“Pain is real when you get other people to believe in it. If no one believes in it but you, your pain is madness or hysteria.” – Naomi Wolf

Fibromyalgia (FM)

A Complementary and Alternative Medicine (CAM) Approach

Complementary and Alternative Medicine (CAM) is defined by the National Institutes of Health (NIH) Center for Complementary and Alternative Medicine as, “those treatments and healthcare practices not taught widely in medical schools, not generally used in hospitals, and not usually reimbursed by medical insurance companies.”


Fibromyalgia (FM), one of the most common chronic pain syndromes, is characterized by diffuse musculoskeletal pain, in addition to extreme fatigue and mood and sleep disturbances. The cause(s) of fibromyalgia is not known but it usually affects women more than men, it has a genetic predisposition and its prevalence in the general population is approximately 7%. Sadly, there are still practicing physicians who don’t even believe that fibromyalgia is “real.” At this point in time, conventional medicine has limited offerings to patients suffering from fibromyalgia (FM).

For  more information regarding conventional assessment and management of FM,

see: Fibromyalgia.

The recent changes in access to medical marijuana and marijuana-based medication offers hope for a new alternative treatment for many of the symptoms associated with FM.

See: Marijuana (Cannabis) – Fibromyalgia


While one focus of conventional treatment for FM is on exercise, many FM patients do not tolerate or benefit much from exercise due to their underlying FM and associated central sensitivity or due to other co-morbid pain conditions. That being said, exercise within tolerable limits is still encouraged with special emphasis on low-impact exercise such as swimming or other water-based exercise and yoga or tai chi as directed by an instructor with sensitivity to the physical limitations of their student.

See: yoga or tai chi


With FM as with all forms of chronic pain, conventional medicine turns to non-conventional mind-based activities to improve patient skills with coping techniques for adapting to, and living with, chronic pain. These techniques include cognitive behavior training (CBT), meditation and other “mindful” exercises that guide the practicioner to focusing their minds on singular activities that relax and de-stress the patient.

See: CBT, meditation

Another very useful treatment option is hypnosis, which is in effect a guided mindful technique, one with particular effectiveness in FM.

See: Hypnosis

However, many patients continue to fail to achieve adequate relief of their FM symptoms despite conventional medications, exercise and mindful exercises.  These symptoms can be broadly categorized into 3 arenas

  1. Pain
  2. Fatigue including non-restful sleep
  3. Cognitive impairment or “brain fog”

To address these concerns, there are some CAM treatments that can be considered, see below.
For further understanding of FM, see:

See also:



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Definitions and Terms Related to Pain

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CAM Treatment of Fibromyalgia Syndrome (FM)

For more information about the characteristic symptoms and features of FM, including conventional assessment and management,
see: Accurate Education – Fibromyalgia

 also, see: Cannabis – Fibromyalgia

Conventional management of FM focuses on the use of prescription medications including neuromodulating drugs such as anticonvulsants and antidepressants and in some cases, opioids, although most conventional opioids offer limited analgesic benefit for FM pain. Conventional clinical management of FM is now turning also to behavioral approaches including exercise, cognitive behavior therapy (CBT), and a variety of  ‘mindful’ exercises including meditation, yoga and tai chi. Unfortunately the conventional medical community offers little, if any, access to these treatment options and commercial insurers are unlikely to pay for them. 

Fibromyalgia Treatment with a Serotonin-Supportive Diet

A recently proposed hypothesis for a dietary management approach developed from the evidence that low serotonin levels are involved in FM. The serotonin system regulates many neurophysiological processes and behavioral functions, including pain, sensory function, appetite, gastrointestinal function, motor function, mood, cognition, sleep, sexuality, and neuroendocrine function.
Serotonin (5-HT) is synthesized in the body starting from the essential amino acid tryptophan. The presence of non-absorbed molecules in the gut, primarily fructose (fruit sugar), reduces tryptophan absorption from the diet. This low tryptophan absorption then leads to low serotonin synthesis which triggers FM symptoms. Additionally, non-absorbed sugars may also produce a microbiota deterioration activating a positive feedback loop: the increasing microbiota deterioration reduces the functionality of absorption both of fructose and tryptophan in the gut, engaging a vicious circle. The proposed dietary management approach is directed at sustaining serotonin synthesis by allowing the proper tryptophan absorption. The core of this approach is the exclusion from the diet of some carbohydrates and the marked reduction of some others. Because non-absorbed fructose is the major carbohydrate responsible for the impairment of Trp absorption in the gut, it is the main target for dietary limitation.

