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15, Meredith Morckel came down with the flu. She was in a high school musical at the time and didn't want to miss rehearsals or performances, so she kept singing and dancing her way through what seemed like a mild illness.
The flu went away. The exhaustion didn't.
"No matter how much I slept, I never felt rested," she says.
Her parents took her from doctor to doctor looking for an explanation. Every test came back normal. But Morckel knew something was wrong, especially when a deep, heavy ache settled in a few years later. Sometimes the pain turned sharp, "like needles being pushed into my skin," she says.
In college, she saw a physiatrist. That's a physical medicine and rehabilitation doctor who treats pain and helps people move and function better. The specialist connected her symptoms and diagnosed her with fibromyalgia.
Now 42, Morckel has spent more than 20 years trying medications and what she calls "self-care experiments." Over time, she's learned which approaches work for her body — and which don't.
That trial and error can be frustrating. But your care team will partner with you to find treatment and strategies that fit your symptoms and life. Whether you're newly diagnosed or not getting anything from your current plan, Morckel's advice is to keep going.
"You've got to keep trying," she says. "Be brave and try different things until you feel better."
Why Treatment Looks Different for Everyone
Gerard Limerick, MD, PhD, a physiatrist with Johns Hopkins Medicine in Baltimore, describes fibromyalgia as a form of nociplastic pain. With this type, the brain and spinal cord process sensory signals differently. Pain can feel intense even when there's no clear injury to the area that hurts.
"This is not something that is 'all in your head,'" Limerick says. "This is an actual primary pain disorder."
Because fibromyalgia can affect several parts of your health at once, treatment often needs to do the same. Kaitlyn Egan, MD, a physiatrist with the Shirley Ryan AbilityLab in Chicago, says most people benefit from a multimodal approach.
"Maybe it's not just one medicine," she says. "Maybe it's multiple medicines or multiple different therapies."
The right mix depends on how fibromyalgia affects you. For example, pain may be your main concern. Someone else may be more focused on sleep, mood, or thinking clearly. Having enough energy to work, exercise, or spend time with family are common worries as well.
Your priorities may also shift over time. Stress, poor sleep, and illness can trigger a flare or change what you need from treatment. So can surgery, hormonal changes, or other health conditions.
What Medications Treat Fibromyalgia?
The FDA has approved four medications for adults with fibromyalgia:
- Duloxetine (Cymbalta)
- Milnacipran (Savella)
- Pregabalin (Lyrica)
- Cyclobenzaprine sublingual tablets (Tonmya)
Doctors also prescribe medication off-label. These are drugs that are't FDA approved to treat fibromyalgia, but research or clinical experience suggests they may help certain symptoms. Examples include gabapentin or low doses of tricyclic antidepressants (TCAs), such as amitriptyline.
Your doctor may prescribe an antidepressant when depression isn't one of your symptoms. That doesn't mean they think your mood is what's triggering the pain.
"We're not dismissing your symptoms," Limerick says. "These are medications that work on pain-processing pathways, separate from what they do for depression."
It's important to note that every fibromyalgia medication has its own risks, possible interactions, and other reasons it might not be safe for you, especially if you take more than one.
For example, the muscle relaxant cyclobenzaprine and the antidepressants prescribed for fibromyalgia can interact with each other and with drugs like monoamine oxidase inhibitors (MAOIs), so make sure every doctor you see has your full medication and supplement list.
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Which Fibromyalgia Medication is Right for You?
When deciding whether to start or add a medication, Egan considers what that person wants to get back to doing. Drug treatment can be a useful way to control symptoms enough for you to begin physical therapy, walk more, or return to another activity you enjoy.
Egan rarely suggests medication on its own. She may pair it with:
- Specialized physical therapy to help you slowly return to movement
- Pool-based physical therapy if exercising on land or the gym is too hard
- Mental health care for stress, anxiety, or low mood
- Support for sleep problems caused or worsened by pain
- A step-by-step plan to help you return to activities you enjoy.
Think about which symptoms bother you most. Your doctor may lean toward pregabalin if poor sleep is also a big problem. Serotonin and norepinephrine reuptake inhibitors (SNRIs) such as duloxetine or milnacipran may make more sense if you're managing depression on top of pain.
Your health history, other medications, possible side effects, and even insurance coverage may also affect the decision. Even with those clues, doctors can't reliably predict which medicine will work best for you.
