagnosis rests mainly on having pain all over the body along with other symptoms, found through your medical history and an exam (NIAMS).

The ACR criteria. In 2010 the American College of Rheumatology (ACR) published diagnostic criteria that do not require a tender-point exam. They combine a count of painful body regions (the widespread pain index) with a symptom severity scale that scores thinking problems, unrefreshing sleep, fatigue and other body symptoms (Wolfe et al., Arthritis Care & Research, 2010). A 2016 revision combined the doctor-based and questionnaire versions and removed a confusing recommendation about excluding other diagnoses. It also says the self-report questionnaire is meant for research, not for diagnosing an individual — so an online quiz can’t tell you whether you have fibromyalgia (Wolfe et al., Seminars in Arthritis and Rheumatism, 2016).

Ruling out other conditions. Because pain and fatigue are common in many illnesses, doctors try to rule out other causes (NIAMS). Blood tests and x-rays can check for problems such as thyroid disease or diseases driven by inflammation (ACR). Your doctor will examine your joints for signs of another condition, such as rheumatoid arthritis or lupus (NIAMS), and urine tests or scans may also be used (NHS). A sleep specialist can look into problems such as sleep disorders (NIAMS). Having another condition doesn’t rule fibromyalgia out — you can have both — and conditions such as depression, anxiety and irritable bowel syndrome may need their own tests and treatment (NHS).

Conditions that often come with it

People with rheumatoid arthritis, lupus, ankylosing spondylitis, osteoarthritis, depression or anxiety, chronic back pain or irritable bowel syndrome are more likely to have fibromyalgia (NIAMS), and people with fibromyalgia are more likely to have major depression (CDC). Some people have two or more chronic pain conditions at once — such as chronic fatigue syndrome, endometriosis, irritable bowel syndrome, interstitial cystitis, temporomandibular joint (TMJ) problems and vulvodynia — and it isn’t known whether they share a cause (NCCIH). Headaches, including migraines, are common too (MedlinePlus).

See our guides to Arthritis, Depression, Anxiety, Back Problems and Chronic Fatigue & ME/CFS. Guides to Lupus, Irritable Bowel, TMJ, Headaches and Sleep Problems are on the way.

What to expect over time

Fibromyalgia is a long-term condition. Its symptoms are changeable — they can sometimes suddenly improve or get worse — and treatment can ease some symptoms, though they are unlikely to disappear completely (NHS). Finding the right mix of treatments can take time, and improvement is often gradual (NIAMS). Most people are cared for by their primary care provider, often with a team that may include a rheumatologist, physical therapist, mental health professional and sleep specialist (NIAMS, CDC).

Side by side

Six approaches compared

For every condition we look at the same six approaches: what each involves, what it typically costs, and what a patient can realistically expect.

ApproachWhat it involves Estimated costWhat to expect
Conventional medicine (AMA) Education and exercise first, then talk therapy (CBT), sleep care and medicines if needed: the FDA-approved pregabalin, duloxetine, milnacipran and Tonmya (cyclobenzaprine under the tongue), or other antidepressants, anti-seizure medicines and pain relievers. Opioids are not recommended. Physical therapy about $50–$350+ a session without insurance ($10–$75 copay with). Medicare Part B covers medically necessary PT (20% coinsurance after the deductible). Doctor visits and medicines: cost estimate being researched. No cure, and most treatments help modestly. Exercise has the strongest evidence. You may need to try different medicines or combinations, and improvement is often gradual.
Chiropractic Spinal manipulation and soft-tissue work, sometimes offered for fibromyalgia pain. About $50–$200 a visit without insurance (average about $125); $15–$75 with insurance. Medicare Part B covers only spinal adjustment for subluxation. Limited, mostly low-quality evidence. Reviews found no established benefit; one small 2023 trial reported less pain at 3 months. Mild soreness afterward is common. Not a replacement for exercise.
Acupuncture Needle acupuncture or electroacupuncture, alongside exercise and medical care. About $125–$230 for a first private visit and $90–$185 for follow-ups; community clinics about $50–$90. Medicare covers acupuncture only for chronic low back pain. Low- to moderate-quality evidence that it eases pain and stiffness compared with no treatment, but in a Cochrane review it was no better than sham acupuncture. Electroacupuncture may work better. Benefits lasted about a month.
Herbal medicine No herb or supplement is proven for fibromyalgia. Vitamin D only if a blood test shows you are low. Cannabis and CBD are not well studied for it. Cost estimate being researched. Small studies suggest vitamin D may ease pain in people who are deficient. Supplements can interact with fibromyalgia medicines — St. John’s wort with antidepressants can cause serious serotonin-related side effects.
Massage therapy Gentle massage or myofascial release, continued for several weeks. About $50–$90 for 45–60 minutes at clinics, gyms and spas, or $60–$120 with a private therapist. Reviews suggest short-term relief of pain, anxiety and depression when continued for at least 5 weeks, but not better sleep; the evidence is limited. Massage should not hurt — start gentle.
MBHA Wellness Coach Pacing, a start-low, go-slow movement plan (walking, water exercise, tai chi, yoga), sleep habits, stress skills, finding a self-management program, and mood support. Cost estimate being researched. Supports — never replaces — medical care. Regular exercise is one of the most effective treatments for fibromyalgia, and steady habits pay off gradually.

