Non-pharmacological treatments for fibromyalgia
Clinical bottom line
There was no evidence of any beneficial effect. If non-pharmacological interventions are beneficial in fibromyalgia.
Reference
Karjalainen et al. Multidisciplinary rehabilitation for fibromyalgia and musculoskeletal pain in working age adults. Cochrane Database Syst Rev. 2000;(2):CD001984.
Hadhazy et al. Mind-body therapies for the treatment of fibromyalgia. A systematic review. J Rheumatol. 2000 27:2911-2918.
Sim J, Adams N. Systematic review of randomized controlled trials of nonpharmacological interventions for fibromyalgia. Clin J Pain. 2002 18:324-336.
Studies
These three reviews sought to explore the influences of some non-pharmacological interventions on fibromyalgia. Each of them suffers from the same problem - namely the dearth of decent trials, leading to the possibility of over-interpretation.
Results
Karjalainen et al included only four trials and 376 patients. Two of the four trials were of low quality, and the remaining trials could not support any beneficial effects.
Hadhazy et al included only 13 trials and 802 patients. Only three of the 13 studies had appropriate randomisation method, with 201 patients, and only one of these had any positive outcomes. No real evidence for any beneficial effect.
Sim and Adams et al included only 25 trials and 1302 patients. Only 6 of the 25 studies had randomisation methods that excluded bias (three of these were trials included in review above).No real evidence for any beneficial effect.
Comment
There was no evidence of any beneficial effect. If non-pharmacological interventions are beneficial in fibromyalgia, someone has to out and prove it.