Treating Fibromyalgia: Which Natural Substances and Approaches Are Actually Useful

Fibromyalgia is one of the chronic pain syndromes that in everyday life often extend far beyond “mere pain”, which is why many affected individuals look for alternative therapies.

With this article, we follow on from the previously published article on fibromyalgia, in which central mechanisms, everyday factors and the conventional medical classification were described in detail. Today’s continuation explains which complementary therapies and natural substances are used with success in fibromyalgia.

Natural Substances & Alternative Therapies in Fibromyalgia? –

Also a Question of Expectations

In fibromyalgia, the therapeutic focus lies on targeted physical activity. Selected substances may serve as supportive measures. The following overview presents possible approaches and substances:

      ·       Acetyl-L-Carnitine: For Pain, Energy Metabolism and the Nervous System

Acetyl-L-carnitine (ALC) is an acetylated form of carnitine. It is relevant for fatty-acid transport into mitochondria and therefore for energy processes and neurobiological signalling pathways — aspects that are particularly relevant in fibromyalgia in relation to pain processing, sleep and mood.

In a randomized, double-blind multicentre study, ALC was tested against placebo; the authors reported improvements, among other things, in pain and health parameters. In the study, 500 mg capsules were administered orally and additionally via intramuscular injection during the first weeks (Rossini et al., 2007). Naturally, this study design cannot automatically be equated with simply purchasing capsules.

·       Coenzyme Q10: Mitochondrial Support for Fatigue and Pain

Coenzyme Q10 (ubiquinone) is central to mitochondrial energy production (electron transport chain) and also has antioxidant effects. This combination is particularly interesting in fibromyalgia.

According to studies, 300 mg of CoQ10 daily for 40 days led to significant improvements in the Fibromyalgia Impact Questionnaire (FIQ) as well as in pain and fatigue parameters compared with placebo (Cordero et al., 2013). Physical resilience and energy levels may improve.

·       Curcumin: Influencing Inflammation Modulation and Central Sensitization Processes

Curcumin (the bioactive main component of Curcuma longa) has pronounced antioxidant and inflammation-modulating properties. Although fibromyalgia is not classified as a classical inflammatory disease, low-grade inflammatory and neuro-immunological processes are described as contributing factors.

Studies on chronic pain and stress syndromes suggest that curcumin may indirectly influence pain processing through NF-κB modulation, antioxidant effects and influences on stress axes. Specific dosage studies of curcumin in fibromyalgia are limited. In clinical studies on chronic pain syndromes and inflammation-associated complaints, standardized curcumin extracts are usually used in the range of 500–1000 mg daily, sometimes at higher dosages and typically in bioavailable formulations or standardized extracts (Clauw, 2014; Häuser et al., 2015).

·       Magnesium: For Nervous System and Stress Regulation

Magnesium influences neuromuscular excitability, stress axes, sleep and stimulus processing — all aspects that are central in fibromyalgia. Adequate intake may support neuromuscular stability, reduce tension states and potentially influence stress responses and sleep quality, which may indirectly be associated with lower pain intensity and improved functional capacity (Clauw, 2014; Häuser et al., 2015).

In studies, 100 mg per day was commonly used (Macián et al., 2022).

·       Melatonin: For Mood Fluctuations, Pain, and Exhaustion

Melatonin is a central hormone of circadian rhythm regulation and plays an important role in sleep quality, stress axes and neurobiological pain modulation. In addition to its sleep-regulating effects, antioxidant and analgesic effects are also assumed, potentially mediated through modulation of central pain processing and neuroendocrine mechanisms.

Randomized controlled studies show that melatonin supplementation in fibromyalgia may improve pain intensity, sleep quality and functional parameters, particularly in patients with pronounced sleep disturbances. In a randomized double-blind study, 3–5 mg daily resulted in significant reductions in pain and improvements in sleep parameters compared with placebo. The authors attribute the effects in part to circadian stabilization and central pain modulation (Hussain et al., 2011).

·       N-Acetylcysteine (NAC): Antioxidative Stress Regulation and Glutamatergic Modulation

N-Acetylcysteine (NAC) is a precursor of glutathione and has strong antioxidant effects while also modulating neuro-inflammatory and oxidative stress processes. Additionally, NAC influences the glutamatergic system via cystine-glutamate antiporter (system xc-) and can therefore regulate excitatory signalling pathways in the central nervous system.

Because oxidative stress and mitochondrial dysregulation have been described in fibromyalgia, NAC represents a nutritionally plausible approach in relation to fatigue, stress burden and pain processing.

For dosage guidance, controlled studies from chronic pain syndromes can be considered: in a randomized controlled study in complex regional pain syndrome type I, NAC was administered orally at 600 mg three times daily (1,800 mg per day) over several weeks (Perez et al., 2003). Specific large randomized studies in fibromyalgia remain limited.