Approach 1 of 6

Conventional medicine (AMA)

There is no cure for fibromyalgia, so treatment focuses on relieving symptoms. Most plans combine psychological and behavioral therapy, medicines, and self-management such as exercise and other movement therapies like yoga or tai chi (NIAMS). The aim is to ease symptoms and improve your quality of life (NHS).

1. A step-by-step plan, starting with exercise

In the European (EULAR) recommendations published in 2016, exercise was the only treatment to earn a “strong for” recommendation. The experts suggest starting with education and non-drug therapies, then tailoring care if needed: psychological therapies for mood problems or unhelpful coping, medicines for severe pain or sleep problems, and multimodal rehabilitation for severe disability. Most treatments have relatively modest effects (EULAR recommendations, Annals of the Rheumatic Diseases, 2017). CDC’s 2022 pain guideline likewise finds high-quality evidence that exercise therapy for fibromyalgia reduces pain and improves function for at least 2 to 6 months (CDC, 2022). See Movement that helps below.

2. Cognitive behavioral therapy (CBT)

CBT is a talk therapy that can help you cope with negative thoughts about your symptoms (CDC). It teaches skills for better controlling pain and can be especially helpful combined with other treatments, one-on-one or in groups (NIAMS). It can help you learn strategies to deal with pain, stress and negative thoughts, and help with depression if you have it too (MedlinePlus). Using CBT doesn’t mean your pain is imagined — it is a set of skills for living with a real condition.

3. Medicines

  • FDA-approved for fibromyalgia: duloxetine, milnacipran and pregabalin (ACR, CDC, 2022). Duloxetine and milnacipran are SNRI antidepressants; pregabalin is an anti-seizure medicine (CDC, 2022).
  • Tonmya, a tablet of cyclobenzaprine that dissolves under the tongue, was approved by the FDA on August 15, 2025 for fibromyalgia in adults (FDA approval letter, 2025). Its label warns of possible serotonin syndrome with other drugs that affect serotonin, drowsiness that can affect driving, mouth numbness or tingling, and possible birth defects if taken around conception or in early pregnancy. It is not for people taking MAO inhibitors, or with certain heart problems or an overactive thyroid (FDA-approved label).
  • Other medicines used include other antidepressants (some work for fibromyalgia even if you aren’t depressed), other anti-seizure medicines and pain relievers (NIAMS). The ACR also lists cyclobenzaprine, the medicine in Tonmya, among drugs that can help (ACR). Anti-inflammatory medicines usually don’t help fibromyalgia itself, because it doesn’t inflame tissue, though they may help other painful conditions you have (NIAMS). In older adults, tricyclic antidepressants are used with care because of risks of confusion and falls (CDC, 2022).

