By Donna Gregory Burch
A few weeks ago, I had a reader point out that I write a lot about relieving fibromyalgia pain, but very little about reducing fatigue. Well, there’s a reason for that: There always seem to be far more options for pain management than fatigue.
But my reader’s comment got me curious about the research regarding fibromyalgia and fatigue. I wondered if there is anything clinically proven to actually relieve fibro fatigue. I searched PubMed and found a couple of fairly recent (2013 and 2016) meta-analyses that reviewed treatment options for fibromyalgia fatigue. From those, I’ve compiled the following list of treatments, which are supported by clinical trials and can be used as a starting point for your own research. I’ve also included at least one resource for each item on the list for those who want to delve a little deeper into a particular treatment.
I’ll warn you that some of the items on the list are the same old-same old that physicians have been pushing on us for years, but there are many others that I didn’t know about and may be new to you, too.
Also, some of the trials cited involved small numbers of patients. Personally, small trial numbers don’t bother me, but I understand that some readers may question the effectiveness of certain treatments based on such limited data. That’s understandable; I am simply compiling and presenting the data for you. How you perceive it and/or use it is up to you.
And finally, this list wasn’t written with entertainment in mind, so please forgive the overuse of wording like “a small study found…” and “[fill in the blank with any treatment] reduced fatigue…” Yes, I know the wording on the list is redundant, but there are only so many ways to essentially say the same thing.
So, without further delay, here is my list of 23 clinically-proven ways to reduce fibromyalgia fatigue:
1. Aerobic exercise
Yep, you knew this would be on the list, didn’t you? A 2010 meta-analysis involving almost 2,500 fibromyalgia patients found that aerobic exercise improved their pain, fatigue, depressed mood and overall quality of life. The analysis looked at land-based versus water-based forms of exercise, but did not find one superior over the other.
The German researchers concluded, “The amount and intensity of initial AE [aerobic exercise] should be adapted to the individual level of physical fitness. Patients should start at levels just below their capacity and gradually increase the duration and intensity until they are exercising with low to moderate intensity for 20 to 30 minutes 2 to 3 times/week. … Patients should be educated that they may have some tolerable short-term increases in pain and fatigue but, if they exercise at an appropriate intensity, these symptoms should return to baseline levels within the first few weeks of exercise.”
In other words, start low and go slow, but expect to feel worse before you feel better.
2. Strength training
A small 2008 Finnish study involving 26 post-menopausal women with fibromyalgia found that concurrent strength and endurance training improved fatigue, but added that more studies need to be conducted to confirm the results. A similar study involving pre-menopausal women also supported improvements in fatigue levels.
National Fibromyalgia Association: Strength Training for the Person with Fibromyalgia (article)
A 2013 meta-analysis with 300+ fibromyalgia patients looked at various forms of meditative movement, such as tai chi, qigong, etc., and found that only yoga was beneficial in relieving fibromyalgia fatigue. Yoga also improved pain and depression.
Aroga Yoga: Yoga Sequence for Chronic Illness (video, 22 minutes)
4. Whole-body vibration exercise
A small Spanish study using traditional exercise in tandem with whole-body vibration exercise led to reduced fatigue.
Cochran Library: Whole Body Vibration Exercise for Fibromyalgia (article)
Join any fibromyalgia support group, and chances are many of its members will recommend Epsom salt baths for pain reduction. Well, it turns out my fellow fibro warriors are onto something! At least three research studies (2001, 2004 and 2005) using mineral-rich baths, or balneotherapy, as a treatment for fibromyalgia reported an improvement in fatigue.
Balneotherapy Association of North America: North American Waters (article)
Spa Index: 30 Favorite Hot Springs and Mineral Springs (article)
6. Sleep hygiene
Fatigue, pain and sleep quality all improved when fibromyalgia patients followed certain sleep hygiene guidelines as part of a 2012 Brazilian study. “Sleep hygiene instructions include advice to have regular sleeping routines; avoid coffee, tea, food, alcohol, smoking and watching TV close to bedtime; regulate the sleeping environment, such as having a comfortable bed and optimal room temperature; avoid light and loud noise and be regularly physically active, however, not too close to bedtime,” read a 2016 Swedish meta-analysis.
American Sleep Association: Top Sleep Hygiene Tips (PDF)
7. Raw vegetarian diet
Broccoli lovers rejoice! Eating a mostly raw vegetarian diet was found to improve fatigue in a small study involving 30 fibromyalgia patients.
Everyday Health: Diet Cures for Fibromyalgia – Do They Work? (article)
TENS (transcutaneous electrical nerve stimulation) units have been a staple in fibromyalgia patients’ pain-fighting arsenal for many years, but a small Brazilian study found these inexpensive, over-the-counter devices can also relieve fatigue.
