23 clinically-proven ways to reduce fibromyalgia fatigue

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This article on “23 clinically-proven ways to reduce fibromyalgia fatigue” was originally published on NationalPainReport.com. It is being republished here with permission from the editor. 

23 clinically-proven ways to reduce fibromyalgia fatigue | Fed Up with Fatigue

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.

Frida Center for Fibromyalgia: Intro to Fibromyalgia Exercise (video, 2 minutes) and Warm-Up Exercise for Fibromyalgia (video, 9 minutes)

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 researchers 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)

3. Yoga

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)

5. Balneotherapy

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 (20012004 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

Fibromyalgia patients in two small studies (2007 and 2011) reported reduced fatigue after receiving transcranial magnetic stimulation.

HealthRising: Zapping Your Pain Away – Is Transcranial Magnetic Stimulation the Future of Pain Relief for Fibromyalgia and ME/CFS? (article)

10. Electroconvulsive therapy

An extremely small Finnish study involving 13 patients found electroconvulsive therapy improved fatigue and depression from fibromyalgia.

Health.com: 10 Myths and Facts about Shock Therapy (article)

Healthline: Electroconvulsive Therapy Overview (article)

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)

Two research studies (2008 and 2011) have found duloxetine, an antidepressant commonly prescribed for fibromyalgia, relieves fatigue, but a third study didn’t show any improvement.

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 second 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.

HealthRising: Could A Mitochondrial Enhancer Replace Cymbalta in Fibromyalgia?

23. D-ribose

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.

Smart Publications: D-Ribose is Awesome – An Interview with Dr. Jacob Teitelbaum (This link includes Dr. Teitelbaum’s d-ribose protocol.)

Now it’s your turn: What is your best tool for relieving fibromyalgia fatigue? Please share in the comments!

You might also like…

A few of my favorite things for relieving the pain and fatigue of fibromyalgia.

Tired all the time? D-ribose has been shown to increase energy levels in those with fibromyalgia and ME/CFS. | FedUpwithFatigue.com

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  1. Kelly says:

    Great list. I particularly appreciate the focus on non-Rx/natural options.
    I agree that mitochondrial supports such as D-Ribose & CoQ10 are key (I use Ubiquinol, the more active form of CoQ10, since after age 30 our ability to metabolize the CoQ10 drops significantly (progressively).
    I’d also recommend the Wahl’s Diet to rebuild the body’s ability to heal and increase stamina.
    I would LOVE to see a similar list that goes a step further, with resources that specifically address BRAIN FOG. Mine brain fog is partially a cognitive fatigue, and typically follows closely with physical fatigue (so all much of the above list applies)… but there also seems to be an additional layer, as often it is prominent even when I’m physically “OK”. The cognitive cognitive issues for me are by far the worst… Being unable to depend on my brain to maintain my finances, plan a meal & grocery shop, follow a complex conversation socially, read/retain new info and sometimes even drive safely in traffic are by far the most debilitating & isolating symptoms as well. My abilities fluctuate daily & hourly, and anything that sets my health back in general (stressors, infection, over-exertion) plays havoc on my ability to function cognitively. Not knowing when I can expect to function reliably makes it impossible to maintain a social life, much less employment. I live alone… no kids… no energy to date… so it’s isolating effect has quite an impact on me emotionally at times too.
    Any new research/supplements/dietary protocols to help get my brain back would be much appreciated! I am interested in knowing how LDN or similar options my help reverse this over time too. Would love to hear some success stories from those following.

    • Donna Gregory/FedUpwithFatigue.com says:

      Thank you for the idea. It’s a good one, and I will put it on my future post ideas list. It’ll be interesting to see if researchers have even begun to address fibro-related brain fog. I don’t recall seeing much research on it.

      Just FYI: If you haven’t already, you might want to ask your physician for a full thyroid panel – not just the TSH test. I’m working w/ an integrative doctor now and he ran some thyroid testing on me and found that my free T3 level was normal but in the lower range of normal. He told me that a low dose of thyroid medication often clears the brain fog in his fibro patients. I added a low dose of T3 hormone last fall, and it has noticeably reduced my brain fog. (Some of it has come back recently for some reason – not sure why – but it’s not to the extent that it was when I started the medication.) When I interviewed Dr. David Brady a few weeks ago, he said thyroid dysfunction is really common among those of us with fibro, but it goes undiagnosed many times b/c doctors are only testing TSH levels, and then some will only treat if levels are in the low range.

      • I finally ran the panel myself last fall, along w labs for Hashimotos & a general autoimmune panel. T3 was barely in range, so doc started me on WP Thyroid (a NDT).
        Good results for a couple months, then leveled off, then diminishing returns last couple months. (I’m told this indicates poor adrenal reserve). Last month I had very painful bout of post-viral thyroiditis, and the inflammation settling in my thyroid ramped up hormone release throwing me into transient hyperthyroid state, so had to quickly taper off, & will retest 6 wks later. Doc was not sure if the NDT itself might not have actually exacerbated the inflammation

        • Donna Gregory/FedUpwithFatigue.com says:

          Hey Kelly, I’m glad you shared your experience. It’s similar to my own. I haven’t written about this on my blog yet, but my doctor did thyroid testing on me last fall – not a full panel, but more than the TSH test – and my free T3 was normal but on the lower side of normal. He suggested trying thyroid medication b/c he said it often helps clear the brain fog of his patients with fibro symptoms. I decided to try the medication and it dramatically reduced my brain fog for a while, but I’ve noticed the effect seems to be wearing off. My fog isn’t as bad as it was in the beginning, but I’m not as clear as I was when I started the medication. I’d been wondering why it seemed like the effects of the thyroid medication were wearing off. Your mention of having poor adrenal reserve makes sense to me. I know I have issues w/ my adrenal function based on saliva testing.