Medicine is just one part of treatment, alongside non-drug approaches such as exercise and good sleep habits (NCCIH). No single treatment works for everyone (NHS), and you may need to try different combinations before you find relief (NIAMS). We don’t list doses — your prescriber will.

4. Why opioids are not recommended

The ACR says opioids are not recommended for treating fibromyalgia symptoms (ACR). CDC’s 2022 guideline says that for fibromyalgia the expected benefits of starting opioids are unlikely to outweigh the risks, and that long-term opioid use is linked with limited benefit or worse outcomes (CDC, 2022).

5. Treating sleep

A sleep specialist can help with sleep disorders (ACR, NIAMS). The ACR does not recommend sleep medicines such as zolpidem for fibromyalgia symptoms (ACR). See Sleep and fibromyalgia below.

What it costs

  • Physical therapy: about $50–$350 or more a session without insurance, or a $10–$75 copay or 10%–50% coinsurance with it (cost guide: CostHelper). Medicare Part B covers medically necessary outpatient PT; you pay 20% of the approved amount after the deductible (Medicare.gov).
  • Doctor visits, CBT, sleep studies and medicines: cost estimate being researched.

Find a medical doctor in our directory

Approach 2 of 6

Chiropractic

Chiropractic care for fibromyalgia has been studied only a little, and the research is mostly low quality. The ACR’s patient page lists chiropractic, with acupuncture and massage, as things that can help (ACR), but NCCIH says so little research has been done on chiropractic for fibromyalgia that no conclusions can be reached (NCCIH).

What the research says

Safety and practical tips

  • Mild to moderate side effects such as more pain, stiffness or headache are common after spinal manipulation and usually pass within 24 hours. Serious problems are very rare; manipulation of the neck has been linked to rare artery tears that can lead to stroke (NCCIH).
  • Tell your chiropractor you have fibromyalgia and that you may be sensitive to touch and pressure. If a treatment leaves you sore for days, it isn’t the right fit.
  • Exercise, not passive treatment, has the strongest evidence; any hands-on care works best as an extra to an active plan (CDC, 2022).

What it costs

About $50–$200 a visit without insurance (average about $125), or $15–$75 with insurance (MedicalCostInfo). Medicare Part B covers only adjustment of the spine by a chiropractor to correct a subluxation, and you pay 20% of the approved amount after the deductible (Medicare.gov).

Find a chiropractor in our directory

Approach 3 of 6

Acupuncture

Acupuncture has some evidence behind it for fibromyalgia, though the evidence is modest. MedlinePlus lists it among complementary therapies that have helped some people, though more studies are needed (MedlinePlus), and CDC’s 2022 pain guideline includes it among non-drug options for fibromyalgia (CDC, 2022).

What the research says

  • Cochrane review, 2013 (9 trials, 395 people): low- to moderate-level evidence that acupuncture improves pain and stiffness compared with no treatment or standard therapy alone. But moderate-level evidence showed it worked no better than sham (fake) acupuncture for pain, fatigue, sleep or overall well-being. Electroacupuncture (needles with a mild electrical current) was probably better than manual acupuncture. Effects lasted up to a month but were not maintained at six months. Acupuncture appeared safe, though the studies were small (Cochrane review, 2013).
  • NCCIH summarizes the picture the same way: limited evidence of improvement compared with no treatment, no clear advantage over simulated acupuncture, and possibly better results with electroacupuncture (NCCIH). A newer 2019 review of 12 studies (824 people) found acupuncture better than sham for pain, but the evidence was of low-to-moderate quality (NCCIH).

Safety and practical tips

  • Relatively few complications have been reported; problems have come from non-sterile needles and poor technique. FDA requires acupuncture needles to be sterile and single-use (NCCIH).
  • Ask your fibromyalgia provider or a nearby hospital to recommend a practitioner, and check with your insurer about coverage (NCCIH).

What it costs

Published cash prices run about $125–$230 for a first private visit and $90–$185 for follow-ups; community clinics about $50–$90 a visit (The Pricer). Medicare covers acupuncture only for chronic low back pain, not for fibromyalgia (Medicare.gov).