VeryWell: TENS Unit for Fibromyalgia Pain (article)
9. Transcranial magnetic stimulation
10. Electroconvulsive therapy
An extremely small Finnish study involving 13 patients found electroconvulsive therapy improved fatigue and depression from fibromyalgia.
11. Noninvasive cortical electrostimulation
A 2012 study involving 39 fibromyalgia patients and 38 healthy controls found moderate improvement in fibromyalgia fatigue using noninvasive cortical electrostimulation. (Say that 10 times fast!)
American College of Rheumatology: Long-Term Outcomes In Fibromyalgia Patients Treated with Cortical Electrostimulation (article)
12. Sensory motor rhythm treatment
Sensory motor rhythm treatment, a form of neurofeedback, was associated with a decrease in fatigue among 18 fibromyalgia patients in a small Turkish study.
Taylor & Francis Online: A Systematic Review of Neurofeedback as a Treatment for Fibromyalgia Syndrome Symptoms (article)
13. Low-energy laser therapy
Studies are mixed on the effectiveness of low-energy laser therapy for fibro fatigue – one study found no improvement while another one did – but it was helpful for reducing other fibromyalgia symptoms.
Pain News Network: Lasers Work for Fibromyalgia But Why So Pricey? (article)
14. Pulsed ultrasound and interferential current
One study found a reduction in morning fatigue using pulsed ultrasound and interferential current.
Fibromyalgia News Today: Ultrasound for Pain Therapy (article)
Prohealth: Ultrasound Therapy for Fibromyalgia and Lyme Disease (article)
15. Duloxetine (Cymbalta)
Eli Lilly: Cymbalta Medication Guide (PDF)
16. Milnacipran (Savella)
Milnacipran was shown to decrease fatigue during a 2011 Portuguese study, but six other trials found either no improvement or were unable to draw a conclusion one way or another.
Allergan: Savella Medication Guide (PDF)
17. Fluoxetine (Prozac)
“Significant improvement” in fatigue was experienced by 60 fibromyalgia patients taking fluoxetine (Prozac) during a University of Cincinnati Medical Center study. There were also improvements in pain and depression.
U.S. Food and Drug Administration: Prozac Medication Guide (PDF)
18. Gamma-hydroxybutyrate (GHB)/sodium oxybate (Xyrem)
A University of Texas Health Science Center study involving more than 500 patients found that GHB reduced fibro-related pain, fatigue and sleep disturbance. Another larger study out of Canada with 300+ fibromyalgia patients also found benefit. Unfortunately, GHB has developed a bad reputation because it’s been dubbed a date rape drug, and few physicians will prescribe it.
U.S. Food and Drug Administration: Xyrem Medication Guide (PDF)
19. Pramipexole (Mirapex)
Fibromyalgia patients in a small Washington state study experienced improvements in pain, fatigue and overall functionality after taking pramipexole (Mirapex), a drug commonly prescribed for Parkinson’s disease and restless leg syndrome. Researchers concluded the drug was “safe and well tolerated.”
Boehringer Ingelheim: About Mirapex (article)
20. Quetiapine (Seroquel)
Fibromyalgia patients in a small Spanish study had a moderate improvement in fatigue and stiffness after taking quetiapine, an antipsychotic medication commonly prescribed for schizophrenia and bipolar disorder. While quetiapine failed its goal of reducing pain, researchers said the drug should be tested in larger trials because early data suggests it could improve overall quality of life for fibromyalgia patients.
U.S. Food and Drug Administration: Seroquel Medication Guide (PDF)
21. Raloxifene (Evista)
A double-blind, randomized Iranian study involving 100 menopausal women with fibromyalgia found that raloxifene, a drug used to prevent osteoporosis and breast cancer, was effective at reducing pain, fatigue, sleep disturbance and tender point count.
U.S. Food and Drug Administration: Evista Medication Guide (PDF)
22. Acetyl l-carnitine
Acetyl L-carnitine, an amino acid available as an over-the-counter supplement, was found to improve general health and mental health (including fatigue) in an Italian study involving 100+ fibromyalgia patients.
D-ribose, a form of sugar produced naturally by the body and available in supplement form, actually wasn’t included in either of the meta-analyses that I used to compile this list, but I’m adding it to the list because I’ve personally found it to be so helpful for boosting my energy levels. Well-known fibromyalgia specialist Dr. Jacob Teitelbaum has conducted two d-ribose trials involving fibromyalgia and chronic fatigue patients. In 2006, Teitelbaum conducted a small study with 41 patients with fibromyalgia and/or chronic fatigue syndrome. At the end of the three-week study, approximately 66 percent of patients reported significant improvement while taking d-ribose, with an average increase in energy of 45 percent. Teitelbaum followed up the pilot study with a larger multicenter study in 2012, involving 257 people who were given d-ribose for fibromyalgia and/or chronic fatigue. The result was an average energy boost of 61 percent among patients.