The presence of non-absorbed fructose may have different causes: the easiest one to solve is excessive fructose intake. Eating excessive amount of fructose is very easy to do because modern Western diets are rich in fructose from foods and sodas/beverages containing high fructose corn syrup (HFCS) as well as fresh fruit and honey that naturally contain fructose. Therefore, reducing fructose intake may be the fastest and easiest way to reduce symptoms of FM. In addition, wheat and most cereals and legumes and many vegetables contain fructans which also contribute to the total amount of ingested fructose.The second cause is fructose malabsorption which may be due to failure in the transporter proteins responsible for absorbing fructose from the gut. Ingesting glucose activates the transporters responsible for absorbing both fructose and glucose so ingesting glucose with fructose may actually help fructose absorpti0n. Thus, eating the disacchoride sucrose, or table sugar, which consists of equal amounts of fructose and glucose may enhance absorption of fructose and reduce the levels of non-absorbed fructose.
lacose (the sugar in milk and dairy products as well as other hexose sugars used as artificial sweeteners such as xylose and sorbitol may also contribute to non-absorbed fructose. Finally, monosodium glutamate (MSG) and aspartame should be removed from the diet also. MSG can have excitotoxic effects in both the central and peripheral nervous system. Aspartame may significantly impair the release of serotonin in the brain. To summarize:
It may be an effective strategy to stimulate remission of FM symptoms based on the above principles. Theoretically, the most effective dietary management of FM would be a fructose-free, fructan-restricted, lactose-free, sorbitol-free, aspartame-free, and MSG-free diet together with proper tryptophan intake. In severe cases a near to zero fructans intake would also be necessary, at least for a period. This is expected to obtain a remission in FM symptoms, not a cure: straying from this diet is expected to allow the reappearance of symptoms.
For more specifics regarding this diet, please contact the registered dietitian or naturopath physician at Accurate Clinic.


Fibromyalgia Treatment with Marijuana (Cannabis)

The current state of medical marijuana research, especially in the field of fibromyalgia, is based mostly on studies using the cannabis plant, whether smoked, vaped or ingested, in which virtually nothing is known about the dosages associated with use, i.e. how much THC, CBD and other constituents were used and how often. This leaves a serious weakness in applying the findings to the use of marijuana-based products which have fixed amounts and ratios of constituents. Most cannabis research is in the form of observational studies with very few randomised controlled trials to guide management of fibromyalgia with specific cannabis-based treatments.

A 2014 online survey of over 1,300 fibromyalgia patients conducted by the National Pain Foundation and published in the National Pain Report indicated that while over 70% of the people who responded to the survey indicated they had not tried medical marijuana, but of those who did try medical marijuana said it was far more effective than any of the FDA-approved prescription medications for fibromyalgia (Cynbalta, Lyrica, Savella).
Sixty-two percent of respondents who had tried cannabis considered it very effective for treating their fibromyalgia symptoms and another 33% said it helped a little, while only 5% said it did not help at all. Some responders reported that nothing had worked for them apart from marijuana. Adverse effects reported included brain fog with use of medical marijuana.
See: Marijuana (Cannabis)  – Fibromyalgia

CAM Treatment of FM – Pain

Most opioid analgesics offer limited benefit for FM pain and the anticonvulants and antidepressants are also of limited benefit and often not tolerated well due to side effects. As alternatives to these medications, CAM medications provide some helpful options for managing FM pain.

CAM Treatment and Exercise

While exercise for FM pain is beneficial for some and intolerable for others, there are some CAM alternatives that may improve the effectivenss and tolerability of exercise for FM pain. Recent research indicates that the pathophysiology of FM pain is related to oxidative stress and mitochondrial dysfunction (please read about mitochondrial dysfunction). It is known that exercise activates SIRT1 which in turn stimulates mitochondrial biogenesis resulting in mitochondrial repair and improved function. However, it is also known that activating SIRT1 is not likely to benefit in the absence of adequate amounts of NAD+. Therefore, treatments that supplement SIRT1 activity (NRF2 activators) and increase NAD+ such as Nicotinamide Riboside (NR) are likely to have a synergistic effect on the benefit of exercise on FM pain.

For more information, see: antioxidants,mitochondrial dysfunction, NRF2 activators, and Nicotinamide Riboside (NR).

Caloric Restriction and Fasting

There is a growing amount of research that indicates that restricting calorie intake below the individual’s daily needs and fasting provide potential benefit for improving mitochondrial function and this benefit has been noted in patients with fibromyalgia.  


Diet & Fasting

Mitochondrial Dysfunction.

Antioxidants and NRF2 Activators

Oxidative stress and free radicals (ROS and RNS) have been found to play a role in the pain of FM, as related to mitochondrial dysfunction but also with the process of central sensitization. Studies indicate that antioxidants and NRF2 activators may reduce FM pain.

See: Antioxidants and Oxidative Stress and NRF2 activators.)

Palmitoylethanolamide (PEA)

Palmitoylethanolamide (PEA) is emerging as a new agent in the treatment of pain and inflammation with studies showing improved pain with FM. PEA appears to interact with glial cells and mast cells in the central nervous system as their mechanism of action in reducing nerve and inflammatory pain. It is also believed that glial cells play a role in central sensitization and PEA may be an effective treatment option for manifestations of central sensitivity in FM.

See: Palmitoylethanolamide (PEA)


Animal studies suggest melatonin is able to improve behavior, oxidative and nitrosative stress, mast cell infiltration and activation of microglia in a FM model. In humas, treatment of pain in fibromyalgia patients with melatonin has been tested in a limited number of studies. In one study carried out on 21 female patients, melatonin was administered in doses of 3 mg for 4 weeks, 30 minutes before bed time. Improvements with respect to pain, fatigue and depressive symptoms were noted. Another study looked at 10 mg night time dosing with significant improvement of fibromyalgia pain.

In a clinical trial, the combination of amitriptyline and melatonin provided better results than amitriptyline alone in subjects with FM. A randomized trial found that melatonin alone or in combination with fluoxetine (Prozac) was beneficial for the treatment of FM. Dosing melatonin (3 or 5 mg/day) in combination with 20 mg/day fluoxetine caused a significant reduction in both total and individual components of the Fibromyalgia Impact Questionnaire score.

