Fibromyalgia: Therapy

General measures

• Nicotine restriction (refraining from tobacco use).
• Aim for normal weight! Determination of BMI (body mass index, body mass index) or body composition by means of electrical impedance analysis and, if necessary, participation in a medically supervised weight loss program.
• If necessary, increase the physical activity!
• Avoidance of psychosocial stress:
  • Stress

Nutritional medicine

• Nutritional counseling based on nutritional analysis
• Nutritional recommendations according to a mixed diet taking into account the disease at hand. This means, among other things:
  • A total of 5 servings of fresh vegetables and fruit daily (≥ 400 g; 3 servings of vegetables and 2 servings of fruit).
  • Once or twice a week fresh sea fish, i.e. fatty marine fish (omega-3 fatty acids) such as salmon, herring, mackerel.
  • High-fiber diet (whole grains, vegetables).
• Observance of the following special dietary recommendations:
  • Diet rich in:
    • Vitamins (Vitamin D)
    • Minerals (magnesium)
    • Vitaminoids (coenzyme Q10)
• Selection of appropriate food based on the nutritional analysis
• See also under “Therapy with micronutrients (vital substances)” – if necessary, taking a suitable dietary supplement.
• Detailed information on nutritional medicine you will receive from us.

Sports Medicine

• Circulatory training* (cardio training; areobic endurance training), with low to moderate intensity (e.g., fast walking, cycling, walking, or ergometer training); should be performed permanently two to three times per week for at least 30 minutes; patients who experience improvement as a result should perform this permanently
• Muscle training/strength training* ; low to moderate intensity (guideline: strong recommendation).
• Functional training (dry and aquatic exercise, twice a week for at least 30 minutes) (guideline: strong recommendation).
• Stretching* (Stretching and flexibility training may be considered. Evidence exists for a training frequency of two to three times 60 minutes per week (guideline: recommendation: open, strong consensus).
• For detailed information on sports medicine, please contact us.

* Long-term therapy

Physical therapy (including physiotherapy)

• Physiotherapy/movement therapy
• Massage therapies
  • Connective tissue massage – can reduce depression and improve quality of life.
  • Manual lymphatic drainage – suitable for stiffness and depression; can improve quality of life.
• Posture training
• Functional training (dry and aquatic exercise) should be used twice a week (at least 30 minutes) (AWMF guideline: strong recommendation, strong consensus).
• Medical exercise therapy – muscle strengthening exercises and stretching exercises lead to improved joint flexibility in fibromyalgia.
• Thermotherapy
  • Heat* – thermal baths should be used. Evidence is available for a frequency of five times per week for two to three weeks (guideline: recommendation, strong consensus).
  • Cold therapy
• Electrotherapy
• Thermal baths

* Long-term therapy!

Psychotherapy

Psychotherapeutic treatment in FMS is recommended for the following clinical constellations in adults (AWMF guideline FMS):

• Maladaptive coping with illness (e.g., catastrophizing, inappropriate physical avoidance behavior, or dysfunctional perseveration strategies); and/or
• Relevant modulation of symptoms by everyday stress and/or interpersonal problems and / or
• Comorbid mental disorders

The following procedures are recommended:

• Biofeedback can be used (guideline: open recommendation, strong consensus).
• Relaxation techniques in combination with aerobic exercise (multimodal therapy) should be used (guideline: strong recommendation, strong consensus)
• Cognitive behavioral therapy (CBT) (guideline: strong recommendation).
• Meditative movement therapy (Tai-Chi, Qi-Gong, Yoga) (Guideline: strong recommendation).
• Medical hypnosis (synonym: hypnotherapy)/guided imagination may be used (guideline: open recommendation, strong consensus)
  • Behavioral therapy with hypnosis or guided imagination can reduce pain and psychological stress and also improve night sleep, according to a meta-analysis.

Behavioral therapy

• To work through stressful mental states and existing mental illnesses such as depression.
• Operant-behavioral therapy (OVT)Indications: when pronounced pain behavior and physical impairment are present, the disease is “catastrophized,” frequent visits to the doctor occur, and the spouse suffers greatly. Results of one study: one year after the end of therapy, 53.5% in the OVT group versus 45.2% in the cognitive-behavioral therapy (CBT), had a pain reduction of at least 50% and 58.1% versus 38.1% had a reduction of more than 50% in impairment caused by the pain. Control group: pain intensity reduction only 5%.

A multimodal therapy is recommended, i.e. at least one physically activating procedure and also at least one psychotherapeutic procedure, such as relaxation techniques or cognitive behavioral therapy combined with aerobic training. Detailed information on psychosomatics (including stress management) is available from us.

Complementary treatment methods

• Acupuncture: temporary use of acupuncture may be considered (guideline: level of recommendation open, strong consensus)Weekly acupuncture relieved symptoms in patients with fibromyalgia syndrome in a randomized trial. Control group were patients with sham treatment, in which needles were not inserted through the skin.
• Homeopathy
• Meditative movement therapies (tai chi, qi gong, yoga, guideline: strong recommendation, strong consensus).