Fibromyalgia: Non-pharmacological and Novel therapies

- By


Fibromyalgia affects an upwards of 6% people in the United States[1] and has a considerable impact on individuals’ quality of life[2] . It is a clinical syndrome of chronic widespread pain and reduced pain thresholds to palpation. Because of the relatively high prevalence, comorbidities, degree of disability and global severity, there is a significant burden of disease for this condition[1,2] . Pain, which is the primary symptom in fibromyalgia, may be extremely hard to quantify and hard to treat, since most of the limited treatment options are often associated with adverse effects. Evidence suggests that the widespread pain experienced by these patients is related to deficits in an endogenous pain control system that involves several brain structures[3].

Why does fibromyalgia patients have so much pain? – Impair Endogenous pain modulation system theory

Endogenous pain control mechanisms have long been known to produce analgesia. The idea of this system is that “pain inhibits pain”, when a noxious stimuli triggers signals to the nervous system, it activates the endogenous pain inhibitory system to relieve pain. One theory is that fibromyalgia pain is related to an impairment on this endogenous pain modulation system[3] .

Due to its clinical importance, there are a relatively large number of studies being performed to help us understand the mechanisms underlying fibromyalgia but also to find other potential non- pharmacological treatments targeting this endogenous pain modulation system.


Common pharmacological interventions in fibromyalgia involve the use of nonsteroidal anti- inflammatory drugs(NSAID), antidepressants, and/or anticonvulsants. However, there is a variable response rate, some patients may response better than others. Moreover, other non-pharmacological treatments include exercise, mind and Body Therapy or acupuncture[4] .

Non-pharmacological therapies

  • Exercise: Exercise, in the form of aerobic exercise, resistance training, or flexibility training, has been shown in trials to provide benefits in fibromyalgia patients[5]. Exercise leads to enhancement of endogenous pain inhibitory systems and decrease of pain sensitization through brain modulation[3]. 
  • Mind-body therapy: Several mindfulness and relaxation interventions have been proposed for the treatment of fibromyalgia pain. Nonetheless, a systematic review and meta-analysis found that therapies such as tai chi, qigong, and yoga have been effective in diminishing sleep disturbances in patients with fibromyalgia, among others but not pain[6] . Other techniques such as meditation have shown to reduce mildly fibromyalgia pain and fatigue[7].
  • Acupuncture: conflicting results regarding the effect of acupuncture have been raised for fibromyalgia. Although it has proven to have a marginal benefit when compared to placebo in other pain conditions, most trials in fibromyalgia render this difference insignificant[8].

Novel Non-pharmacological Therapies on Research

Given the difficult treatment of fibromyalgia pain with other types of pharmacological and non-pharmacological interventions, brain stimulation techniques are currently being studied to fill in this therapeutic gap[9–11]. One of these techniques is transcranial direct current stimulation (tDCS), a non-invasive, non-painful stimulation that is supposed to act by strengthening dysfunctional endogenous pain pathways present in patients with fibromyalgia[12]. Several studies have depicted benefit to the use of tDCS in patients with fibromyalgia with significant reductions in pain, when compared to a placebo procedure [13,14]. The use of tDCS has shown to possibly modulate and enhance the function of defective endogenous pain system in fibromyalgia, conveying significant results for future studies about tDCS for this condition[3].

Clinical trial:

Ongoing fibromyalgia studies at Spaulding Hospital:

To Particpate and enrol in the research, visit this link :

Click “I Am Interested” to get started. If you have questions, contact:

Meghan Whalen
Research Assistant II
(617) 952-6158

symptoms of fibromyalgia shirt
Symptoms of fibromyalgia shirt

Fibromyalgia Symptoms T-Shirt: A brief list of fibromyalgia symptoms that almost everyone with fibro suffering with. Wear this Fibromyalgia symptoms t-shirt on this fibro awareness day and spread fibromyalgia awareness. Click Here to Get this

[1]        A.P. Marques, A. de S. do E. Santo, A.A. Berssaneti, L.A. Matsutani, S.L.K. Yuan, Prevalence of
fibromyalgia: literature review update, Revista Brasileira de Reumatologia (English Edition). 57 (2017)
[2]        J.O. de Oliveira Júnior, J.V.C. Ramos, Adherence to fibromyalgia treatment: challenges and impact on the
quality of life, Brazilian Journal Of Pain. 2 (2019) 81–87.