See: Melatonin


A recent 2013 publication on the use of ginseng (Panax ginseng) at a dose of 100mg/day in fibromyalgia found it to be effective for pain, sleep and fatigue. It was also helpful for anxiety, although amitriptylene was somewhat more effective than the ginseng but took longer (6 weeks) for the benefits to begin.

Ginseng’s antinociceptive effects have been demonstrated in preclinical studies. The mechanism by which the active agents (ginsenosides) in ginseng work may be the same as gabapentin (Neurontin) and pregabalin (Lyrcica), by inhibiting calcium channels in nerves in dorsal spinal cord, thus suggesting a potential synergistic benefit when taken with either of these medications. The inhibitory effects of ginsenosides on substance P-induced pain has also been confirmed.

Opioid Antagonists – Naltrexone and Naloxone

Recent research suggests that the opioid blockers, naltrexone and naloxone, may have clinical benefit for fibromyalgia. While not yet frequently used, they are well tolerated and there is growing evidence suggesting the benefit of naltrexone in fibromyalgia particularly when associated with hyperalgesia and central sensitization. Fibromyalgia, a “central sensitivity syndrome,”  shares pathophysiological mechanisms with conditions such as irritable bowel syndrome, temporomandibular disorders, interstitial cystitis, and chronic fatigue syndrome. Central sensitivity is produced at least in part by central nervous system inflammation induced by proinflammatory agents (cytokines) released by immune cells including glial cells or microglia. This central neuroinflammation contributes to the hyperalgesia, fatigue, and other symptoms of fibromyalgia.

Naltrexone is a competitive antagonist of opioid receptors that blocks analgesic and other effects of opioids. It has been used for over 30 years to treat opioid addiction and also for the treatment of alcoholism. More recently, naltrexone (and the shorter acting naloxone) has been found to reduce the release of the proinflammatory cytokines and other agents produced by microglia cells in  conditions of chronic pain. This mechanism of action is independent of naltrexone’s actions on opioid receptors and is believed to be due to its inhibition of the TLR-4 receptors on glial cells (See TLR-4 Antagonists). Naltrexone has also been proposed to provide neuroprotective benefits via effects on mitochondrial pathways.

Naltrexone has been used clinically in a wide range of doses. Standard doses used in the management of opioid addiction range between 25-100 mg/day. Because they are opioid blockers, they cannot be used, at least with usual doses  at the same time as opioids. The doses used in treating fibromyalgia and other central sensitivity syndromes generally range between 1-4.5 mg/day, termed “low dose natrexone”(LDN).  Even lower doses in the 1-5 mcg/day range (ultra low-dose naltrexone (ULDN) are used to provide neuroprotective benefits, especially when the patient is concurrently taking opioids for pain.

Naltrexone is well tolerated as noted in all studies, but patients do report headaches, insomnia, and vivid dreams that usually improve within a few weeks. If insomnia is a problem, dosage can be changed to morning. No serious side effects have been reported.

Patients using LDN usually start to get benefit at about 2–3 weeks, with a maximum benefit achieved in 2-3 months.  Patients using ultra low-dose naltrexone (ULDN) may take a little longer to get benefit.

Unfortunately, high quality human studies are few, with most studies of small scale.  A small 2009 pilot study evaluated ten women with fibromyalgia treated with LDN 4.5 mg taken one hour before bedtime for 8 weeks. Six of the 10 women experienced a significant response to the LDN, showing a greater than 30% reduction of symptoms, including average pain, highest pain, fatigue, and stress. This degree of symptom reduction corresponds with “much improved” or “very much improved.”  Treatment was accompanied by a very low incidence of side effects, including rare insomnia and vivid dreams described as minor and transient.

Of interest in this study is that patient’s baseline erythrocyte sedimentation rate (ESR), a blood test that measures general inflammation, appeared to predict drug response. Individuals with higher ESRs (indicating general inflammatory processes) had the greatest reduction of symptoms in response to the low-dose naltrexone.

A 2013 follow-up study was completed by the same researcher with thirty-one women with fibromyalgia. In this study 32% of the women experienced an average 29% reduction in pain plus a significant reduction in either fatigue or sleep problems. The LDN was well tolerated, equivalent to placebo, and no serious side effects were reported.

In 2017 a study with eight women with an average age of 46 years, symptom severity of 62 out of 100, and symptom duration of 14 years was published evaluating treatment with LDN for 8 weeks. It was found that LDN treatment significantly reduced plasma concentrations of multiple markers for inflammation (interleukin (IL)-1β, IL-1Ra, IL-2, IL-4, IL-5, IL-6, IL-10, IL-12p40, IL-12p70, IL-15, IL-17A, IL-27, interferon (IFN)-α, transforming growth factor (TGF)-α, TGF-β, tumor necrosis factor (TNF)-α, and granulocyte-colony stimulating factor (G-CSF). These are markers commonly associated with pain, including hyperakgesia and allodynia. LDN treatment in this study was associated with a 15% reduction of FM-associated pain and an 18% reduction in overall symptoms.

