The year 2026 marks a historic turning point in care for the person with fibromyalgia in Brazil. The combination of the new guidelines of the Brazilian Society of Rheumatology (SBR), published in the journal Advances in Rheumatology, and Law No. 15.176/2025, sanctioned in July 2025, redesigns the therapeutic and rights map of this syndrome that, according to the SBR, affects between 2.5% and 5% of the Brazilian population — a contingent estimated at more than 5 million people.
The message from medical societies is clear: fibromyalgia has ceased to be treated as a "diagnosis of exclusion" or psychosomatic condition and is now managed as a nociplastic pain syndrome of central origin, that requires a multiprofessional approach based on evidence.
A real disease, with significant numbers
Fibromyalgia is a clinical syndrome characterized by generalized musculoskeletal pain, without identifiable inflammatory signs or tissue lesions. In a recent interview with the press, the SBR president, Dr. José Eduardo Martinez, emphasized that the condition is usually accompanied by persistent fatigue, sleep disturbances, and cognitive alterations — the so-called fibro fog.
FIBROMYALGIA IN BRAZIL — EPIDEMIOLOGIC OVERVIEW
Law No. 15.176/2025: fibromyalgia as a disability
Sanctioned in July 2025, Law No. 15.176/2025 equates the person with fibromyalgia to the person with disability for all legal effects. The measure is considered one of the most relevant achievements of the patient movement in the last decade.
Rights guaranteed by Law 15.176/2025
- Quotas in public competitions and employment selection processes
- Exemption from IPI, ICMS, and IOF on the acquisition of adapted vehicles
- Disability retirement and sickness benefit, upon expert assessment
- Continuous Cash Benefit (BPC) for low-income persons
- Death pension in cases in which work incapacity is proven
The law also paves the way for integrated public policies between the Ministry of Health, the INSS (National Social Security Institute), and state assistance systems, with the goal of reducing underdiagnosis and involuntary unemployment among patients.
The new SBR guidelines: what changed in 2026
The Fibromyalgia Treatment Guidelines — Part I and Part II, published by the Pain, Fibromyalgia, and Other Pain Syndromes Commission of the SBR in Advances in Rheumatology (Heymann RE et al., 2026), update the previous 2017 document and adopt the GRADE methodology to rank recommendations. The new text structures the treatment in four pillars.
1. Health education and self-care
Considered the first step of any therapeutic plan. It involves explanation about the nature of nociplastic pain, demystification of the condition, sleep hygiene, stress management, and coping strategies. Studies cited in the guideline show reductions of up to 30% in the Fibromyalgia Impact Questionnaire (FIQ)with structured education programs alone.
2. Supervised physical activity
Recommendation with high level of evidence. Aerobic exercises of low to moderate impact (walking, aquatic gymnastics, swimming), resistance training, and practices such as yoga and tai chi are indicated with maximum strength. The suggested initial goal is 150 minutes per week, progressing according to tolerance.
3. Non-pharmacologic treatment: acupuncture and neuromodulation in focus
Here lies one of the great novelties of the 2026 guidelines. The Brazilian guidelines recommend acupuncture as part of the multidisciplinary plan for pain control in fibromyalgia. The evidence is considered favorable for pain control, although the magnitude of the effect varies between studies and patients, and the technique should be performed by a trained physician, with clinical assessment and individualized indication.
The pathophysiologic basis is solid: acupuncture modulates central neurotransmitters (serotonin, endorphins, substance P), acts on the hypothalamic-pituitary-adrenal axis and, according to neuroimaging studies such as that of Mawla et al. published in Arthritis & Rheumatology, increases connectivity of the primary somatosensory cortex and elevates levels of insular GABA — mechanisms directly related to pain relief.
Non-invasive neuromodulation: tDCS and rTMS formally incorporated
For the first time, techniques such as transcranial direct current stimulation (tDCS)and repetitive transcranial magnetic stimulation (rTMS)are formally incorporated. The guidelines indicate evidence for non-invasive neuromodulation in fibromyalgia — tDCS and rTMS — in pain reduction. The most studied protocols target the primary motor cortex (M1) and the left dorsolateral prefrontal cortex (DLPFC-L), with daily sessions in cycles of 2 to 4 weeks.
Other recognized interventions include cognitive-behavioral therapy (CBT), mindfulness, hydrotherapy, and, in selected cases of overlap with myofascial pain, dry needling and management of trigger points.
