Nonpharmacologic Treatments for Fibromyalgia: What Works for Which Symptoms?
Fibromyalgia (FM) is often viewed as primarily a pain disorder, yet usually presents with a variety of other problems.In addition to widespread pain, the most common of these FM symptoms are fatigue, sleep problems, and depression. Nonpharmacologic interventions are recommended as first-line treatment for FM and related symptoms but there are no comprehensive reviews of the literature regarding efficacy. A recent systematic literature review and meta-analysis sought to identify the most efficacious nonpharmacologic therapies for the 4 common manifestations of FM. The primary outcome measure was disease-specific quality of life (QoL), as measured by the Fibromyalgia Impact Questionnaire (FIQ). Secondary outcomes were the impact of the interventions on pain, fatigue, sleep problems, and depression, the most common complaints associated with FM. Note: Many of the studies reviewed included relatively small numbers of subjects. Of the 11 012 participants included in these trials, 88% were women, and the median age, BMI, and FIQ score were 49 years, 27.6 kg/m2, and 59.2, respectively.
EXERCISE. Exercise had a moderate effect on QoL and depression but resulted in a large improvement in pain, fatigue, and sleep.
PSYCHOLOGICAL THERAPIES. Psychological therapies of various types appeared effective for improvement of QoL, pain, sleep, and depression, but not fatigue.
BALNEOTHERAPY. Balneotherapy appeared effective for QoL, pain, and depression relative to usual care.
ACUPUNCTURE. Acupuncture appeared effective for pain and fatigue compared to sham acupuncture and usual care and was more effective than a sham procedure for depression but no more effective than ususal care.
EDUCATION. Education was found only particularly beneficial for fatigue but no better than other therapies for the other symptoms.
MULTIDISCIPLINARY TREATMENTS. Treatments that combined exercise, education, and psychological therapies appeared to be effective for QoL, pain, sleep, and depression and more effective than usual care alone.
OTHER TREATMENTS. A wide variety of therapies have been studied for FM management, such as massage, laser, electrotherapy, manual therapy, and weight loss. The most promising appear to be electrotherapy and manual therapy, with each category comprising a range of treatments.