No studies have been published that specifically evaluate treating fibromyalgia patients currently taking opioids with naltrexone. Due to the anttagonistic effect of naltrexone on opioids, simultaneous treatment with both agents could trigger withdrawal symptoms in someone physically dependent on opioids related to extended use. As such it is recommemded that opioids be tapered off first, or failing that, opioid doses be significantly reduced and the use of naltrexone be limitied to low dose or ultra low dose.

It has been reported that use of ultra-low doses of opioid antagonists (including naltrexone) along with opioids can reduce opioid side effects such as opioid-induced hyperalgesia, sweating, lower leg edema, and itching as well as imcrease analgesic benefits and suppress build-up of tolerance. Anecdotal reports from experienced pain management physicians indicate the combination of buprenorphine and naloxone is associated with greater pain control and a lower abuse rate compared with the use of pure buprenorphine preparations alone. It has been recommended to combine ULDN micro-doses of oral naltrexone (1 to 8 mcg) with the buprenorphine patch (Butrans), buprenorphine buccal film (Belbuca), or generic sublingual buprenorphine.

Ginevra Liptan MD (medical director of The Frida Center for Fibromyalgia), a physician with experience managing fibromyalgia patients with naltrexone, reports her observations on her website (see www.DrLiptan.com). She notes that everyone is very different in their sensitivity to opiates and withdrawal symptoms when adding LDN or ULDN. Her experience is that if someone has been on high dosages of opiates for years and only recently tapered down, naltrexone may not work as well and patients should be started with ULDN. She advises treatment be limited to those patientw on relatively low dosage of opiates; for example a total daily dosage of 40 mg or less of morphine or hydrocodone, 30 mg or less per day of oxycodone, or 300mg or less per day of tramadol. She advises to separate dosages of short-acting opiates from ULDN or LDN by at least six hours. Even with this separation one may still experience some withdrawal symptoms.

CAM Treatment of FM – Fatigue, Insomnia and Non-Restful Sleep

As noted above, recent research has indicated that the underlying pathophysiology of FM points to issues of oxidative stress and mitochondrial dysfunction. The mitchondria are components within the cell that contribute to energy production and the manufacture of antioxidants and it is believed dysfunction here leads to the fatigue, non-restful sleep and many other symptoms associated with FM.

In addition to the potential benefits of PEA, nicotinamide riboside (NR) and NRF2 activators (see above) for fatigue, additional supplements have been identifed as helpful for fatigue and sleep.


Coenzyme Q10 (CoQ10) is an antioxidant found in high levels in healthy mitochondria and is critical in mitochondrial function.  CoQ10 levels (as measured in blood mononuclear cells) have been noted to be low in FM patients and  treatment with CoQ10 has been found to improve multiple symptoms of FM.

Redearch suggests that CoQ10 supplementation improves the mitochondrial dysfunction and oxidative stress that can induce headaches in individuals with FM. CoQ10 supplementation has also  shown to provide additional benefits for relieving pain in FM patients treated with pregabalin, possibly by improving mitochondrial function and reducing inflammation.


Melatonin has multiple studies supporting the use of melatonin for the treatment of the pain, fatigue and insomnia related to fibromyalgia. Research suggests that it may require higher doses, up to 10 mg/day, to achieve the most benefits from melatonin.

Palmitoylethanolamide (PEA)

PEA is a natural powerful anti-inflammatory, analgesic and neuroprotective compound produced in central and peripheral organs and nerves. PEA is emerging as a new therapeutic option due to anti-inflammatory and anti-hyperalgesic benefits especially for peripheral neuropathic pain and other symptoms of FM.

PEA acts via many mechanisms including activity in the endoccannabinoid system and downregulation of mast cell activation. These actions contribute to synergistic benefits when treatment with PEA is combined with other medications including cannabinoids such as CBD and BCP as well as pregabalin (Lyrica).

Please review the following CAM treatment options that are believed helpful with the fatigue and insomnia associated with FM:

  1. Beta-Caryophyllene BCP)
  2. CoQ10
  3. Melatonin
  4. Nicotine Riboside (NR)
  5. NRF2 activators
  6. Palmitoylethanolamide (PEA


CAM Treatment of FM – Cognitive Impairment (“Brain Fog”)

Brain “fog” is a collection of symptoms that include reduced or inability to concentrate and multitask, as well as impaired short and long term memory. Like most of the FM symptoms described above, the cognitive impairment of FM is believed to be related to mitochondrialdysfunction and may respond to the treatments outlined above for the pain and fatigue of FM. A recent study published in 2014 pioneered a new application of a safe, established medication, memantine (Namenda), used for a variety of neurodegenerative disorders and now found to be beneficial in the cognitive impairment of fibromyalgia (see Fibromyalgia, NMDA antagonists).


Recent research implicates dysfunction of mast cells and glial cells as contributors to “brain fog.” Mast cells are found throughout the body and brain, adjacent to blood vessels, which contain histamine and various inflammatory substances that upon release into surrounding tissues lead to inflammation. In the case of mast cells in the brain and nervous system, their dysfunction can lead to impairment of the blood-brain barrier and activation of glial cells that stimulate neuroinflammation and dysfunction in the nervous system thought to contribute to the cognitive impairment typical of FM and other diseases.

