A Functional Medicine Approach to Fibromyalgia: Causes, Treatments, and New Frontiers

February 3, 2025

Fibromyalgia is a chronic condition characterized by widespread pain, fatigue, cognitive dysfunction (“fibro fog”), and a host of other debilitating symptoms. Affecting an estimated 2-4% of the population—predominantly women—fibromyalgia often leaves patients seeking answers beyond conventional medicine. Functional medicine offers a deeper, root-cause-focused approach, integrating emerging therapies, lifestyle changes, and cutting-edge science.

Fibromyalgia is a real, complex, and life-altering condition, yet it remains one of the most misunderstood and misdiagnosed disorders in modern medicine. Patients are often told that their pain is “all in their head” or that they’re just experiencing stress or depression. Instead of addressing the root causes, conventional medicine frequently resorts to prescribing antidepressants, painkillers, and muscle relaxers—treating the symptoms rather than the underlying issue.

While fibromyalgia can be associated with mood disorders, it is not a mental illness, nor is it simply due to depression or anxiety. Research has shown that fibromyalgia is a disorder of central pain processing, meaning the brain and nervous system amplify pain signals abnormally (American College of Rheumatology).

Fibromyalgia has become a default diagnosis when doctors cannot explain widespread pain, fatigue, and other symptoms. However, many individuals diagnosed with fibromyalgia may actually have an underlying, undiagnosed condition contributing to their symptoms.

A study in Arthritis Care & Research found that nearly 50% of patients meeting the criteria for fibromyalgia were not diagnosed by their doctors, while 11% of patients diagnosed with fibromyalgia did not meet the criteria (ACR Journal).

This means fibromyalgia is both underdiagnosed and overdiagnosed, often serving as a catch-all for unexplained symptoms. Many cases of chronic pain and fatigue are rooted in issues such as:

Chronic infections (e.g., Lyme disease, Epstein-Barr virus, mold toxicity)
Thyroid dysfunction (often undiagnosed hypothyroidism or Hashimoto’s disease)
Nutrient deficiencies (such as magnesium, vitamin D, and B vitamins)
Mitochondrial dysfunction (leading to low cellular energy production)
Gut dysbiosis and leaky gut (which drive systemic inflammation and pain)

Fibromyalgia has been described as a systems-wide breakdown rather than a disease with a single cause, which is why it is so difficult to understand and treat.

Understanding the Root Causes of Fibromyalgia

Functional medicine views fibromyalgia as a syndrome driven by multiple underlying factors. Addressing these root causes helps create a personalized treatment approach.

1. Mitochondrial Dysfunction

Mitochondria, the powerhouses of cells, play a crucial role in energy production. Research has indicated that mitochondrial dysfunction can lead to impaired energy metabolism and oxidative stress, both of which may contribute to fibromyalgia symptoms. A study published in Clinical Rheumatology found increased markers of oxidative stress and reduced antioxidant capacity in fibromyalgia patients, suggesting mitochondrial involvement.

2. Chronic Inflammation

Systemic, low-grade inflammation has been implicated in fibromyalgia. Elevated levels of pro-inflammatory cytokines like IL-6 and TNF-alpha have been observed in patients. Functional medicine providers aim to identify sources of inflammation, such as gut dysbiosis, hidden infections, or food sensitivities, and address them to reduce the inflammatory burden.

3. Gut-Brain Axis Dysfunction

The gut-brain axis, a bidirectional communication system between the gastrointestinal tract and the central nervous system, plays a significant role in fibromyalgia. Studies have found that up to 70% of fibromyalgia patients also have irritable bowel syndrome (IBS). Dysbiosis (imbalance of gut bacteria) and intestinal permeability (“leaky gut”) can amplify systemic inflammation and contribute to neuroinflammation, a hallmark of fibromyalgia.

4. Stress and HPA Axis Dysregulation

The hypothalamic-pituitary-adrenal (HPA) axis, which governs the stress response, is often dysregulated in fibromyalgia patients. Chronic stress can lead to elevated cortisol levels initially, followed by adrenal fatigue and reduced cortisol, impairing the body’s ability to handle pain and inflammation effectively.

5. Fascial Dysfunctions and Scar Tissue

Emerging research suggests the fascia, the connective tissue network surrounding muscles and organs, can contribute to fibromyalgia. Restricted fascia and adhesions from scar tissue may trap crystalline water deposits, causing localized stiffness and amplifying pain signals.