4. Rational pharmacologic treatment
Part II of the guidelines (Heymann et al., 2026) maintains as the main options:
- Tricyclic antidepressants (amitriptyline, nortriptyline) at low doses
- Duloxetine and milnacipran (SNRIs)
- Pregabalin and gabapentin
- Cyclobenzaprine for sleep disturbances
Opioids — especially the strong ones — are discouraged. Nortriptyline, the subject of recent national clinical updates, reappears with prominence due to its better tolerability profile compared with amitriptyline and to a new NeuPSIG (2025) meta-analysis, which pointed to NNT of 4.6 for neuropathic pain (this NNT refers to neuropathic pain in general; fibromyalgia is predominantly a nociplastic syndrome, which may limit direct extrapolation).
Impact on SUS and on acupuncture practice
In February 2026, the Ministry of Health published a booklet with structured care planning for fibromyalgia in Brazil’s Unified Health System (SUS), foreseeing training of Primary Care teams, referral flows to the rheumatologist, and integration with the National Policy on Integrative and Complementary Practices (PNPIC).
What changes for the patient
FIBROMYALGIA — BEFORE 2025 VS. FROM 2026
| BEFORE 2025 | FROM 2026 |
|---|---|
| Delayed diagnosis and frequent pilgrimage among specialists | Structured flow in primary care, with ACR criteria |
| Focus on medications, with little access to integrative practices | Multidisciplinary treatment with acupuncture, exercise, and neuromodulation |
| No legal recognition of incapacity | Equation to person with disability by Law No. 15.176/2025 |
| Limited coverage of non-pharmacologic therapies | Progressive incorporation via SUS and expansion of the PNPIC network |
Frequently Asked Questions
Not automatically. The law equates the person with fibromyalgia to the person with disability for all legal effects, which opens the right to benefits such as disability retirement and sickness benefit — but the granting depends on expert assessment by the INSS, which analyzes the degree of functional impairment in each case. Detailed clinical documentation, including reports from the rheumatologist, the medical acupuncturist, and other professionals of the multidisciplinary team, is decisive for the result of the expert evaluation.
The SBR guidelines of 2026 recommend cycles of 10 to 20 sessions, with initial frequency of one to two times per week. After this intensive phase, monthly maintenance is common to consolidate the gains. Electroacupuncture tends to be superior to manual acupuncture in some outcomes, and the combination with supervised physical exercise and low-dose tricyclic antidepressant is what presents the greatest effect in national studies.
Not yet broadly. Formal incorporation into the SBR guidelines is the first step toward building a SUS supply policy — a process that typically takes months to years and involves evaluation by CONITEC. Currently, tDCS and rTMS are available mainly in university centers, teaching hospitals, and private clinics specialized in chronic pain and neuromodulation. The expectation is that the Ministry of Health booklet of February 2026 will accelerate this expansion.
Yes — and this is precisely the recommendation of the guidelines: multidisciplinary treatment with combination of therapies. National studies have demonstrated that acupuncture combined with low-dose amitriptyline or nortriptyline produces benefit superior to any of the interventions alone. The medical acupuncturist should document the medications in use and communicate with the rheumatologist to adjust doses according to clinical response, avoiding unnecessary therapeutic duplication.
There is no laboratory or imaging examination that confirms fibromyalgia. The diagnosis is exclusively clinical, based on the criteria of the American College of Rheumatology (ACR), which evaluate the pattern and duration of generalized pain, presence of fatigue, sleep disturbances, and cognitive alterations. Examinations may be requested to exclude other causes of musculoskeletal pain (thyroid, rheumatologic, neurologic), but there is no specific marker for fibromyalgia.
Sources consulted
- Heymann RE, Paiva ES, Martinez JE, et al. Fibromyalgia treatment guidelines — Part I and Part II. Advances in Rheumatology. 2026. DOI: 10.1186/s42358-025-00483-2.
- Brazil. Law No. 15.176, of July 24, 2025. Recognizes fibromyalgia as a disability for legal effects.
- Ministry of Health. Booklet on the management of fibromyalgia in SUS. Brasília, February 2026.
- Deare JC, Zheng Z, Xue CCL, et al. Acupuncture for treating fibromyalgia. Cochrane Database of Systematic Reviews.
- Mawla I, Ichesco E, Zöllner HJ, et al. Greater somatosensory afference with acupuncture increases primary somatosensory connectivity and alleviates fibromyalgia pain via insular GABA. Arthritis & Rheumatology.
- Araújo RAT. Treatment of pain in fibromyalgia with acupuncture. Doctoral Thesis, Faculty of Medicine of USP, 2007.
- Souza JB, Perissinotti DMN. The prevalence of fibromyalgia in Brazil — a population-based study. Brazilian Journal of Pain. 2018.
Founded in 1989 by physicians trained at the University of São Paulo (USP) and specialized in China, CEIMEC is a Brazilian national reference in the teaching and practice of medical acupuncture. With more than 3,000 physicians trained over 35 years, it collaborates with HC-FMUSP and is recognized by the Brazilian Medical College of Acupuncture (CMBA/AMB).
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