A study published in 2015 suggests the potential benefit of luteolin, a potent antioxidant with anti-inflammatory and anti-cancer properties found in fruits and vegetables that is reported to stabilize mast cells, may be effective in the treatment of cognitive impairment. Unfortunately, luteolin is not well absorbed, or bioavailable, when ingested from food sources. A luteolin supplement formulated with olive oil was found to increase intestinal absorption. Also possibly noteworthy is that Luteolin appears to be metabolized by COMT so there may be genetically variant responses to Luteolin as well as possible drug interactions if taken with COMT inhibitors (green tea, quercetin and various prescription medications used in the treatment of Parkinson’s Disease.

Alpha Lipoic Acid (ALA) and Acetyl L-Carnitine

Alpha lipoic acid (ALA), a mitochondrial nutrient, offers protective effects and possible improvements in age-associated cognitive and mitochondrial dysfunction of the brain. ALA improves age-associated decline of memory, improves mitochondrial structure and function, inhibits age-associated increase of oxidative damage, elevates the levels of antioxidants, and restores the activity of key enzymes. In addition, co-administration of ALA with other mitochondrial nutrients, such as acetyl-L-carnitine and coenzyme Q10, appears more effective in improving cognitive dysfunction and reducing oxidative mitochondrial dysfunction.

(For more information, seeAlpha Lipoic Acid (ALA) and Acetyl L-Carnitine)

Bacopa Monnieri

Bacopa monnieri, (also known as brahmi, water hyssop, Bacopa monniera, and Herpestis monniera), is an herb native to Australia and India that has been used for 1400 years in Ayurvedic medicine, prescribed for cognitive dysfunction to sharpen intellect and improve memory. However, the study of Bacopa monnieri is in it’s infancy in western medicine and there does not appear to be any studies that look directly at Bacopa for cognitive impairment associated specifically with fibromyalgia. There is evidence for Bacopa effectiveness in improving cognitive function but most of the evidence is still weak and concentrated on animal studies.

Bacopa appears to be safe and well tolerated at usual recommended doses but no specific recommendations for Bacopa in fibromyalgia can be advised at this time.

(For more information, see:Bacopa).


Citicoline is a natural food supplement that has been evaluated for treatment of the cognitive impairment and memory dysfunction associated with aging and several neurodegenerative conditions such as Alzheimer’s disease, Parkinson’s disease and traumatic brain injury. While there is evidence for citicoline effectiveness in improving cognitive function in these conditions, most of the evidence is still weak and concentrated on animal studies.  Furthermore, there are no studies evaluating the benefits of citicoline in fibromyalgia.

Citicoline appears to be safe and well tolerated at usual recommended doses but no specific recommendations for Citicoline in fibromyalgia can be advised at this time.

(For more information, see:Citicoline).

CAM Treatment of FM – Music Therapy

Numerous recent studies have provided evidence that listening to music reduces perception of pain intensity and/or perception of control over pain and reduces stress, a contributor to pain. In recent studies looking at music and pain in fibromyalgia patients, listening to music provided many benefits with respect to pain, sleep and improvement of activities.

For more information, see: Music Therapy


CAM, FMS – Overview

  1. Fibromyalgia – Diet & CAM Summary
  2. Fibromyalgia and nutrition – what news? – 2015
  3. Nutrition and Supplements for Fibromyalgia
  4. Modulation of NMDA Receptor Activity in Fibromyalgia – 2017
  5. Fibromyalgia- Pathogenesis, Mechanisms, Diagnosis and Treatment Options Update – 2021
  6. Fibromyalgia- Recent Advances in Diagnosis, Classification, Pharmacotherapy and Alternative Remedies – 2020



  1. CBT, Exercise May Ease Chronic Pain – in Clinical Context, Fibromyalgia
  2. Psychotherapy for patients with fibromyalgia syndrome. Systematic review, meta-analysis and guidelines. – PubMed – NCBI – 2012


CAM, FMS – Mindful Exercise, Meditation

  1. Mindfulness exercises
  2. Forever Young(er) – potential age-defying effects of long-term meditation on gray matter atrophy – 2015


CAM, FMS – Music Therapy

  1. Music as a sleep aid in fibromyalgia – 2014
  2. The effects of music listening on pain and stress in the daily life of patients with fibromyalgia syndrome – 2015
  3. The neurochemistry of music. – PubMed – NCBI
  4. Predictions and the brain: how musical sounds become rewarding. – PubMed – NCBI
  5. Effects of music on pain in patients with fibromyalgia. – PubMed – NCBI
  6. Music listening as a means of stress reduction in daily life. – PubMed – NCBI
  7. The impact of acute stress on hormones and cytokines and how their recovery is affected by music-evoked positive mood – 2016
  8. Stress exacerbates pain in the everyday lives of women with fibromyalgia syndrome–The role of cortisol and alpha-amylase. – PubMed – NCBI