·       Omega-3 Fatty Acids (EPA/DHA): Inflammation Modulation and Neuronal Membrane Stabilization

Omega-3 fatty acids — particularly eicosapentaenoic acid (EPA) and docosahexaenoic acid (DHA) — have inflammation-modulating properties and influence the membrane fluidity of neuronal cells as well as the regulation of serotonergic signalling pathways. The complementary use of omega-3 fatty acids can therefore be reasonable in relation to pain, fatigue and functional impairment (Calder, 2017).

For individuals with fibromyalgia who wish to supplement omega-3 fatty acids, recommended amounts are typically 1,000–2,000 mg EPA + DHA daily over several weeks.

1,000 mg can be achieved through high-quality fish meals once or twice a week. However, if the aim is approximately 2,000 mg daily, this would require near-daily fish consumption; supplementation with standardized preparations is therefore often more practical in everyday life.

·       Saffron (Crocus sativus): Neurotransmitter Modulation in Stress-Associated Complaints

In phytotherapeutic research, saffron is studied particularly because of its effects on serotonergic, dopaminergic and antioxidant signalling pathways. Mood fluctuations, stress sensitivity and fatigue are frequently part of the overall clinical picture in fibromyalgia.

Randomized studies in affective and stress-associated conditions show that 30 mg of saffron extract daily over 6–8 weeks may significantly improve depressive symptoms and stress parameters.

·       Vitamin D: Modulation of Muscle Function, Immunity, and Pain

Vitamin D is a fat-soluble hormone-vitamin that influences musculoskeletal function, immune modulation and neuro-inflammatory processes. In fibromyalgia, low 25-hydroxyvitamin-D levels are frequently reported and may be associated with higher pain intensity and reduced quality of life. Because vitamin-D receptors are also expressed in the central nervous system and play a role in neuromuscular regulation, targeted supplementation can be a supportive approach, particularly in cases of documented deficiency.

In a randomized placebo-controlled study, patients with fibromyalgia and vitamin-D deficiency received vitamin D₃ at 50,000 IU weekly for eight weeks, followed by a maintenance phase. A significant improvement in pain parameters compared with placebo was observed (Wepner et al., 2014).

Complementary Approaches: Not “Esotericism”, but Nervous System Training

Complementary approaches in fibromyalgia aim to influence stress responses, body awareness and central pain processing. Here are several helpful methods we have compiled for you:

      ·       Tai Chi: Movement and Regulation

Tai Chi does not act like a medication but rather like a training programme involving breathing, body awareness, weight shifting, coordination, attention regulation and stress regulation. Movements are performed in structured sequences (“forms”), usually standing, without abrupt strain or high intensity.

Tai Chi can lead to significant improvements in functional capacity (Wang et al., 2010).

A typical session (about 45–60 minutes) includes:

·       a short breathing and warm-up phase

·       slow practice of individual movement sequences

·       flowing repetition of a complete form

·       a calm conclusion for breathing and tension regulation.

Tai Chi can be practised alone; however, especially at the beginning, instruction is advisable in order to avoid incorrect posture or unnecessary tension. Options include courses offered in physiotherapy practices or rehabilitation centres, Tai-Chi schools, certified prevention courses or reputable online programmes / video formats.

·       Mindfulness / MBSR: Less Sensory Overload

Approaches such as Mindfulness-Based Stress Reduction (MBSR) aim to change the processing of pain and stress stimuli. Training focuses on directed attention, non-judgemental perception of bodily sensations and a conscious handling of automatic stress reactions.

In fibromyalgia, where central sensitization and increased stress vulnerability play a role, such training may help reduce over-arousal and improve functional coping with symptoms (Pérez-Aranda et al., 2019).

Mindfulness does not mean “simply sitting still”, but systematic training. Without guidance, many people either drift into rumination or abandon the exercise too quickly when restlessness or pain arises. The goal, however, is not relaxation in the narrow sense, but conscious awareness.

How can one begin? With guidance! Options include:

·       certified MBSR courses (8-week programmes)

·       courses offered by adult education centres, rehabilitation centres or pain clinics

·       programmes subsidised by health insurance

·       structured online MBSR courses.

A typical MBSR course includes:

·       weekly group sessions (around 2 hours)

·       daily practice at home (20–40 minutes)

·       body scan, breathing meditation and mindful movement.

After an introduction, independent practice is also possible:

·       with guided audio instructions

·       structured online programmes

·       fixed daily practice time (e.g., 10–20 minutes at the beginning).

      ·       Acupuncture: Targeted Stimulus Modulation and Supportive Pain Regulation

Acupuncture is frequently used in fibromyalgia as an adjunctive measure and influences pain processing modulation as well as the regulation of autonomic stress responses.