6. Neurological Sensitization

Central sensitization, where the nervous system becomes hypersensitive to stimuli, is a well-documented feature of fibromyalgia. Functional medicine seeks to identify triggers that perpetuate this state, such as nutritional deficiencies, sleep disturbances, or environmental toxins.

A Functional Medicine Approach to Treatment

Functional medicine combines evidence-based therapies with individualized care, focusing on lifestyle changes, nutrition, and emerging interventions.

1. Lifestyle and Nutrition Strategies

Nutrition plays a crucial role in managing fibromyalgia. A whole-food, anti-inflammatory diet can reduce systemic inflammation and enhance energy levels. Your doctor may recommend an elimination diet, an anti-inflammatory diet, a low fodmap diet, or even a vegan diet, based on your situation.

Functional medicine provider often recommend:

Beginning with an Elimination Diet: Identifying and removing trigger foods such as gluten, dairy, or sugar can reduce inflammation and gut-related symptoms. Studies suggest that up to 30% of fibromyalgia patients improve after dietary modifications.

Transitioning to an Anti-Inflammatory, Whole-Food, Nutrient-Dense Diet:

High-quality proteins: Grass-fed meat, organic poultry, and wild-caught fish to support muscle repair and reduce inflammation.
Fiber-rich vegetables: Cruciferous vegetables (broccoli, kale, Brussels sprouts) enhance detoxification pathways.
Omega-3 fatty acids: Found in wild-caught fish, flaxseeds, and walnuts, these reduce inflammation and pain perception.
Polyphenols: Foods like berries, turmeric (curcumin), and green tea support antioxidant defenses and mitigate oxidative stress.
Gluten and dairy elimination: Removing common inflammatory foods may reduce gut-related symptoms and systemic inflammation.

Support for Blood Sugar Stability

Maintaining balanced blood sugar is critical for reducing the energy crashes and fatigue common in fibromyalgia. Practitioners often recommend:

Eating balanced meals with protein, healthy fats, and fiber.
Avoiding refined sugars and processed carbohydrates.

2. Sleep Optimization

Fibromyalgia is closely linked to poor sleep quality. Functional medicine approaches include:

Supporting melatonin production with magnesium and tryptophan-rich foods.
Implementing sleep hygiene practices, such as consistent sleep schedules and reduced blue light exposure before bed.

3. Movement Therapy

Graded exercise therapy, tailored to individual tolerance, is critical. Gentle, low-impact exercises improve flexibility, reduce stiffness, and enhance mitochondrial health.

Recommended activities include yoga, tai chi, and aquatic therapy.

4. Mind-Body Therapies

Chronic stress and dysregulation of the autonomic nervous system play a major role in fibromyalgia. Many patients have a constant “fight-or-flight” response, leading to heightened pain perception. Stress reduction through mind-body practices can regulate the HPA axis and reduce central sensitization. Emerging research supports the efficacy of:

Mindfulness-Based Stress Reduction (MBSR)
Cognitive Behavioral Therapy (CBT)
Biofeedback
HRV (heart rate variability) training and breathwork to regulate the nervous system
Meditation, yoga, and tai chi to promote relaxation
Cold exposure therapy to improve nervous system resilience

5. Addressing Chronic Infections and Toxin Overload

Chronic infections (such as Lyme disease, Epstein-Barr, and mold toxicity) can mimic fibromyalgia. Many patients find relief after treating underlying infections and detoxifying environmental toxins.

Test for hidden infections and heavy metals
Support detox pathways with saunas, binders (like activated charcoal), and glutathione
Reduce exposure to mold, pesticides, and endocrine disruptors

6. Improving Sleep and Restorative Healing

Poor sleep worsens fibromyalgia symptoms. Studies show that deep sleep is crucial for pain modulation and recovery.

