The Four R's of Fibromyalgia Treatment

Dr. Ginevra Liptan has utilized her extensive clinical, personal, and research experience with fibromyalgia to develop a comprehensive treatment approach with the goal of achieving a new level of daily life functionality through meaningful symptom improvement. Dr. Liptan organizes fibromyalgia treatment into The Four R’s: Rest, Repair, Rebalance, and Reduce, which are explained below. Through this systematic approach to the many symptoms of fibromyalgia, we can greatly decrease their impact.  

Successful fibromyalgia treatment must work to repair the complex negative effects generated by a chronic hyperactive “fight-or-flight” response. This hyperactive fight-or-flight, or stress response, is like a smoke alarm going off, even without any smoke. This malfunctioning “smoke alarm” is below the level of conscious control and is the underlying root cause of fibromyalgia. 

To schedule an appointment and learn more about costs, please click here. A thorough explanation and guide to treatment is available in Dr. Liptan's book, The FibroManual: A Complete Fibromyalgia Treatment Guide for You and Your Doctor, which is available at

Step One: Rest

The first step is the most important and provides the foundation for everything else. This foundational step is called Rest because it involves giving the body rest from the constant pummeling by a hyperactive stress response by purposefully enlisting a relaxation response and by restoring deep sleep. The inability to get adequate deep sleep wreaks havoc on the body, so specific combinations of medications and supplements must be used to override the stress response to push body into deep sleep. Restoring deep sleep results in the greatest improvement in fatigue and pain, so Dr. Liptan focuses on finding a regimen that works for each patient. 

Step Two: Repair 

Once the foundation of Rest is in place, we work on Repair, both structural and nutritional. The chronic hyperactive stress response in fibromyalgia weakens the body’s ability to break down and absorb nutrients, so treatment focuses on repairing digestion. Structurally, the fascia and muscles in fibromyalgia are tight and “stuck.” Treatment is directed at unsticking the fascia to lessen those tight, inflamed and painful areas that are the major source of fibromyalgia pain. Gentle movement therapy increases blood flow to muscles and joints and reduces pain and inflammation. Together, gentle movement therapy and treatment of the fascia repairs function and reduces pain in the myofascial system. 

Step Three: Rebalance 

The next step is to Rebalance the imbalance in energy production, hormones, and inflammation caused by a chronic hyperactive stress response. The chronic stress response is a state of inefficient energy production, so supporting the energy-producing mitochondria with adequate nutrition and targeted supplements will reduce fatigue. High levels of inflammation from food sensitivities and chronic infections worsen fibromyalgia symptoms and also must be addressed. The adrenal glands can burn out from the constant signals of the stress response, leading to abnormal patterns of cortisol release and causing fatigue. The adrenal glands need to be supported with lifestyle changes, diet, and supplements to bring them back into balance. In some patients, thyroid and sex hormones get out of balance as well and need to be addressed. 

Step Four: Reduce 

The final step of fibromyalgia treatment is to Reduce any remaining pain, fatigue, or fibrofog by treating those symptoms with targeted medications and therapies. Although by the time they get to this step, after working on the first three steps, patients usually have gained significant symptom improvement. However in this final step, we treat any remaining symptoms with medication and other therapies.

To schedule an appointment and learn more about costs, please click here.