Fibromyalgia is a chronic condition characterized by widespread pain and is often accompanied by fatigue, sleep issues, tenderness, stiffness, and mood changes. It can significantly impact quality of life, limiting the ability to work, engage in daily activities, and maintain social relationships. Fibromyalgia affects about 0.2% to 6.6% of the general population with women being more frequently affected (about 80% to 95%).

People with fibromyalgia may experience pain in their muscles, tendons, and soft tissues, as well as specific tender points on the body that hurt when pressure is applied. Other common symptoms include headaches, digestive issues, and mood changes like anxiety or depression.

Less frequent symptoms include joint stiffness, skin tenderness, pain following physical activity, irritable bowel syndrome, cognitive issues, irritable bladder syndrome or interstitial cystitis, tension headaches or migraines, dizziness, fluid retention, tingling or numbness (paresthesia), restless leg syndrome, Raynaud’s phenomenon, and mood disorders.

Some research reported about 90% of people with fibromyalgia had used massage therapy and other forms of alternative therapies to treat their symptoms. While massage therapy may decrease pain, anxiety, and depression, research behind massage’s effectiveness is mixed because of the research bias, lack of larger sample sizes, sunk-cost fallacy, and file drawer effect.

Does massage work for fibromyalgia?

Several research has found that certain types of massage have therapeutic effects for people with fibromyalgia. A 2015 systematic review and meta-analysis of 10 studies found that myofascial release has “beneficial effects” on fibromyalgia in terms of pain, fatigue, stiffness, anxiety, depression, and quality of life.

The researchers reported that these were the only two trials with a low risk of bias, both examining the same type of massage in comparable contexts, enabling a meta-analysis of pain, anxiety, and depression. The meta-analysis revealed a significant reduction in pain immediately after treatment, which gradually lessened during short- and medium-term follow-ups. 

A moderate reduction in anxiety was observed post-treatment, but it disappeared during short-term follow-up. However, a moderate improvement in depression was noted after treatment, which gradually diminished over the short term. They also reported limited data were available on pain pressure threshold, and sleep, and the trials used varying tools to assess quality of life, which prevents these outcomes from being included in the meta-analysis.

The study also examined other types of massage and found:

  • Limited evidence that connective tissue massage has beneficial, immediate effects on depression and quality of life.
  • Swedish massage had no positive effect on the outcomes at any assessment time point when compared to standard care.
  • Limited evidence that shiatsu is beneficial and has immediate effects on pain, pain pressure threshold, fatigue, sleep and quality of life.
  • No evidence that a combination of Swedish massage, shiatsu, and Trager massage was more effective than guided progressive relaxation.
  • Manual lymphatic drainage may be superior to connective tissue massage in terms of stiffness and depression.

A 2024 study that examined 17 systematic reviews from 2018 to 2023 found that most types of massage can reduce pain and improve quality of life, but the certainty quality of the evidence was “low” or “very low.” 

“This is a challenge given that massage, like other complementary and integrative health interventions, does not have the historical research infrastructure that most health professions have,” the researchers wrote. “Nevertheless, it is only when systematic reviews and meta-analyses are conducted with high-quality primary studies that the association or lack of association of massage therapy with pain will reach higher certainties of evidence.”

Who gets fibromyalgia?

While most studies reported that women are more likely to have fibromyalgia than men, some researchers suggested that some studies overestimated fibromyalgia in women and underestimated it in men. 

A 2020 Italian study on fibromyalgia reported that studies using the 1990 American College of Rheumatology (ACR) criteria have recorded prevalence rates that range from 0.4% in Greece to 8.8% Turkey, with a global average of 2.7%. They cited a 2018 review by Wolfe et al. where the latter reported that at least 80% to 90% of diagnosed fibromyalgia occurs in women. 

However, two large population studies (one in Japan, one in Germany) that used a modified ACR criteria reported 60.8% and 60.5% of people with fibromyalgia were women.

Also, a 2017 Brazilian study found that fibromyalgia prevalence differs geographically, ranging from 0.7% to 11.4% in urban areas and 0.1% to 5.2% in rural regions.