CAM, FMS – Spa Therapy

  1. Fibromyalgia Syndrome and Spa Therapy – Myth or Reality?


CAM, FMS – Diet

  1. 5 Ways To Control Fibromyalgia With Diet – 2013
  2. Fibromyalgia and nutrition, what do we know? – PubMed – NCBI – 2010
  3. Dietary aspects in fibromyalgia patients: results of a survey on food awareness, allergies, and nutritional supplementation. – PubMed – NCBI
  4. Neurobiology of fibromyalgia and chronic widespread pain. – PubMed – NCBI
  5. Fibromyalgia and nutrition: what news? – PubMed – NCBI
  6. Fibromyalgia Syndrome – A Metabolic Approach Grounded in Biochemistry for the Remission of Symptoms -2017
  7. Fibromyalgia syndrome – a Case Report on Controlled Remission of symptoms by a Dietary strategy – 2018
  8. Dietary interventions in fibromyalgia- a systematic review – 2019
  9. Vegetarian and Vegan Diet in Fibromyalgia – A Systematic Review – 2021
  10. A systematic review of the association between fibromyalgia and functional gastrointestinal disorders – 2020
  11. Dietary Interventions in the Management of Fibromyalgia – A Systematic Review and Best-Evidence Synthesis – 2020
  12. Nutritional Interventions in the Management of Fibromyalgia Syndrome – 2020
  13. The Role of Nutrient Supplementation in the Management of Chronic Pain in Fibromyalgia A Narrative Review – PubMed
  14. Fibromyalgia – Pathogenesis, Mechanisms, Diagnosis and Treatment Options Update – 2021
  15. Coenzyme Q10 supplementation alleviates pain in pregabalin-treated fibromyalgia patients via reducing brain activity and mitochondrial dysfunction – PubMed – 2019



CAM, FMS, Diet – Aspartame & MSG (glutamate)

  1. Aspartame-induced fibromyalgia, an unusual but curable cause of chronic pain. – PubMed – NCBI
  2. Relief of Fibromyalgia Symptoms Following Discontinuation of Dietary Excitotoxins – 2000
  3. Hidden Sources Of MSG And Aspartame In Foods
  4. the-effect-of-dietary-glutamate-on-fibromyalgia-and-irritable-bowel-symptoms
  5. The effect of dietary glutamate on fibromyalgia and irritable bowel symptoms. – PubMed – NCBI
  6. Relief of fibromyalgia symptoms following discontinuation of dietary excitotoxins. 2001 – PubMed – NCBI
  7. Monosodium glutamate and aspartame in perceived pain in fibromyalgia. 2014 – PubMed – NCBI
  8. Influence of pro-algesic foods on chronic pain conditions. 2015- PubMed – NCBI
  9. High-Intensity Sweeteners Permitted for use in Food in the United States (FDA)
  10. MSG – Questions and Answers on Monosodium glutamate (FDA)

CAM, FMS, Diet – Gluten & Celiac Disease

  1. Clinical impact of a gluten-free diet on health-related quality of life in seven fibromyalgia syndrome patients with associated celiac disease
  2. Nonceliac gluten sensitivity. – PubMed – NCBI
  3. Non-celiac gluten sensitivity – Time for sifting the grain – 2015
  4. Non-celiac gluten hypersensitivity. – PubMed – NCBI
  5. The Overlap between Irritable Bowel Syndrome and Non-Celiac Gluten Sensitivity – A Clinical Dilemma – 2015
  6. Non-celiac Gluten Sensitivity. Is it in the Gluten or the Grain? – 2013
  7. Fibromyalgia and non-celiac gluten sensitivity – a description with remission of fibromyalgia – 2014

CAM, FMS – Genetics

CAM, FMS – Genetics: COMT

  1. Stress, the stress response system, and fibromyalgia

CAM, FMS – Genetics: COMT Inhibitors

CAM, FMS – Genetics, COMT Inhibitors: Quercetin

  1. Phytochemicals Inhibit Catechol-O-Methyltransferase Activity in Cytosolic Fractions from Healthy Human Mammary Tissues – Implications for Catechol Estrogen-Induced DNA Damage – 2004


CAM, FMS – Genetics, COMT Inhibitors: Green Tea

  1. Quercetin increased bioavailability and decreased methylation of green tea polyphenols in vitro and in vivo


CAM, FMS – Oxidative Stress

(See also: Antioxidants and NRF2 Activators)

  1. Oxidative Stress in Fibromyalgia – Pathophysiology and Clinical Implications – 2011
  2. Oxidative Stress in Fibromyalgia and its Relationship to Symptoms – 2009
  3. Clinical Symptoms in Fibromyalgia Are Better Associated to Lipid Peroxidation Levels in Blood Mononuclear Cells Rather than in Plasma
  4. free-radicals-and-antioxidants-in-primary-fibromyalgia-an-oxidative-stress-disorder-pubmed-ncbi
  5. Oxidative Stress Correlates with Headache Symptoms in Fibromyalgia – Coenzyme Q10 Effect on Clinical Improvement 2012
  6. Free radicals and antioxidants in primary fibromyalgia: an oxidative stress disorder? – PubMed – NCBI
  7. Current concepts in the pathophysiology of fibromyalgia: the potential role of oxidative stress and nitric oxide. – PubMed – NCBI
  8. Evidence of central inflammation in fibromyalgia — Increased cerebrospinal fluid interleukin-8 levels 2012
  9. Vitamins C and E treatment combined with exercise modulates oxidative stress markers in blood of patients with fibromyalgia: a controlled clinical … – PubMed – NCBI
  10. Total antioxidant capacity and the severity of the pain in patients with fibromyalgia. – PubMed – NCBI
  11. Stress, the stress response system, and fibromyalgia
  12. Serum prolidase enzyme activity and oxidative status in patients with fibromyalgia. – PubMed – NCBI
  13. Serum ischemia-modified albumin and malondialdehyde levels and superoxide dismutase activity in patients with fibromyalgia. – 2014 – PubMed – NCBI
  14. Pathophysiology and antioxidant status of patients with fibromyalgia. 2011 – PubMed – NCB
  15. Metformin and caloric restriction induce an AMPK-dependent restoration of mitochondrial dysfunction in fibroblasts from Fibromyalgia patients. 2015 – PubMed – NCBI
  16. Fibromyalgia and chronic fatigue: the underlying biology and related theoretical issues. – PubMed – NCBI
  17. Current concepts in the pathophysiology of fibromyalgia: the potential role of oxidative stress and nitric oxide. 2006 – PubMed – NCBI
  18. Antioxidant status, lipid peroxidation and nitric oxide in fibromyalgia: etiologic and therapeutic concerns. 2006 – PubMed – NCBI