Morckel's experience shows how differently people can respond to the same drugs. Duloxetine (Cymbalta) was the first medication she tried. She stopped taking it after less than a year because it "did absolutely nothing" for her symptoms. Pregabalin has worked much better, and Morckel has taken it for years.
Her current drug treatment doesn't take away all her pain, "but it does take the edge off so it's more bearable," she says.
Before you decide to try a new medication, ask:
- What symptoms are we trying to improve?
- When might I notice a change?
- How long should I stay on this dose?
- Which side effects should I call or message about?
- Should I taper the drug?
- What's the next step if this does't help?
Limerick begins with medication backed by the strongest evidence. If one doesn't control the pain enough, he may change the dose, try a different type of drug, or add another.
"I tell people, 'This is going to be a long journey,'" he says. "I'm here to walk you through it."
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Give Treatment Time to Work
Long-term fibromyalgia medications don't work overnight. Egan generally tells people to expect a trial of about 4 to 8 weeks. You may notice results sooner, but a full trial helps you and your doctor judge whether the benefits are enough to outweigh any side effects.
Your doctor may keep the dose the same or raise it gradually based on how you respond. Giving a drug time doesn't mean you have to wait out concerning side effects. Contact your care team sooner if they're hard to manage or include changes in your mood.
Measure What Treatment Gives Back
Changes in what you can do may reveal progress that a number on the pain scale misses. That's why Egan and Limerick both focus on improving daily life. Does pain keep you from walking your dog, shopping for groceries, playing with your grandchildren, making dinner, or washing the dishes?
"If we can at least control the pain enough to where you can do some of those functional activities that are really important to you, well, then that's a win," Limerick says.
To gauge how well your fibromyalgia plan is working, choose one or two goals that matter to you and make them specific enough to track. For example, does treatment help you:
Keep notes about what gets better, how long the benefit lasts, and any side effects you notice. This information helps your doctor decide whether to continue treatment, adjust it, or try something else.
A journal can also show patterns as your symptoms and response to treatment change over time.
"Healing isn't linear," Morckel says. "You can find a medication that works great, and then six months later it doesn't work at all. You can find a medication that doesn't work very well one year, and then your doctor wants to try it again six years later, and voil — it's working. It's just such an experiment."
Think of Activity As Treatment
Exercise is one of the best-supported treatments for fibromyalgia. Aerobic activity, strength training, and mind-body practices may ease pain and fatigue, and boost sleep, physical function, and quality of life.
Regular movement may also calm the body's stress response and make the nervous system less reactive. Exercise "helps your brain release chemicals that combat the pain," Limerick says.
The right activity depends on your symptoms, abilities, and preferences. You might:
Walk around the block
Stretch for a few minutes
Practice yoga or tai chi
Use an elliptical or rowing machine
Exercise in a pool, especially a heated one
Whatever you choose, start slowly. Egan suggests increasing activity little by little so you can build strength and endurance without triggering a major setback. A physical or occupational therapist who understands fibromyalgia or chronic pain can come up with a movement plan that fits your body.
Morckel has learned how personal that plan can be.
Water aerobics helps many people. But pool therapy caused Morckel's symptoms to flare. Most of her activity now comes from chores and cleaning around the house. That may not look like a traditional exercise program, but she's able to keep moving without pushing past her limits.
Some discomfort during activity or soreness afterward can be normal. But if intense pain is still there a couple of hours later, Limerick says you're probably pushing a little too hard and doing something that may not be great for you in the long run. Try a shorter or easier session next time.
Your response may also be delayed. Pay attention to whether pain or fatigue gets worse later that day or over the next day or two. If that keeps happening, change the type or length of activity until you find an amount your body can recover from.
Pace the Energy You Have
Pacing basically means paying attention to how much energy you have and deciding where to use it. You might break big jobs into smaller steps, switch between harder and easier tasks, or rest before you feel completely worn out.
Morckel sometimes thinks in terms of "spoon theory," a way many people with chronic illness describe having a limited supply of energy. If she wakes up with what feels like 10 spoons, she thinks carefully about how to spend them. She may choose the three things that matter most and leave the rest for another time.
"If I know I'm going to have a busy day, then I know that I need to prioritize," she says.
