Types of Therapy for Fibromyalgia

Living with fibromyalgia presents unique challenges, from widespread pain and fatigue to sleep disturbances and reduced quality of life. Medications can play an important role in managing these symptoms. But there is increasing evidence supporting different types of therapy for fibromyalgia in addition to medication management.

Most individuals with fibromyalgia have tried at least one complementary or alternative treatment to help manage their symptoms.¹ In this article, we will review the evidence for these fibromyalgia therapies, what you need to know about them, and how you can seek treatment.

Physical Therapies

Physical therapies focus on movements that help strengthen or improve the body’s functions—these types of therapy range from physical touch to self-directed exercises. And although your first thought might be working with a physical therapist, there are many types of physical therapies that you can do on your own.

Since those with fibromyalgia have a heightened sense of pain to various stimuli, the thought of movement or touch may make you wonder, “Can physical therapy make fibromyalgia worse?” In the moment, some treatments may increase immediate discomfort instead of relieving it (more on that below). But, in the long term, overall data supports the use of physical therapies to improve fibromyalgia symptoms.

Movement and Stretching

Regular movement and stretching activities has been shown to lessen pain, fatigue, and muscle tension related to fibromyalgia.² These practices can also reduce levels of stress, anxiety, and depression, which can be major triggers for fibromyalgia flares. 

There’s no one-size-fits-all approach to movement, so figuring out something that you enjoy is key. There are various forms of movement and stretching activities to choose from, including:

• Aerobic exercises, such as walking or dancing
• Resistance or strength training with or without weights
• Flexibility exercises like yoga or modified pilates
• Aquatic therapy 

Aquatic therapy is when one performs exercises in waist-deep water.² Many people with fibromyalgia report finding it relaxing due to the water temperature, which is heated to about 90 degrees Fahrenheit; this temperature helps reduce muscle contractions and improves circulation.² The water also removes stress from joints during movements, making movements easier and improving muscle stiffness and aches.²

A comprehensive review conducted in 2017 analyzed studies that focused on the benefits of aerobic exercise in those with fibromyalgia.³ Although the findings are somewhat conflicting,  studies showed that aerobic exercises improved fibromyalgia symptoms, including pain, stiffness, and physical function.³ As a result, those with fibromyalgia had a greater quality of life.  

Comparing studies incorporating movement and stretching into fibromyalgia treatment plans can be challenging, given differing protocols and insufficient descriptions of activities.⁴ It’s hard to say which is the best therapy for fibromyalgia. However, the evidence is clear: those who regularly take part in movement and strength exercises gain the most benefits.

Massage Therapy

Massage therapy is another type of physical therapy many with fibromyalgia try. Massage therapy may improve fibromyalgia symptoms such as pain, anxiety, depression, and sleep disturbances.²

While the exact mechanism is unknown, experts suspect that the stimulation of different tissues in the body results in chemical changes.¹ For instance, massage therapy may increase serotonin, a hormone that helps regulate our mood, amongst other things. In turn, this may improve mood and pain. 

A 2014 review analyzed nine studies to determine the benefits of massage therapy for fibromyalgia.¹ These studies showed that those who received massage therapy for more than five weeks had a significant reduction in pain, anxiety, and depression.¹ But, massage therapy did not affect other fibromyalgia symptoms, like sleep disturbances.¹ 

There are two things to note about this review. First, not all nine studies looked at the same outcomes; therefore, some categories, such as sleep disturbances, had less data to analyze.¹ Second, this review included studies from different countries. Because of this, massage techniques may vary, affecting the results.¹ 

More than half of those with fibromyalgia will try massage therapy at some point; if you do try massage therapy, communicate with your massage therapist about the intensity.² Experts suggest a moderate intensity to gain the benefits of massage therapy without the added pain. 

Cupping Therapy

Cupping therapy is an alternative healing technique practiced worldwide. This type of therapy involves placing special cups on your skin that create suction, drawing the skin and the underlying tissues into the cup. 

There are two types of cupping therapy: wet and dry. The main difference is that the therapist pierces your skin in wet cupping, allowing blood and bodily fluids to flow into the cups. With dry cupping, no blood or body fluids are drawn into the cup. 

Cupping therapy may improve blood circulation, relieve muscle tension, and promote relaxation.⁵ However, evidence is low-quality and limited, meaning experts don’t yet know how helpful cupping is for treating certain medical conditions like fibromyalgia. 