CAM, FMS – Mitochondrial Dysfunction

See also:

Antioxidants and Oxidative Stress

Antioxidants and NRF2 Activators


  1. The role of mitochondrial dysfunctions due to oxidative and nitrosative stress in the chronic pain or chronic fatigue syndromes and fibromyalgia patients – 2013
  2. Oxidative stress and mitochondrial dysfunction in fibromyalgia. – PubMed – 2010
  3. Roles of Reactive Oxygen and Nitrogen Species in Pain – 2011
  4. Is Inflammation a Mitochondrial Dysfunction-Dependent Event in Fibromyalgia? – 2012
  5. Metformin and caloric restriction induce an AMPK-dependent restoration of mitochondrial dysfunction in fibroblasts from Fibromyalgia patients. 2015 – PubMed – NCBI
  6. Mitochondrion-Permeable Antioxidants to Treat ROS-Burst-Mediated Acute Diseases – 2016
  7. Melatonin-Mitochondria – 2006
  8. noninvasive-optical-characterization-of-muscle-blood-flow-oxygenation-and-metabolism-in-women-with-fibromyalgia-2012

CAM, FMS – Treatment (Tx)

  1.  Fibromyalgia Syndrome in Need of Effective Treatments – 2015


CAM, FMS Tx – Beta Caryophyllene (BCP)

See: Beta Caryophyllene (BCP)


CAM, FMS Tx – Antioxidants & NRF2 Activators

(See also: Antioxidants and NRF2 Activators)

  1. Fibromyalgia, Oxidative Stress and NRF2 – Any Hope


CAM, FMS Tx – Antioxidants: CoQ10

  1. Benefits of Coenzyme Q10 | Fibromyalgia Natural Relief
  2. Can coenzyme q10 improve clinical and molecular parameters in fibro… – PubMed – 2013
  3. Coenzyme Q10 Regulates Serotonin Levels and Depressive Symptoms in Fibromyalgia Patients – 2013
  4. Effect of coenzyme Q10 evaluated by 1990 and 2010 ACR Diagnostic Criteria for Fibromyalgia and SCL-90-R – 2013
  5. Fibromyalgia: unknown pathogenesis and a “chicken or the egg” causa… – PubMed – 2012
  6. NLRP3 inflammasome is activated in fibromyalgia: the effect of coen… – PubMed – 2014
  7. Oral coenzyme Q10 supplementation improves clinical symptoms and re… – PubMed – 2012
  8. Oxidative stress and mitochondrial dysfunction in fibromyalgia. – PubMed – 2010


CAM, FMS Tx – Antioxidants & NRF2 Activators: Curcumin

  1. Therapeutic roles of curcumin – lessons learned from clinical trials. – 2013


CAM, FMS Tx – Antioxidants: Luteolin

  1. Brain “fog,” inflammation and obesity – key aspects of neuropsychiatric disorders improved by luteolin – 2015
  2. Role of Catechol-O-Methyltransferase in the Disposition of Luteolin in Rats – 2011


CAM, FMS Tx – Bacopa

  1. Neuropharmacological Review of the Nootropic Herb Bacopa monnieri – 2013


CAM, FMS Tx – Clonidine

  1. Analgesic synergy between opioid and α2-adrenoceptors – 2014
  2. Clonidine May Help in Chronic Fatigue Syndrome (CFS) and Fibromyalgia Because – 2013
  3. Idiopathic Peripheral Neuropathy Responsive to Sympathetic Nerve Blockade and Oral Clonidine – 2012
  4. Clonidine – clinical pharmacology and therapeutic use in pain management
  5. Clonidine for management of chronic pain – A brief review of the current evidences – 2014
  7. Topical clonidine for neuropathic pain – 2015



  1. Influence of cortisol and DHEA-S on pain and other symptoms in post menopausal women with fibromyalgia. – PubMed – NCBI
  2. Proinflammatory cytokines and DHEA-S in women with fibromyalgia – impact of psychological distress and menopausal status