Find an acupuncturist in our directory

Approach 4 of 6

Herbal medicine

We found little good evidence that any herb or supplement treats fibromyalgia. NCCIH says there isn’t enough evidence to know whether soy, SAMe, creatine or capsaicin creams help, and that researchers are still studying magnesium (NCCIH). Remember that “natural” doesn’t necessarily mean safe: natural products can have side effects and interact with medicines, and even vitamins and minerals can be harmful in excess (NCCIH).

Vitamin D — only if you are low

Vitamin D may reduce fibromyalgia pain, particularly in people with vitamin D deficiency (NCCIH). In a small trial of 30 women with fibromyalgia and low vitamin D levels, raising their levels reduced pain compared with placebo; the authors said larger studies were needed (randomized trial, Pain, 2014). A 2025 review pooled four studies for each of its analyses and found less pain with vitamin D, but said higher-quality trials are still needed (systematic review, Nutrients, 2025). Ask your clinician whether to check your level before taking it. We don’t list doses here.

Cannabis and CBD

Products containing THC and CBD from cannabis may reduce chronic pain in the short term, but can cause dizziness and sleepiness, and little is known about long-term use (NCCIH). NCCIH’s pages don’t report studies in fibromyalgia specifically. Over-the-counter CBD products may contain more or less CBD than the label says, or contain THC, and CBD has been linked with liver injury and drug interactions (NCCIH).

St. John’s wort and other interactions

  • St. John’s wort can interact in dangerous, sometimes life-threatening ways with many medicines. Taken with certain antidepressants or other drugs that affect serotonin, it may cause serotonin-related side effects that can be serious, and it can weaken some antidepressants, including amitriptyline (NCCIH). Several fibromyalgia medicines are antidepressants, so don’t combine them without your prescriber’s advice.
  • Tell all your providers about any supplements you use (NCCIH).

Approach 5 of 6

Massage therapy

Massage may bring some relief from fibromyalgia symptoms, but the benefits seem to be short-term. MedlinePlus lists massage therapy among complementary therapies that have helped some people, though more studies are needed (MedlinePlus).

What the research says

Practical tips

  • It shouldn’t hurt. Experts recommend that massage for fibromyalgia not cause pain; you may need to start very gently and increase the pressure gradually (NCCIH).
  • The risk of harm appears low, but rare serious side effects have been reported, some with vigorous techniques such as deep tissue massage (NCCIH).

What it costs

About $50–$90 for 45–60 minutes at clinics, gyms and spas, or $60–$120 with a private therapist; massage schools sometimes charge less (CostHelper).

Find a massage therapist in our directory

Approach 6 of 6

MBHA Wellness Coach

An MBHA Wellness Coach can help you turn the advice in this guide into daily habits you can keep. A coach doesn’t diagnose or treat, never pushes you through severe pain, and works alongside your medical care.

Pacing

Try not to use up all your energy each day, because doing too much can make symptoms worse (NIAMS). Learning to balance activity with rest is part of managing fibromyalgia (MedlinePlus). A coach can help you plan your week, break big jobs into smaller pieces and keep a simple diary of activity and symptoms.

A gradual movement plan

A coach can help you start low and build slowly with walking, water exercise, tai chi or yoga — see Movement that helps below. Setting small goals along the way helps (ACR). Check with your doctor before starting an exercise routine (NIAMS).

Sleep habits

A coach can help you build a steady sleep routine and track your sleep to share with your clinician — see Sleep and fibromyalgia below.

Stress

Managing stress is part of self-care for fibromyalgia (CDC), and deep breathing, meditation and mindfulness can help (ACR). Mindfulness training has led to short-term improvements in pain and quality of life in several small studies (NCCIH).

Self-management programs and support

Learning self-management skills can help people with fibromyalgia reduce pain and improve function (CDC). CDC recognizes more than 20 physical activity and self-management programs for arthritis — such as the Chronic Pain Self-Management Program, Walk With Ease, the Arthritis Foundation Aquatic Program and Tai Chi for Arthritis — which you can find through the Arthritis Foundation Helpline at 1-800-283-7800 (CDC). They were recognized for arthritis, not tested for fibromyalgia specifically. A support group can also help you through difficult times (NIAMS).