Establish a strict sleep schedule and eliminate blue light exposure before bed
Use magnesium and glycine to promote deep, restorative sleep
Consider red light therapy and melatonin for circadian rhythm support

7. Supplements & Medications

Key Supplements

Functional medicine providers often incorporate evidence-based supplements, including:

Magnesium and malic acid: For muscle relaxation, pain reduction, and energy production.
CoQ10 and acetyl-L-carnitine supplementation to enhance ATP production and reduce oxidative stress.
Curcumin: The active compound in turmeric, curcumin is a powerful anti-inflammatory and antioxidant that has been shown to reduce pain and improve overall symptom management in fibromyalgia patients by modulating inflammatory pathways and supporting mitochondrial health.
Vitamin D: Improves pain sensitivity and immune modulation.
Probiotics and prebiotics: Enhance gut health and reduce systemic inflammation.
Alpha-lipoic acid and B vitamins to support energy metabolism

Low-Dose Naltrexone (LDN)

LDN is a promising prescription therapy that modulates the immune system and reduces inflammation. It works by calming overactive microglia in the central nervous system, reducing hypersensitivity to pain.

Sulfur-containing Compounds DMSO and MSM

MSM (methylsulfonylmethane) is a sulfur-containing compound known for its anti-inflammatory and pain-relieving properties, which may benefit fibromyalgia by reducing muscle soreness, supporting joint health, and aiding detoxification pathways. Since fibromyalgia is often linked to chronic inflammation, mitochondrial dysfunction, and toxin overload, MSM’s role in enhancing glutathione production and cellular energy may help alleviate symptoms. Some studies suggest it can improve physical function and pain levels, though more research is needed. Starting with 1-3 grams daily and gradually increasing may offer benefits, but those with sulfur sensitivities should proceed cautiously.

DMSO (Dimethyl Sulfoxide), also a sulfur-containing compound, has drawn interest for its anti-inflammatory and pain-relieving properties. Its unique ability to penetrate the skin and deliver compounds into systemic circulation offers potential for localized and widespread relief. It can:

Inhibit nerve conduction to reduce pain perception.
Reduce pro-inflammatory cytokines like IL-6 and TNF-alpha.
Improve blood flow and tissue oxygenation.

While promising, DMSO should only be used under professional guidance to minimize risks like toxin transport or organ stress.

Emerging Therapies in Functional Medicine

1. Platelet-Rich Plasma (PRP) Therapy for Fibromyalgia

Platelet-rich plasma (PRP) therapy is an emerging treatment for fibromyalgia that leverages the body’s own healing mechanisms. By injecting concentrated platelets rich in growth factors into areas of pain, such as trigger points, joints, or fascia, PRP can reduce inflammation, promote tissue repair, and modulate pain pathways. Preliminary research suggests that PRP may provide significant, long-lasting relief from pain and stiffness, while improving mobility and overall quality of life. Since PRP uses the patient’s own blood, it carries minimal risk of adverse reactions, making it a promising natural option for those seeking alternative or adjunctive treatments for fibromyalgia.

2. Fascia-Focused Therapies

Restricted fascia can perpetuate pain and stiffness in fibromyalgia. Addressing fascial dysfunction is a key focus in functional medicine.

Myofascial Release (MFR): A hands-on technique to relieve tension and improve mobility.
Trigger Point Therapy: Reduces localized pain caused by tight knots in the fascia.
Hydration and Movement: Regular hydration and gentle stretching keep fascia pliable and healthy.
Low-Level Laser Therapy (LLLT): Stimulates tissue repair and reduces fascial adhesions.

3. Peptide Therapy

Peptides like BPC-157 and thymosin beta-4 show promise in promoting tissue repair, reducing inflammation, and enhancing mitochondrial function.

4. Psychedelic-Assisted Therapy

Emerging studies suggest compounds like psilocybin and ketamine may “reset” neurological pathways associated with chronic pain and central sensitization.

5. Genomics and Precision Medicine

Functional medicine practitioners use genetic testing to personalize care, addressing genetic predispositions for detoxification, inflammation, or neurotransmitter imbalances.

The Functional Medicine Difference

Fibromyalgia demands a multifaceted approach that addresses the body as an interconnected system. Functional medicine excels at uncovering root causes, integrating emerging therapies, and personalizing care. By targeting mitochondrial function, reducing systemic inflammation, optimizing fascia health, and leveraging cutting-edge treatments like DMSO and peptides, patients can find relief and reclaim their quality of life.

If you or a loved one is struggling with fibromyalgia, there is hope. Functional medicine provides individualized care, addressing the unique drivers of your symptoms. At Resolve Medical, we specialize in root-cause-focused interventions, empowering patients to take control of their health.