Muscle ache

There are three types of exercise: aerobic, strengthening and stretching. Research suggests that people with FMS find strength training for 12 weeks improves pain, tender points and well-being but does not help with stiffness. The research on stretching training is patchy so it’s not clear whether it helps.

Aerobics and other vigorous exercise classes make the heart and lungs work harder. Strengthening exercises make muscles work against resistance. Stretching exercises, such as tai chi, qigong and yoga, won’t make you fitter but they do have a wonderfully relaxing effect on the body and mind, and they make your joints more flexible.

If you haven’t been active for some time, you should start slowly and build up. If you have heart or chest problems, get medical advice first. 

Summary
Acupuncture is a traditional form of treatment that began in China thousands of years ago. Thin needles are inserted into the skin at special points on the body, which practitioners believe will help restore health. The treatment sometimes also involves heat, pressure, electrical currents or soft-laser light. In the UK, acupuncture is most commonly used for pain relief.

Evidence
Some small studies seem to show that acupuncture (particularly electro-acupuncture) may help with pain.

Safety
Acupuncture is generally safe if practised by a trained acupuncturist. The most common side-effects are slight discomfort (common) and bruising (occasionally).

Cost
A session may cost £40-£60. Frequency of treatment will depend on you and your practitioner.

Find out more
The following professional organisations can help you find a qualified practitioner:
Acupuncture Association of Chartered Physiotherapists
British Academy of Western Medical Acupuncture
British Acupuncture Council
British Medical Acupuncture Society

Summary
Chiropractic is an approach to treatment based on the idea that illness stems from misalignment of the spinal column. Treatment often involves spinal manipulation.

Evidence
There is very little research testing whether chiropractic might help with fibromyalgia.

Safety
The most common side effect is mild discomfort in the area treated, but this should only last a short time. It is important to find a properly qualified and registered chiropractor.

Cost
A session may cost £40-£60. Frequency of treatment will depend on you and your practitioner.

Further information
Chiropractic is a state-regulated profession and all chiropractors have to be registered with The General Chiropractic Council.

Summary
The basic principle of homeopathy is that like cures like. Homeopaths use tiny amounts of medicine, which are supposed to jolt the body’s self-healing processes into action. Homeopathy has been called ‘unscientific’ because homeopathic remedies are sometimes diluted (watered down) so many times that no detectable trace of medicine remains. Their response is that they capture a non-material trace of the original material.

Evidence
Although it has been suggested that treatment by a homeopath might help patients manage their condition, this has not been proved.

Safety
Homeopathic medicines prescribed by trained professionals are safe. Some patients complain of mild worsening of their symptoms but this generally only lasts a short time. There is potential risk that an enthusiastic pursuit of such a radically different approach can mean that the need for other treatments may be ignored.

Cost
The monthly cost will depend on how regularly you receive treatment. A session with a qualified homeopath varies from £25-£60.

Further information
There are a number of professional organisations covering homeopathy:
The British Homeopathic Association
Faculty of Homeopathy
The Society of Homeopaths

Summary
There are many different types of massage, some more vigorous and going deeper into the muscles than others. Massage has traditionally been used for relaxation. It may be just on one part of the body (for example, the back and shoulders), or it can be done on the whole body. Aromatherapy massage uses pleasant-smelling essential oils.

A key element in massaging fibromylagia is the sometimes acute sensitivity of the muscles, particularly the trigger points. A good practitioner can work gently with these sensitivities to bring real comfort to a sufferer. 

Evidence
Massage may help with pain, although only limited research has been carried out on this. It may also help with general well-being and relaxation.

Safety
Massage is safe if carried out by qualified massage therapists, and it rarely causes problems.  The increased muscle sensitivity in fibromyalgia may provoke more pain after treatment if not handled sensitively. Vigorous massage should be avoided if you have blood disorders, some forms of cancer, skin problems or are on blood-thinning medications (such as warfarin). Allergies or skin irritation can occur with some essential oils used in massage.

Cost
Monthly cost will depend on how regularly you receive treatments.

Further information
It is important to find a qualified practitioner such as one registered with The General Council for Soft Tissue Therapies.

Summary
Osteopathy is an established hands-on diagnosis and treatment method, whose main emphasis is on the way the muscles and joints work. Its main feature is that it recognises that pain and disability often stems from physical strains and tensions in the body, rather than from damage caused by disease. Osteopathy focuses on whole body health by treating and strengthening the musculoskeletal framework. This includes the joints, muscles and spine. The aim is to positively affect the body’s nervous, circulatory and lymphatic systems

Evidence
One very small study seemed to show that osteopathy improved symptoms of muscle ache in fibromyalgia.