CAM, FMS Tx – Ginseng

  1. Effects of Panax ginseng extract in patients with fibromyalgia – 2013


CAM, FMS Tx – Melatonin


   Melatonin – Fibromyalgia Pain

  1. Melatonin therapy in fibromyalgia. – PubMed – NCBI
  2. Melatonin therapy in fibromyalgia, Commentary – 2006
  3. Melatonin analgesia is associated with improvement of the descending endogenous pain-modulating system in fibromyalgia – a phase II, randomized, double-dummy, controlled trial – 2014
  4. The effect of melatonin in patients with fibromyalgia: a pilot study. – PubMed – NCBI
  5. Adjuvant use of melatonin with fluoxetine (Prozac) for treatment of fibromyalgia. – 2012
  6. Fibromyalgia–a syndrome associated with decreased nocturnal melatonin secretion. – PubMed – NCBI
  7. Abnormality of Circadian Rhythm of Serum Melatonin and Other Biochemical Parameters in Fibromyalgia Syndrome – 2011
  8. A Quest for Better Understanding of Biochemical Changes in Fibromyalgia Syndrome – 2014
  9. Is the Deficit in Pain Inhibition in Fibromyalgia Influenced by Sleep Impairments? – 2012


   Melatonin – Insomnia

  1. The effectiveness of melatonin for promoting healthy sleep – a rapid evidence assessment of the literature – 2014
  2. Insomnia associated with valerian and melatonin usage in the 2002 National Health Interview Survey. – 2007
  3. Ramelteon: MedlinePlus Drug Information

CAM, FMS Tx  – Naltrexone

  1. Effects of Naltrexone on Pain Sensitivity and Mood in Fibromyalgia – 2009
  2. Low-Dose Naltrexone Eases Pain and Fatigue of Fibromyalgia
  3. Low-Dose Naltrexone Effective Therapy for Fibromyalgia
  4. Naltrexone for Fibromyalgia – Learn About Research Studies!
  5. fibromyalgia-symptoms-are-reduced-by-low-dose-naltrexone-a-pilot-study-2009
  6. Low-dose naltrexone for the treatment of fibromyalgia: findings of a small, randomized, double-blind, placebo-controlled, counterbalanced, crossove – 2013 – PubMed – NCBI
  7. The use of low-dose naltrexone (LDN) as a novel anti-inflammatory treatment for chronic pain – 2014
  8. Reduced Pro-Inflammatory Cytokines after Eight Weeks of Low-Dose Naltrexone for Fibromyalgia – 2017
  9. Combine Opiate and Opiate Blocker for Less Fibromyalgia Pain? — Dr Ginevra Liptan
  10. Three Letters You Need to Know If You Have Fibromyalgia: LDN — Dr Ginevra Liptan
  11. Answers to Some FAQs on Low-Dose Naltrexone — Dr Ginevra Liptan
  12. Lessons Learned on Opiates and LDN for Fibromyalgia — Dr Ginevra Liptan
  13. Low-dose naltrexone for the treatment of fibromyalgia: findings of a small, randomized, double-blind, placebo-controlled, counterbalanced, crossove – 2013 – PubMed – NCBI
  14. Aversive effects of naltrexone in subjects not dependent on opiates. – PubMed – NCBI
  15. More Evidence That Naltrexone Aids Fibromyalgia
  16. Fibromyalgia and Integrative Approaches
  17. Management of Opioid Tolerability and Related Adverse Effects – 2010
  18. The use of naltrexone in low doses beyond the approved indication – 2015
  19. A sudden and unprecedented increase in low dose naltrexone (LDN) prescribing in Norway. Patient and prescriber characteristics, and dispense patterns. A drug utilization cohort study – 2017


CAM, FMS Tx  – NMDA Antagonists Overviews

  1. Modulation of NMDA Receptor Activity in Fibromyalgia – 2017


  1. S-adenosylmethionine – overview


CAM, FMS Tx – Dopamine Support

CAM, FMS Tx – Dopamine Support: Synaptamine

  1. A Multi-Locus Approach to Treating Fibromyalgia by Boosting Dopaminergic Activity in the Meso-Limbic System of the Brain
  2. Fibromyalgia patients show an abnormal dopamine response to pain. – PubMed – NCBI
  3. Reduced presynaptic dopamine activity in fibromyalgia syndrome demo… – PubMed – NCBI
  4. Stress and dopamine: implications for the pathophysiology of chroni… – PubMed – NCBI
  5. Hypothesizing that brain reward circuitry genes are genetic antecedents of pain sensitivity and critical diagnostic and pharmacogenomic treatment targets for chronic pain conditions – 2009


CAM, FMS Tx – Vitamin D

  1. Fibromyalgia_Linked to Deficient Vitamin D
  2. Effects of vitamin D on patients with fibromyalgia syndrome: a randomized placebo-controlled trial. – PubMed – NCBI
  3. Vitamin D May Be of Help in Fibromyalgia – in Meeting Coverage, BSR from MedPage Today

Emphasis on Education


Accurate Clinic promotes patient education as the foundation of it’s medical care. In Dr. Ehlenberger’s integrative approach to patient care, including conventional and complementary and alternative medical (CAM) treatments, he may encourage or provide advice about the use of supplements. However, the specifics of choice of supplement, dosing and duration of treatment should be individualized through discussion with Dr. Ehlenberger. The following information and reference articles are presented to provide the reader with some of the latest research to facilitate evidence-based, informed decisions regarding the use of conventional as well as CAM treatments.


For medical-legal reasons, access to these links is limited to patients enrolled in an Accurate Clinic medical program.


Should you wish more information regarding any of the subjects listed – or not listed –  here, please contact Dr. Ehlenberger. He has literally thousands of published articles to share on hundreds of topics associated with pain management, weight loss, nutrition, addiction recovery and emergency medicine. It would take years for you to read them, as it did him.


For more information, please contact Accurate Clinic.



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