A 2016 study looked at the benefits of cupping therapy for fibromyalgia.⁵ Participants were randomly assigned to receive five treatments of cupping, placebo (fake) cupping, or standard fibromyalgia care. Cupping was more effective than the standard of care in improving pain and quality of life.⁵ Interestingly enough, cupping had similar outcomes to the placebo cupping therapy.⁵

Cupping isn’t without side effects and safety concerns. Upon removing the cups from your skin, there will be temporary circles due to the suction. These circles should go away on their own. Other side effects to be aware of include:

• Skin discoloration
• Burns
• Scars
• Infections, especially if cups aren’t sterilized between use
• Worsening of skin conditions such as eczema or psoriasis
• Anemia due to blood loss from repeat wet cupping

Acupuncture

Acupuncture, a type of traditional Chinese medicine, involves a trained practitioner inserting thin needles into specific points on your skin. These needles are then manipulated manually by the practitioner or stimulated using a mild electrical current – a technique known as electroacupuncture.

Acupuncture is best known for its role in reducing pain. Experts believe acupuncture activates the peripheral and central pain centers while improving blood flow to your muscles.⁶ Both these actions help reduce pain.⁶ 

A 2019 review of nine studies examined the benefits of acupuncture in those with fibromyalgia, and indicated that both manual and electroacupuncture reduce pain and improve ones’ quality of life in the short and long term.⁷ A more recent 2022 review of twelve studies reaffirmed acupuncture’s role in relieving pain in those with fibromyalgia.⁶ Acupuncture doesn’t appear to improve other fibromyalgia symptoms including sleep disturbances, fatigue, physical function, or stiffness.⁶ 

These studies also show that the amount of pain relief people experience increase over multiple acupuncture sessions, with most recommending at least ten sessions.⁶ While acupuncture is generally considered safe, it can cause mild side effects, including ⁷

• Bruising
• Soreness
• Nausea
• Worsening of symptoms
• Mild pain or discomfort at the site of needle insertion

Before starting any type of physical therapy, including all the ones we discussed, schedule an appointment with your healthcare provider to discuss your plans. Some treatments may not be the best option for you based on your medical history. 

Seeing a Physical Therapist

A physical therapist is a healthcare provider that evaluates and treats disorders related to movement and function. Physical therapy for fibromyalgia may include light therapy, massage, exercises, or electrostimulation. 

Here are a few treatments that a physical therapist may recommend for fibromyalgia:.

Myofascial release

Myofascial release, also known as myofascial trigger point therapy, focuses on releasing tension in your fascial tissues. Fascial tissue is a type of tissue that is woven throughout the different structures in your body. Fascia usually can move without restrictions, but in those with fibromyalgia, it can become tight and more rigid, causing pain and loss of motion.

In a recent study, myofascial release improved pain, fatigue, stiffness, and mental health in those with fibromyalgia when compared to a placebo.⁴ Because of these improvements, individuals reported a better quality of life. 

Myofascial release has minimal side effects and is considered safe for those with fibromyalgia. 

Light therapy

Low-level laser therapy (LLLT), also called red light therapy, is a noninvasive therapy that may help relieve muscle or nerve pain. The exact mechanism behind this is unclear, but may be related to reducing inflammation and cell turnover. 

When compared to a placebo, the benefits of red-light therapy include improvements in the following:⁸

• Fibromyalgia impact questionnaire score (FIQR)
• Pain severity
• Number of tender points
• Fatigue
• Stiffness
• Mood

In those with fibromyalgia, LLLT was no better than exercise alone in improving pain.⁸ But, those receiving LLLT and LED phototherapy in combination with exercise saw a reduction in pain, tender points, and fatigue.⁸ 

Red light therapy is safe with minimal side effects. You can receive treatments at a health clinic or spa, as well as through several red-light home products on the market. Before purchasing, make sure to do your homework. Not all products are the same, and overuse or misuse of home red-light products can damage your skin or eyes.

Electrostimulation

Electrostimulation uses electrical currents to relieve pain. Physical therapists can perform two types of electrostimulation for fibromyalgia in their clinics.⁴

• TENS (transcutaneous electrical nerve stimulation): TENS uses low voltage electrical current to relieve pain. 

• IFC (interferential current):  IFC applies a medium-frequency electrical current to the skin to relieve pain and improve sleep quality. 

Current evidence supporting electrostimulation in those with fibromyalgia is low quality and limited.⁴ But, evidence supporting its use is growing as it is non-invasive with little to no side effects. 

Behavioral Therapies

Physical and emotional stress may worsen fibromyalgia symptoms, especially pain. Behavioral therapies focus on helping people with fibromyalgia better manage stress-related events, to see an improvement in their symptoms and well-being. 

Mindfulness Practices

Mindfulness is a type of meditation that allows individuals to connect their thoughts and emotions to how their body feels.⁹ This can be accomplished through various techniques, including deep breathing, body scan, or mindfulness movement. 