  2. Dagmar MacQueen says:

    I’ve been taking LDN for 9 months and it’s helped my energy levels hugely. Took me several weeks to work up to the optimum dose, 4.5mgs and now I can live a reasonablish life for most of the day as long as I don’t exert myself. I still can’t find any excercise that helps.

    • Donna Gregory/FedUpwithFatigue.com says:

      Congratulations! I’m so happy to hear you’re feeling better! LDN is a miracle drug for some people. Thank you for telling me. I always love to hear about LDN success stories!

  3. Great article! I appreciate that you took the time to include evidence based tips! Thanks!

  4. Katrina says:

    I’m confused. Why is there a dog on the advert? I was hoping animal therapy was going to be on the list so I could talk my hubby into getting one!!! L

    • Donna Gregory/FedUpwithFatigue.com says:

      LOL! I didn’t mean to confuse you. It’s supposed to be a tired, exhausted dog! 🙂 I love animals and often use them for my graphics b/c they’re more fun to look at than people.

  5. Melissa stevens says:

    Hi i discovered quite by accident that taking apple cider vinegar is beneficial. I take 2 table spoons in a glass of water once a day. I also have a teaspoon of cumin (spice) once day. I feel more energised and memory and concentration has improved. Also less stiff and sore. I’m taking it for about 2 months now. Thanks.

    • Donna Gregory/FedUpwithFatigue.com says:

      Raw apple cider vinegar is great for lots of things! Gut health, blood sugar control, weight loss, etc. It’s not surprising to me that you’re finding it helpful.

    • Catherine says:

      My pain doctor, just last week, told me about the possible pain relief (anti-inflammatory) benefits from taking cumin. I’m looking forward to see how it works for me. I figure it can’t hurt to try.

  6. Wow, this is a really interesting list! I was surprised that yoga specifically was found to be effective compared to other mindful movement practices. Same surprise for epsom salt baths which I usually associate with relaxation and bedtime. It’s great to have a list of options to try.
    In addition to acetyl-L-Carnitine and d-ribose, I also take rhodiola, which has been found to generally improve concentration and mental function under stress or fatigue but not specific to FM. I also find CoQ10 helps, I think because it’s supposed to improve mitochondrial function. It’s a shame more supplements aren’t better studied, when they offer a lot of potential in this area. Thanks so much for a great post!

  7. 2 things help me: Epsom Salts baths and Reiki.

  8. Caprice West says:

    My name is Caprice and my reason problems with fibromyalgia is all I want to do is sleep and have nothing accomplish. I call out a lot from work cause I don’t want to go. Any advice will be appreciated. Thank you

    • Donna Gregory/FedUpwithFatigue.com says:

      Fatigue is a huge issue w/ fibro. I have a lot of days where I feel the same. I’m planning to explore some of the items on the list and see what happens. Maybe something will help!

  9. Thank you for this list!!!

    • Donna Gregory/FedUpwithFatigue.com says:

      You’re welcome! Hope you find something on it that helps!

  10. Please don’t ever take Xyrem. It did help me in the short term but caused extreme problems after my Doctor upped my dose. It is a very difficult drug to regulate and very dangerous. It can cause sleep walking and you can lose touch with reality to the point of a psychotic break. It can cause terrible trauma.

    I do believe that a lot of our symptoms are caused by sleep issues. I had a sleep study done and they found that I have sleep fragmention which disrupts the bodies ability to get the healing powers of sleep. I use gaba which is availale over the counter and relaxes me and helps me sleep better.

  11. Jennfer Craine says:

    Thank you for researching and creating a list of option to reduce fatigue. I am going to explore the natural options and see what happens. I love reading your posts. You have excellent resources that Fibro Warriors can tap into:).

    • Donna Gregory/FedUpwithFatigue.com says:

      Thank you! I hope you find something that works! If you do, be sure to share it w/ me!!!

  12. Doreen Luck Salter says:

    Excellent list. At least 10 that I have not heard of. Do you have any suggestions on how to find clinical trials?

  13. Thanks for this list!! I am really interested in herbal remedies too, it’s unfortunate we don’t have research for those.
    Another thing I have found really helpful in managing fatigue are 20-30 minute guided meditations (Yoga Nidra, body scans, self hypnosis) it seems to really assist my body to rest while keeping my brain quiet, it helps me get through the long days!

  14. Thank you, Donna.

    I found that soaking in a warm bath with Epsom Salts helped me. I also benefitted from water aerobics, aquacise, and even swimming. The water cushions the impact on tender joints and muscles.

    My ultimate help was a beautiful mind/body/spirit wellness work that helped me to discover and resolve the many unresolved issues in my life that kept resurfacing and contributing to my fibromyalgia which was devastating my life.

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