Mood support

Depression and anxiety are common with fibromyalgia (CDC). If emotional problems arise, a mental health professional can help, and CBT teaches skills for controlling pain (NIAMS). A coach can help you notice when it’s time to reach out — see our Depression and Anxiety guides.

Another approach

Movement that helps: starting low and going slow

Exercise is a key part of fibromyalgia treatment. Pain and fatigue can make it hard, but research shows regular exercise is one of the most useful ways to fight fibromyalgia, and even modest amounts help. Aerobic activity can also improve sleep and ease anxiety and depression (NIAMS).

Start low, go slow

  • Begin gently. Start exercising at a low level and increase gradually over time (NIAMS). If pain or fatigue is too much for vigorous exercise, begin with walking or other gentle exercise and build endurance and intensity slowly (NCCIH).
  • Choose low-impact activities such as walking, biking, swimming and water exercise (NIAMS). Stretching and yoga are good options too, and small changes count, like taking the stairs instead of the elevator (ACR).
  • Get help designing a plan from a physical therapist or exercise physiologist (NIAMS).
  • Expect ups and downs. Doing too much can make symptoms worse (MedlinePlus), so build up in small steps rather than doing a lot on a good day.

Tai chi and yoga

Mind-body activities such as yoga and tai chi are also helpful (NIAMS). In a 2018 trial partly funded by NCCIH, 226 adults with fibromyalgia did either supervised aerobic exercise or tai chi. Everyone improved, but the tai chi groups improved more overall, 24 weeks of tai chi helped more than 12, and no serious side effects were reported (Wang et al., BMJ, 2018). Participants knew which group they were in, which is a limitation (NCCIH). A 2019 review of 6 studies also found tai chi reduced pain, though larger, higher-quality studies are needed (NCCIH). Yoga, tai chi and qigong generally have good safety records with a qualified instructor but may need adapting for fibromyalgia (NCCIH).

If you also have ME/CFS, the advice is different. Fibromyalgia and chronic fatigue syndrome can occur together (NCCIH). In ME/CFS, standard exercise recommendations for healthy people can substantially harm patients, and any activity plan must be carefully individualized (CDC). If effort leaves you much worse a day or two later, talk with your clinician and see our Chronic Fatigue & ME/CFS guide.

Another approach

Sleep and fibromyalgia

Trouble sleeping is one of the main symptoms of fibromyalgia (NIAMS). Many people wake up feeling unrefreshed even after a full night (NHS, ACR), and persistent fatigue is one of the most troubling symptoms (NIAMS). Some people also have restless legs syndrome (NCCIH).

Habits that help

NIAMS suggests these steps to sleep better and feel more rested (NIAMS):

  • Go to sleep and get up at the same time every day, with a relaxing bedtime routine.
  • Keep your bed for sleeping — TV, laptops and phones in bed can keep you awake.
  • Keep your bedroom dark, quiet and cool.
  • Avoid caffeine and nicotine, and limit alcohol.
  • Wind down before bed: avoid working or exercising close to bedtime, and try soft music, meditation or a warm bath.
  • Pace yourself during the day.

The ACR also suggests not eating in the hour before bed and avoiding screens before sleep (ACR). Regular aerobic activity can improve sleep, too (NIAMS).

When to get a sleep check

If your sleep doesn’t improve, ask about a sleep specialist (NIAMS), who can look for other sleep disorders. Medicines may be considered for severe sleep problems (EULAR, 2017), but the ACR does not recommend sleep medicines such as zolpidem for fibromyalgia (ACR). Massage did not improve sleep in a 2014 review (meta-analysis, PLoS One, 2014). A separate MBHA guide to Sleep Problems is on the way.

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This page is for education only and is not medical advice. Costs are typical U.S. ranges and estimates; yours will depend on your provider, location and insurance. Talk with your doctor before starting, stopping or combining any treatment. In an emergency, call 911. See our disclaimer.

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