Among people with specific diseases, the prevalence of fibromyalgia is higher. According to a 2017 Iranian study, people with type II diabetes and irritable bowel syndrome had a rate of 15.2% and 14.8%, respectively. People who were on hemodialysis had a rate of 6.3%. The researchers concluded that the “prevalence of fibromyalgia in the general population was significantly lower than that in populations” with certain diseases.

Other factors that increase the likelihood of getting fibromyalgia include:

  • Smoking
  • Obesity
  • Middle or old age
  • Childhood difficulties
  • Alcohol abstinence
  • Sleep disorders
  • Depression
  • Chronic headaches

Causes

The exact cause of fibromyalgia (FM) is unknown, but possible triggers include infections, stress, and physical trauma.

Genetics

Familial studies suggested fibromyalgia has a hereditary component. For example, a 2004 U.S. study of 533 relatives of 78 probands (people who serve as the starting point for the genetic study of a family) with fibromyalgia found that the prevalence was 6.4% among the relatives and 18.5% among those who were interviewed. This group was compared to another cohort with non-fibromyalgia arthritis, which had a prevalence of 1.1% and 4.3% among those who were interviewed.

Research has found genetic variations, DNA methylation, and miRNA profiles that may be fibromyalgia markers.

D’Agnelli et al. reported that some genetic studies have identified potential such genes and biomarkers, such as serotonin transporter (SLC64A4) and myelin transcription factor (MYT1L). Retrotransposons, including human endogenous retroviruses (HERVs), may contribute to fibromyalgia’s development, with increased HERV expression and elevated interferon levels linked to fibromyalgia symptoms, particularly pain. (Retrotransposons are mobile DNA segments that replicate and insert themselves into new locations within the genome, influencing genetic variation and evolution.)

Fibromyalgia may be caused by increased sensitivity in the central nervous system (CNS). This means the brain and spinal cord become more reactive to pain and other sensory signals. Your genetics influence how your body regulates pain, but this can also be affected by psychological factors (e.g. anxiety, depression, negative thinking) and environmental factors and negative experiences, such as trauma, childhood hardships, major life events, or infections. (Illustration by Nick Ng)

Central and peripheral sensitization

Fibromyalgia may be caused by increased sensitivity in the central nervous system (CNS). This means the brain and spinal cord become more reactive to pain and other sensory signals. Your genetics influence how your body regulates pain, but this can also be affected by psychological factors (e.g. anxiety, depression, negative thinking) and environmental factors and negative experiences, such as trauma, childhood hardships, major life events, or infections.

Several changes also occur in the CNS, including imbalances in brain chemicals, differences in how brain regions communicate, and changes in the hypothalamic–pituitary–adrenal (HPA) axis, which helps regulate the body’s response to stress and controls automatic functions like heart rate and digestion.

Fibromyalgia may involve two main processes causing chronic pain: peripheral and central sensitization. Some researchers suggest that nerve, glial, and immune cells communicate to amplify nociceptive signals, turning short-term pain into chronic pain through prolonged inflammation. 

In fibromyalgia patients, higher levels of certain pro-inflammatory and anti-inflammatory cytokines (like TNF-α and interleukin-6) may trigger pain responses. Both the immune and nervous systems can “remember” past injuries or stress, leading to ongoing pain. 

Thus, fibromyalgia pain likely results from a combination of genetic predisposition, stress, inflammation, and changes in how the brain and nerves process pain, making it a complex condition to study and treat.

While the scientific evidence is not yet robust, many fibromyalgia patients report anecdotal improvements in their symptoms after incorporating massage therapy into their treatment plans. Therefore, massage can be considered a complementary option, especially when tailored to the individual’s needs and combined with other treatments.

Patients should consult with healthcare providers to determine the most suitable approach and ensure safety, particularly given the rare risks associated with vigorous massage techniques.

Further reading of fibromyalgia and treatment options: A Rational Guide to Fibromyalgia.

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Nick Ng is the editor of Massage & Fitness Magazine and the managing editor for My Neighborhood News Network.

An alumni from San Diego State University with a bachelor’s in graphic communications, Nick also completed his massage therapy training at International Professional School of Bodywork in San Diego in 2014. In 2021, he earned an associate degree in journalism at Palomar College.

When he gets a chance, he enjoys weightlifting at the gym, salsa dancing, and exploring new areas in the Puget Sound area in Washington state.