Systematic reviews and meta-analyses of randomized studies show that acupuncture can achieve significant improvements in pain and quality of life compared with sham or control interventions. Both short-term effects and, in some cases, improvements lasting several weeks have been described, although the overall quality of evidence is considered moderate (Zhang et al., 2019). Conventional medicine still does not fully understand the mechanisms of acupuncture and therefore sometimes hesitates to recognise it fully.

A typical treatment includes:

·       insertion of fine needles at defined points

·       retention for approximately 20–30 minutes; 1–2 sessions weekly

·       treatment series over several weeks.

The treatment is generally well tolerated and can be adapted to individual resilience.

Acupuncture is offered, among others, by:

·       physicians with additional acupuncture qualifications

·       pain therapy practices

·       orthopaedic or rheumatology practices

·       non-medical practitioners

·       integrative medicine centres.

To avoid fraudulent offers, attention should always be paid to the qualifications of the respective providers.

Fibromyalgia Conclusion: Nature’s Offers of Help Are More Diverse Than Often Assumed

Although there is no single miracle solution, research shows that natural substances and regulatory approaches offer relevant therapeutic options — particularly in relation to stress axes, sleep quality, energy metabolism and central pain processing.

What matters is not the isolated trial of individual measures but a structured and realistically evaluated strategy: selected supplements where indicated, regulatory practices such as Tai Chi or mindfulness to stabilise the nervous system, and complementary approaches such as acupuncture as additional elements.

Not every intervention works equally well for every person. However, there is room for action — and it is worthwhile to make use of it in an informed and individualized manner.

FAQ – (Further) Frequently Asked Questions About Complementary Medicine and Phytotherapies in Fibromyalgia

1. Why can the effects of phytotherapies and complementary approaches vary strongly between individuals with fibromyalgia?

Phytotherapies and complementary approaches target different physiological processes, such as sleep regulation, stress processing, energy metabolism or pain modulation. Because fibromyalgia does not represent a uniform disease pattern but varies individually, affected individuals may not respond identically to the same intervention. Factors such as symptom focus, comorbidities, baseline values (e.g., vitamin-D levels), medication use and individual stress burden strongly influence the magnitude of effects.

2. How long should a supplement be tested in fibromyalgia before its effects are evaluated?

Since fibromyalgia is a chronic regulatory syndrome, short-term effects are rarely reliable. Many clinical studies on supplements last several weeks. A testing period of 4–12 weeks, depending on the substance and available evidence, is therefore reasonable in order to assess changes in pain, fatigue or sleep quality. If improvement occurs, supplementation may be continued while tolerance and benefit should be regularly reassessed.

3. Can several supplements be taken simultaneously or should one proceed step by step?

A gradual approach is professionally recommended because otherwise effects and potential side effects are difficult to attribute. In addition, some substances — particularly those influencing neurotransmitters — may interact with certain medications. A structured and controlled supplementation strategy is therefore preferable to taking multiple preparations simultaneously.

The newly published fifth volume of our “Codex Humanus” is now available in our online shop. The other four volumes of the series are also available there, as well as all volumes of the “Medizinskandale” series. You can find further information on fibromyalgia and many other topics on our blog. 

Sources:

·       Rossini, M. et al. (2007): “Double-blind, multicenter trial comparing acetyl-L-carnitine with placebo in the treatment of fibromyalgia patients,” Clinical and Experimental Rheumatology.

·       Cordero, M. D. et al. (2013): “Can coenzyme Q10 improve clinical and molecular parameters in fibromyalgia?,” Antioxidants & Redox Signaling.

·       Clauw, D. J. (2014): “Fibromyalgia: A Clinical Review,” JAMA.

·       Häuser, W. et al. (2015): “Fibromyalgia,” Nature Reviews Disease Primers.

·       Hussain, S. A. R. et al. (2011): “Adjuvant use of melatonin for treatment of fibromyalgia,” Journal of Pineal Research.

·       Perez, R. S. G. M. et al. (2003): “The treatment of complex regional pain syndrome type I with free radical scavengers: a randomized controlled study,” Pain.

·       Calder, P. C. (2017): “Omega-3 fatty acids and inflammatory processes: from molecules to man,” Biochemical Society Transactions.

·       Hausenblas, H. A. et al. (2013): “Saffron (Crocus sativus L.) and major depressive disorder: a meta-analysis of randomized clinical trials,” Journal of Integrative Medicine.

·       Wepner, F. et al. (2014): “Effects of vitamin D on patients with fibromyalgia syndrome: a randomized placebo-controlled trial,” Pain.

·       Wang, C. et al. (2010): “A randomized trial of tai chi for fibromyalgia,” New England Journal of Medicine.

·       Pérez-Aranda, A. et al. (2019): “A randomized controlled efficacy trial of mindfulness-based stress reduction compared with an active control group and usual care for fibromyalgia: the EUDAIMON study,” Pain.

·       Zhang, X.-C. et al. (2019): “Acupuncture therapy for fibromyalgia: a systematic review and meta-analysis of randomized controlled trials,” Journal of Pain Research.