Fibromyalgia Treatment Protocol

Fibromyalgia is a life-changing and complex condition that causes widespread muscle pain and weakness, fatigue, and a host of other symptoms. At Arizona Pain, we focus on creating individualized treatment plans to help each fibromyalgia patient get their life back. Our evidence-based, comprehensive fibromyalgia protocol provides optimal patient outcomes. Here’s what you can expect.


One of the most challenging aspects of fibromyalgia is getting a proper diagnosis. Unfortunately, on average, it takes fibromyalgia patients five years to receive their diagnosis. Up to an estimated 70% of cases go undiagnosed annually. Arizona Pain works with patients to get them a diagnosis that forms the foundation of care for fibromyalgia from the start.

Our diagnostic process may include the following tools:

  • Relevant imaging tools, like MRIs, X-rays, and CT scans
  • Full neurological examinations
  • An EMG to evaluate for neurological changes
  • Vitamin, mineral, and hormone testing
  • A sleep study

Once we rule out other potential causes of your symptoms, we can begin to establish a comprehensive, multi-disciplinary treatment approach.

Treatment Approaches

Because we focus on individualized care and the latest in fibromyalgia treatment research, we have built a fibromyalgia protocol that is responsive to what works. It is our goal to restore our patients’ functional abilities while also improving their overall quality of life.

These are the research-based approaches we use to manage your care.

Complimentary and hands-on care

Poor sleep can worsen fibromyalgia symptoms and fibromyalgia makes adequate, quality sleep challenging. We focus on making sleep improvements from the start with sleep training. Improved sleep hygiene and other support can have a profound effect on levels of pain and fatigue.

Exercise has long been recognized as a primary, complementary treatment for fibromyalgia. Aquatherapy, strength training, and aerobic activity provide relief from pain and fatigue. Meditative exercise such as tai chi and yoga also offer significant mental health benefits.

There are also a variety of supplementation and nutritional program options with good support in the latest research. Vitamin D deficiencies, for example, may increase a person’s perception of pain. Supplementation with the “sunshine vitamin” has been shown to reduce pain scores.

Similarly, magnesium deficiency, occurring in an estimated 75% of people in the U.S., has been related to poor sleep, decreased function in a variety of bodily systems, and increased pain in fibromyalgia patients. Applying topical magnesium appears to reduce fibromyalgia symptoms in as few as two weeks, with limited, if any side effects.

Other hands-on therapies may include:

These therapies are an important part of care for fibromyalgia as many have few, if any, side effects and can be done in combination with other treatments.


Moving into medication options, low dose naltrexone, the medication used in addiction treatment, may block the body’s opioid receptors. The resulting increase in endorphins can help relieve pain for fibromyalgia patients.

Other pharmacological approaches we may use include:

  • Compounding creams
  • Vitamin and hormone optimization
  • Non-opioid options, like tricyclics, serotonin, norepinephrine reuptake inhibitors, and gabpentinoids

Finally, although research is still in its infancy for this last pharmacological approach, cannabis-based medicine research (or CBD) is showing good results for many. Patients experiencing chronic pain of many different kinds report pain relief and quality of life improvements when using CBD for fibromyalgia.

Behavioral health

The team at Arizona Pain also understands the research-based power of mental health support in our fibromyalgia protocol. Chronic pain can be debilitating to mental health. It’s crucial to provide treatment in a variety of forms to support patients as they work through other treatments.

This may mean counseling, biofeedback therapy, or cognitive behavioral therapy in combination with other treatments.

Interventional procedures

Finally, interventional procedures can help reduce the most persistent or severe pain symptoms for patients. At Arizona Pain, we may use any of the following to manage your pain:


  • Chinn, S., Caldwell, W., & Gritsenko, K. (2016). Fibromyalgia Pathogenesis and Treatment Options Update. Current Pain and Headache Reports, 20(4). doi:10.1007/s11916-016-0556-x
  • Choy, E. H. (2015). The role of sleep in pain and fibromyalgia. Nature Reviews Rheumatology, 11(9), 513-520. doi:10.1038/nrrheum.2015.56
  • Clauw, D. J. (2014). Fibromyalgia: A clinical review. Jama, 311(15), 1547. doi:10.1001/jama.2014.3266
  • Metyas, S. K., Chen, C. L., Yeter, K., Solyman, J., & Arkfeld, D. (2018). Low Dose Naltrexone in the Treatment of Fibromyalgia. Current Rheumatology Reviews, 14(2), 177-180. doi:10.2174/1573397113666170321120329
  • Mücke, M., Phillips, T., Radbruch, L., Petzke, F., & Häuser, W. (2018). Cannabis-based medicines for chronic neuropathic pain in adults. Cochrane Database of Systematic Reviews. doi:10.1002/14651858.cd012182.pub2
  • Wepner, F., Scheuer, R., Schuetz-Wieser, B., Machacek, P., Pieler-Bruha, E., Cross, H. S., . . . Friedrich, M. (2014). Effects of vitamin D on patients with fibromyalgia syndrome: A randomized placebo-controlled trial. Pain, 155(2), 261-268. doi:10.1016/j.pain.2013.10.002
  • Wu, Y., Chang, L., Lee, H., Fang, S., & Tsai, P. (2017). Sleep disturbances in fibromyalgia: A meta-analysis of case-control studies. Journal of Psychosomatic Research, 96, 89-97. doi:10.1016/j.jpsychores.2017.03.011