Safety
Side effects are rare and mainly linked to manipulation of the neck. Some mild after-aches from treatment can happen but they usually last less than 48 hours.

Cost
A session may cost £40-£60. Frequency of treatment will depend on you and your practitioner.

Further information
Osteopathy is a state-regulated profession and all osteopaths have to be registered with The General Osteopathic Council.

Summary
Psychotherapy helps people learn better ways of thinking or behaving that can reduce their symptoms, disability and distress. Some psychotherapists are trained to help you explore possible causes of distress or symptoms in your past. Cognitive behavioural therapy (CBT) is the type of psychotherapy that is currently most widely available in the NHS.

Instead of exploring causes of distress or symptoms in the past (like many other types of therapy), CBT looks for ways to improve your state of mind right now. The therapist does this by helping you spot unhelpful thought processes and change them. The Royal College of Psychiatrists says “CBT can help you to change how you think (‘cognitive’) and what you do (‘behavioural’)”. For instance, CBT can help you make sense of what seem like overwhelming problems by breaking them down into smaller parts. This makes it easier to see how they are connected and how they affect you.

Treatment with CBT for fibromyalgia aims to ease the symptoms, and ‘turn down the pain volume’ by reducing central sensitisation. You might find it helpful to try using a range of approaches – such as painkillers combined with mind-body approaches like yoga or meditation, and psychological methods such as CBT, as well as lifestyle changes that help reduce stress and promote well-being.

Evidence
A number of good studies have shown that CBT can improve problems related to chronic pain.

Safety
These techniques are generally safe if carried out by or under the guidance of a qualified counsellor or psychologist.

Cost
In most areas your GP can refer you for CBT or a psychological therapist in the NHS. There are often long waiting lists. A session of CBT or psychological therapy may cost between £20-£60. Frequency will depend on you and your therapist. A typical course of CBT lasts between 6-12 weekly sessions.

Further information
It is important to find a qualified counsellor or psychologist. Contact The British Psychological Society.

Summary
Qigong uses slow graceful movements and controlled breathing techniques. It is often confused with tai chi, which is also from China, but qigong is usually much slower.

Evidence
Qigong therapy seems to reduce pain and improve movement. But you have to be taught and supervised to do it effectively.

Safety
Supervised exercise programmes are safe for most people, although at first you might feel more tired.

Cost
Once you have learned the movements, you can do the exercises at home, at no cost.

Further information
Classes are run in most areas by both private tutors and by adult education services.

Summary
Tai chi is also known as ‘moving meditation’ It is a series of slow, graceful, controlled movements, which develop strength, balance, posture and inner peace. It is a discipline that has to be learned in a class from a teacher and can then be practised at home.

Evidence
In a 12-week tai chi programme, the 66 patients with fibromyalgia who did tai chi experienced significantly greater improvement than those who only did stretching and classes teaching about wellbeing. We need more research to be sure about this, but the signs are that tai chi could help you if you have chronic muscle pain.

Safety
Tai chi is safe for most people. Though tai chi is slow and gentle, anyone with severe osteoporosis, joint problems, acute back pain or recent injuries should avoid strenuous exercise and build up gently.

Cost
Once you have learned the movements, you can do the exercises at home, at no cost.

Further information
Classes are run in most areas by both private tutors and by adult education services or you can contact the The Tai Chi Union.

Summary
Yoga, as taught in the UK, generally includes physical postures or stretches, breathing techniques, meditation and relaxation. There are several different types of yoga. Some of them are mainly based on the physical exercises (some types are much more strenuous than others). Others focus more on meditation.

Evidence
Two small studies suggest that gentle yoga can help reduce pain and possibly other symptoms in patients with fibromyalgia.

Safety
Yoga is generally safe when practised appropriately and at the right level. Classes are run for different ability levels so look for one that is right for you. Yoga stretches should be increased slowly. If in doubt, check with your doctor, osteopath or physiotherapist. Avoid with severe osteoporosis or acute joint or back pain, or recent injuries.

Cost
You will have to pay for the classes but once you have learned this technique you can practise it at home at no cost.

Further information
Classes are run in most areas by both private tutors and by adult education services. To find a qualified teacher near you see also the The Yoga Alliance
and the The British Wheel of Yoga.