[3]        D. Duarte, L.E.C. Castelo-Branco, E. Uygur Kucukseymen, F. Fregni, Developing an optimized strategy
with transcranial direct current stimulation to enhance the endogenous pain control system in
fibromyalgia, Expert Review of Medical Devices. 15 (2018) 863–873.
[4]        S. Chinn, W. Caldwell, K. Gritsenko, Fibromyalgia Pathogenesis and Treatment Options Update, Current
Pain and Headache Reports. 20 (2016) 1–10.
[5]        J. Bidonde, A.J. Busch, C.L. Schachter, S.C. Webber, K.E. Musselman, T.J. Overend, S.M. Góes, V. Dal
Bello-Haas, C. Boden, Mixed exercise training for adults with fibromyalgia, Cochrane Database of
Systematic Reviews. 2019 (2019).
[6]        J. Langhorst, P. Klose, G.J. Dobos, K. Bernardy, W. Häuser, Efficacy and safety of meditative movement
therapies in fibromyalgia syndrome: A systematic review and meta-analysis of randomized controlled
trials, Rheumatology International. 33 (2013) 193–207.
[7]        W. van Gordon, E. Shonin, T.J. Dunn, J. Garcia-Campayo, M.D. Griffiths, Meditation awareness training
for the treatment of fibromyalgia syndrome: A randomized controlled trial, British Journal of Health
Psychology. 22 (2017) 186–206.
[8]        J.C. Deare, Z. Zheng, C.C.L. Xue, J.P. Liu, J. Shang, S.W. Scott, G. Littlejohn, Acupuncture for treating
fibromyalgia, Cochrane Database of Systematic Reviews. 2013 (2013).
[9]        F. Carvalho, A.P. Brietzke, A. Gasparin, F.P. dos Santos, R. Vercelino, R.F. Ballester, P.R.S. Sanches, D.P.
da Silva, I.L.S. Torres, F. Fregni, W. Caumo, Home-based transcranial direct current stimulation device
development: An updated protocol used at home in healthy subjects and fibromyalgia patients, Journal
of Visualized Experiments. 2018 (2018).
[10]       F. Fregni, M.M. El-Hagrassy, K. Pacheco-Barrios, S. Carvalho, J. Leite, M. Simis, J. Brunelin, E.M.
Nakamura-Palacios, P. Marangolo, G. Venkatasubramanian, D. San-Juan, W. Caumo, M. Bikson, A.R.
Brunoni, Evidence-based guidelines and secondary meta-analysis for the use of transcranial  direct
current stimulation (tDCS) in neurological and psychiatric disorders., The International Journal of
Neuropsychopharmacology. (2020).
[11]       L. Castelo-Branco, E. Uygur Kucukseymen, D. Duarte, M.M. El-Hagrassy, C. Bonin Pinto, M.E. Gunduz, A.
Cardenas-Rojas, K. Pacheco-Barrios, Y. Yang, P. Gonzalez-Mego, A. Estudillo-Guerra, L. Candido-Santos, I.
Mesia-Toledo, H. Rafferty, W. Caumo, F. Fregni, Optimised transcranial direct current stimulation (tDCS)
for fibromyalgia – Targeting the endogenous pain control system: A randomised, double-blind, factorial
clinical trial protocol, BMJ Open. 9 (2019) e032710.
[12]       C.E. Zhu, B. Yu, W. Zhang, W.H. Chen, Q. Qi, Y. Miao, Effectiveness and safety of transcranial direct
current stimulation in fibromyalgia: A systematic review and meta-analysis, Journal of Rehabilitation
Medicine. 49 (2017) 2–9.

[13]       M.E. Mendonca, M. Simis, L.C. Grecco, L.R. Battistella, A.F. Baptista, F. Fregni, Transcranial direct
current stimulation combined with aerobic exercise to optimize analgesic responses in fibromyalgia: A
randomized placebo-controlled clinical trial, Frontiers in Human Neuroscience. 10 (2016).

[14]       F. Fregni, R. Gimenes, A.C. Valle, M.J.L. Ferreira, R.R. Rocha, L. Natalle, R. Bravo, S.P. Rigonatti, S.D.
Freedman, M.A. Nitsche, A. Pascual-Leone, P.S. Boggio, A randomized, sham-controlled, proof of
principle study of transcranial direct current stimulation for the treatment of pain in fibromyalgia,
Arthritis and Rheumatism. 54 (2006) 3988–3998.

Leave Your Comment