If you struggle with the most debilitating symptoms of fibromyalgia — pain, fatigue, and brain fog — and medication doesn’t bring relief, or not enough, it may be worth trying one or more complementary approaches, such as a form of movement therapy, mindfulness, dietary changes, or talk therapy.
“Experts say medication works in about 30 to 50 percent of fibromyalgia patients,” says Andrea Kane, senior medical editor at Arthritis Today, a magazine published by the Arthritis Foundation.
But even for this group, medication isn’t a cure. Fibromyalgia, she says, is a condition that responds better to a multipronged approach.
“You’ll get better results if you combine medication with other techniques,” Kane says.
The evidence on the effectiveness of nondrug approaches is too limited to indicate whether these approaches are more useful than others, though some studies have shown promising results, says Wendy Weber, PhD, MPH, acting deputy director at the National Center for Complementary and Integrative Health (NCCIH).
The good news is that the mind and body approaches studied by NCCIH, such as tai chi, yoga, meditation, and biofeedback, when done properly “have generally been found to have good safety records,” Dr. Weber says.
Exercise and Movement Therapies
According to Kane, study after study has shown that exercise is one of the best ways to reduce pain, improve mood, enhance sleep, and release stress.
“Gentle mindful movement strategies have demonstrated effectiveness in helping fibromyalgia and other chronic pain patients regain some of their physical capabilities without increasing pain in the process,” says Liz Cash, PhD, director of research and assistant professor in the department of otolaryngology, head and neck surgery, and communicative disorders at the University of Louisville School of Medicine in Kentucky.
“But start off slowly and gradually build up,” adds Kane. “Don’t overdo it, and know your limits.”
A review published in January 2013 in the journal Rheumatology International found that meditative movement therapies, such as tai chi, qi gong, and yoga, may result in modest improvements in fatigue, sleep disturbances, depressed mood, and health-related quality of life for those with fibromyalgia, says Weber, but bigger and better studies are needed to confirm these results. Depending on your symptoms, says Weber, it may be necessary to modify some of these techniques to make them comfortable and safe.
Mindfulness Can Reduce Stress, Improve Sleep
According to Dr. Cash, though a few studies have shown small or no improvements on some measures, the evidence overwhelmingly suggests that “mindfulness practice can reduce stress, depression, anxiety, and the impact of symptoms. Improvements in sleep, pain, and fatigue have also been observed.”
Studies also show that mindfulness may influence physiological markers of stress, she says. For example, they may help in reducing stress hormone levels and reducing activation of the fight-or-flight response to stressful situations.
Cash defines mindfulness as a contemplative practice emphasizing moment-to-moment awareness as a means of working with stressful events. It was popularized by Jon Kabat-Zinn, who created the Mindfulness-Based Stress Reduction (MBSR) program, described in his book Full Catastrophe Living.
Key to the program, says Cash, “is the development of nonjudgmental, focused attention in a relaxed, meditative state.”
Individuals can learn and practice mindfulness in courses offered online or in the community, and by using any of a variety of apps, such as Calm, Headspace, Buddhify, or 10% Happier. There are also many high-quality podcasts, says Cash, which will help individuals create a home practice.
In her group’s research, she’s found that women with fibromyalgia who practiced mindfulness daily at home had even greater benefit than did those who only participated in a program.
“In our randomized controlled trial,” she says, “those who reported meditating more times per week also reported the greatest symptom relief.”
Diet and Nutrition Are Highly Individual
While nutritional strategies may be helpful, “Nutrition is very individual,” says Kane, adding that long-term, quality studies are few because they’re difficult to do well.
“Beyond making sure you eat foods that support your body — fruits, vegetables, whole grains and low-fat dairy if you’re not sensitive to them, healthy oils, legumes, and low-fat protein, like fish and chicken — and cutting out foods that you know are bad for you (junk, processed, fatty, sugary foods and soda), you can experiment to see if you are sensitive to or react to certain foods,” she says. “Some people say that they feel better off gluten, others feel better on a vegetarian or vegan diet, and some cut out dairy and find that helps.” She recommends discussing nutritional approaches with a registered dietitian nutritionist or your doctor.
John (Jack) Shelley-Tremblay, PhD, professor of psychology and adjunct professor of neurology in the psychology department at the University of South Alabama in Mobile, suggests that carbohydrates, and particularly sugars, may contribute to brain fog.
According to Dr. Shelley-Tremblay, research indicates that people with fibromyalgia do not metabolize carbohydrates and sugars normally and that many “improve dramatically when they are on a low-carb or keto (low-carb, high-fat, moderate-protein) diet.”
In Shelley-Tremblay’s own research, based on a previous study of individuals with fibromyalgia who self-reported their diets, those who reported following a very-low-carb diet had better cognitive functioning and lower reported stress.
You don’t necessarily need to follow a ketogenic diet, but you may get relief by following a low-glycemic-index type of diet, removing simple starches and sugars, says Shelley-Tremblay.
His research also indicates that diets rich in vitamins A and C may help with brain fog by addressing the inflammation that contributes to it.
In addition, “There are some studies that suggest vitamin D supplements might reduce pain in people who are deficient in the vitamin and have fibromyalgia,” says Weber.
But there’s insufficient evidence, she says, to suggest that supplements such as soy isoflavones, S-adenosyl-L methionine (SAMe), or creatine are helpful.
“Some of the natural products studied for fibromyalgia may have side effects or interactions with medication,” Weber cautions. Check with your healthcare provider before taking any supplements, she says.
Talk Therapy Teaches Coping Strategies
Cognitive behavior therapy (CBT) and acceptance and commitment therapy (ACT) — types of talk therapy that help individuals reframe their thoughts and change behaviors — can help in numerous ways, says Beth Kane, a licensed clinical social worker and life coach in Point Pleasant, New Jersey, who works frequently with people with chronic illnesses.
These types of psychotherapy can address brain fog by helping you develop targeted coping strategies and address stress by teaching you to use skills such as relaxation, acceptance, mindfulness, and identifying how to best use your energy. They can ameliorate fatigue by helping you identify your stressors and your limiting beliefs, Beth Kane says.
“They can help you see where you might be able to cut back, how to break down tasks into more manageable portions,” and how to prioritize tasks to avoid overextending yourself, says Beth Kane.
CBT and ACT may also be used to mitigate pain.
“Chronic pain can be very wearing on individuals, and they may begin anticipating episodes of pain or focus on the pain itself, which can worsen it.” ACT, she says, helps clients learn to accept what’s in the moment, decrease anticipation, and reduce their focus on the pain.
“We use CBT to help reframe the thoughts around the pain so that it doesn’t become as consuming,” she says.
Where to Begin to Address Brain Fog
Many approaches can help with brain fog. Anything you can do to reduce stress in your life and improve your sleep can be helpful.
Using adaptive techniques may also help you feel sharper. These, says Andrea Kane, include making lists and setting up electronic or physical reminders.
“Brain fog can also be a side effect of medication,” she adds, so it’s important to discuss it with your medical providers.
Because tackling all of the possible contributors to mental fatigue simultaneously would be overwhelming, Andrea Kane suggests taking them one by one.
“Oftentimes,” Andrea Kane says, “when one area begins to improve, the others will, too, because they’re all tied in together. For example, pain or stress might keep you from getting a good night’s sleep, and not getting a good night’s sleep will make pain and stress worse the next day.”
On the flip side, lowering the amount of stress in your life — by following an exercise plan or meeting with a psychotherapist — may help you sleep better, reduce your pain symptoms, and help you feel less “foggy.”
Start with an approach that appeals to you, then assess how you feel once it’s become a habit.