But even careful planning can't make fibromyalgia predictable. Some days Morckel may be able to spread her energy across work, dinner with friends, and staying up to watch her favorite show. On another day, work alone may be enough to trigger a flare.
Pacing may also include finding easier ways to shop, cook, and eat. Food won't cure fibromyalgia, but your choices may support how you feel without adding more work or unnecessary restrictions.
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Care for Your Mental Health
Limerick says that caring for your emotional health is a key part of getting pain under better control. If you have depression or anxiety, he may suggest options like cognitive behavioral therapy (CBT), mindfulness, meditation, or working with a licensed mental health professional who understands ongoing pain.
Research suggests CBT and acceptance and commitment therapy (ACT) are two kinds of talk therapy that can help people with fibromyalgia feel less overwhelmed, improve mood, and deal with day-to-day symptoms.
CBT teaches you to notice unproductive thoughts and behaviors and practice more useful responses. ACT helps you make room for hard thoughts, feelings, and symptoms while taking positive, doable steps toward what matters to you.
For Morckel, managing major depressive disorder is a part of her overall care. Finding the right plan took years of trying different medications, therapy, and self-care. She says being "ridiculously stubborn" is how she held on to hope and stayed open to new treatments.
Morckel recently added esketamine nasal spray to the medication she already takes. This is the best she's felt in nearly 20 years.
"Suddenly, holy cow, the world has colors again," she says. Finding a treatment that worked took a long time, but Morckel says it was worth continuing to try. "I'm actually not having to force a smile. It's amazing."
Treat Sleep as Its Own Symptom
Many people with fibromyalgia have trouble falling or staying asleep. And when you don't sleep well, your pain is often harder to manage the next day.
"It's really, really difficult to try to control chronic pain in someone who is not sleeping well," Limerick says, which is why he spends time talking about good sleep habits as part of a treatment plan.
Simple changes can make a difference. A cooler, darker, quieter room sets the stage for quality sleep. Limiting afternoon caffeine, large meals near bedtime, and screen use before sleep helps, too.
But lifestyle tweaks aren't always enough. You may need a more structured approach, such as cognitive behavioral therapy for insomnia (CBT-I). CBT-I uses evidence-based strategies to change thoughts and behaviors around sleep that keep insomnia going.
Tell your doctor if you snore, gasp or seem to stop breathing during sleep. The urge to move your legs at night or regularly waking up tired is worth mentioning, too. Sleep apnea, restless legs syndrome, and other sleep disorders may need their own treatment.
Build a Care Team You Trust
Your care team can grow around the symptoms you need help with. It may include a:
- Primary care doctor
- Physiatrist
- Rheumatologist
- Pain specialist
- Physical or occupational therapist
- Sleep specialist
- Mental health professional
- Registered dietitian
You probably won't need all of them. What matters most is finding doctors who listen, explain the plan, and involve you in decisions. If your concerns aren't being addressed or you don't feel supported, a second opinion may be the next step.
It's important to learn what your usual pain, fatigue, and flares feel like. And feeling comfortable with your care team can make it easier to speak openly about what you're experiencing.
"Our role as physicians is to make sure that our patients are safe and happy and thriving," Egan says. "If something has changed, or something is new, then we want to know about that to be able to make sure there isn't something else going on that we could address separately."
Find Your Community
Support can also come from people who understand the day-to-day reality of fibromyalgia.
Morckel runs a private Facebook group called Fibromyalgia Community: Support Resources and Discussion. Members share their experience, offer ideas to ask a doctor about, and give each other a safe place to let out frustrations.
"Every week we have somebody show up and say, 'Hey, I'm brand new to this. I was just diagnosed, or I'm about to be diagnosed. Where do I even begin? I'm scared," Morckel says. "Within a day, there will be 60 comments."
She says members are generous with their time and energy because they know how overwhelming the beginning can feel.
A support network can't replace medical care, and someone else's treatment may not work for you. But having people who understand — and a care team you trust — can make it easier to keep going while you find what helps.
"Find your community," Limerick says. "You'll be able to find a doctor. You'll be able to find therapists who believe you and who are willing to walk with you on this journey."
Learn More About Fibromyalgia
The Different Stages of Fibromyalgia Treatment
Care for Your Mental Health With Fibromyalgia
Focused Eating to Help With Fibromyalgia