Mindfulness practices may help manage anxiety, depression, stress, and pain. In addition, these practices can also improve sleep disturbances. A 2019 study showed mindfulness-based stress reduction (MBSR) improved the clinical severity of fibromyalgia in women.

Cognitive Behavioral Therapy

Cognitive behavioral therapy (CBT) for fibromyalgia is another type of behavioral treatment. CBT focuses on  identifying and reshaping negative beliefs or feelings about fibromyalgia symptoms, which can impact pain and overall wellbeing.¹⁰ 

Fibromyalgia cognitive behavioral therapy also teaches behavioral techniques to reduce stress and symptoms of fibromyalgia. These behavioral techniques may include:¹⁰

• Increasing the number of days spent moving
• Learning activity pacing (not overdoing it on good days)
• Identifying and reducing pain behaviors
• Improving sleeping habits

A 2006 study concluded that those with fibromyalgia who received CBT for a year saw a decrease in pain and emotional distress with an increase in physical function.¹¹ They also reported fewer visits with their healthcare provider.¹¹ 

Like mindfulness practices, the longer one takes part in CBT sessions, the better the outcomes, especially for pain.¹¹ CBT appears to be most effective when used as part of a comprehensive fibromyalgia treatment plan.¹⁰ 

Acceptance and Commitment Therapy

Acceptance and commitment therapy (ACT) begins with the understanding that pain, grief, illnesses, fear, and anxiety are part of life.¹² ACT aims not to avoid these experiences but to help foster psychological flexibility.¹² 

Psychological flexibility is the ability to handle tough emotions or thoughts while remaining true to yourself and your values.¹² It teaches individuals ways to control their emotions instead of their feelings controlling their thoughts and actions. ACT works to strengthen six skills:¹²

1. Staying present even when things are tough
2. Not letting negative thoughts and feelings control your actions
3. Understanding what truly matters to you
4. Taking actions that match your values
5. Being okay with uncomfortable feelings when you’re doing things that matter
6. Not letting bothersome thoughts stop you from doing important stuff

ACT doesn’t focus directly on symptom relief but rather focuses on re-engaging in life in meaningful ways and increasing acceptance of difficult internal experiences.¹² As a result, fibromyalgia symptoms are reduced. 

A 2021 review of eight studies showed that ACT for those with fibromyalgia improved anxiety and depression.¹³ As a result, pain acceptance, physiological flexibility, and self-efficacy improved as well, leading to an overall better quality of life.¹³ 

ACT is usually done in person with a trained professional. But, a recent 2023 study showed that 73% of those using a fibromyalgia ACT smartphone-based mobile app called Stanza saw improvement in their symptoms.¹⁴ 

What Fibromyalgia Therapies Does Insurance Cover?

With all the potential benefits of complementary and alternative medicine (CAM), you may wonder: “Will insurance cover massage therapy for fibromyalgia?” Short answer – it depends. 

An estimated 40% of adults in 2020 used CAM therapies to stay healthy or treat chronic medical conditions. But, if your insurance company does not cover CAM treatments, they can become costly. 

Some insurance companies do cover CAM treatments. For instance, a 2016 study conducted by NCCIH showed that about 17% of large insurance companies covered massage therapy. The catch: most require individuals to try physical therapy and medications first. 

The best way to determine if your insurance company covers CAM therapies is to call them or work with your healthcare provider to discuss coverage possibilities. Here are questions you can ask them to determine your coverage:

• Is the treatment (i.e., massage therapy, cupping, CBT, etc) covered for those with fibromyalgia? If not, what CAM treatments are covered? 
• Does the treatment need preauthorization or preapproval?
• Is a prescription or referral from a healthcare provider needed? 
• Are there in-network providers that offer this treatment? 
• Are out-of-network providers covered for this treatment? 
• Are there limits on how often I can receive this treatment?
• How much will I have to pay out-of-pocket, including co-pays and deductibles?

If you have a health savings account (HSA), check if it covers CAM treatments. Some do, but your healthcare provider may need to submit a letter of medical necessity first. 

Accessing Therapies for Fibromyalgia

If you or someone you know has fibromyalgia, you can access fibromyalgia specialists who offer multimodal treatment, combining multiple types of therapies for fibromyalgia, through virtual visits with Swing Care, with services covered by major insurance plans. Visit www.swing.care to learn more or to check your insurance benefits. 

If you are experiencing symptoms of fibromyalgia, this fibromyalgia self-test based on a standardized diagnostic tool may help you determine whether you may need professional evaluation for fibromyalgia from a physician. However, this is not a diagnosis, and Swing Care clinicians are available for a consultation to discuss your symptoms and history, as well as other potential diagnoses. 

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