Fibromyalgia has a wide range of symptoms, of which the most commonly treated are pain and lack of sleep. Criteria developed by the American College of Rheumatology classify fibromyalgia as widespread pain in combination with tenderness at 11 or more of 18 specific sites.1
The aetiology is unclear, so treatment is symptom-based. EULAR guidelines recommend a multidisciplinary approach, including both pharmacological and non-pharmacological interventions.2
Pharmacological approaches include analgesics and low-dosage antidepressants. It is thought that learning to manage the condition is the best approach. Complementary and alternative approaches are popular with patients.
Non-pharmacological approaches include heat, hydrotherapy, rest, exercise, education and stress reduction. This overlaps with the ideology of complementary and alternatives approaches.
In a survey, 91 per cent of patients reported using alternative approaches to manage symptoms, two-thirds using multiple alternative interventions.3
Acupuncture is one of the most popular alternative therapies among fibromyalgia patients, and rheumatology patients in general.4 It is thought to benefit pain by enhancing endogenous descending inhibition in the CNS via a neurochemical cascade of pain-modulating endorphins, serotonin and noradrenaline, resulting in analgesia.
A recent systematic review described five small, randomised clinical trials.5 Three studies of electro-acupuncture showed positive short-term benefits, not persisting more than one month beyond intervention. In the remaining two studies, patients improved in the acupuncture group but the effects were not superior to control groups, which included at least some patients receiving an intervention.
A small randomised, double-blind, placebo-controlled crossover trial reported that a homoeopathic preparation, Rhus toxicodendron 6C, was effective for a selected subgroup of fibromyalgia patients.6
This study met with criticism and the results were reanalysed by a second party. It was concluded that the study provided no firm evidence for the efficacy of homoeopathic treatment for fibromyalgia.7
Since then, only one further randomised placebo-controlled crossover trial has been published, in which individualised homoeopathic remedies were used to treat patients with fibromyalgia. Statistically significant differences were reported in medically assessed tender point count and pain, as well as subjective criteria from the patients compared with a placebo group over three months.8
Two randomised controlled trials (RCTs) found that massage led to improvement in pain and symptoms compared with relaxation techniques or TENS, but these studies were of poor quality.
Of the two remaining RCTs, one showed no benefit from massage and the other only very short-term benefit.9
A Cochrane review assessing multidisciplinary rehabilitation for fibromyalgia of working age adults included seven RCTs, of which more than half were of poor quality.10 The authors conclude that these studies suggest that behavioural treatment and stress management appear to be important components of pain management.
Evidence suggests cognitive behavioural therapy (CBT) and relaxation techniques are of some value, but the effect is modest and positive outcomes largely disappear over the long term.11
Although hypnotherapy has been investigated in the treatment of fibromyalgia, the studies are generally of poor quality.12 Bearing this in mind, hypnosis seems to be more effective than attention control, physical therapies and education.
Qigong, a part of traditional Chinese medicine, is based on a philosophy similar to acupuncture. There are a few small, low-quality studies looking at its benefits for fibromyalgia. The largest (n=128), most rigorous study compared a combination of qigong and mindful meditation with a control group of education over a 24-week period.
It showed that both groups improved in terms of Fibromyalgia Impact Questionnaire scores, pain and depression, but that there was no difference between them.13
- Dr Alyson Huntley is a research associate at Bristol University
- This article was originally published in MIMS Women's Health.
1. Wolfe F, Smythe H, Yunus M et al. The American College of Rheumatology 1990 criteria for the classification of fibromyalgia. Arthritis Rheum 1990; 33: 160-72.
2. Carville S, Arendt-Nielsen S, Bliddal H et al. EULAR evidence-based recommendations for the management of fibromyalgia syndrome. Ann Rheum Dis 2008; 67: 536-41.
3. Pioro-Boisset M, Esdaile J, Fitzcharles M. Alternative medicine use in fibromyalgia syndrome. Arthritis Care Res 1996; 9: 13-17.
4. Breuer G, Orbach H, Elkayam O et al. Perceived efficacy among patients of various methods of complementary alternative medicine for rheumatologic diseases. Clin Exp Rheumatol 2005; 23: 693-6.
5. Mayhew E, Ernst E. Acupuncture for fibromyalgia - a systematic review of randomized clinical trials. Rheumatology 2007; 46: 801-4.
6. Fisher P, Greenwood A, Huskisson E et al. Effect of homeopathic treatment on fibrositis (primary fibromyalgia). BMJ 1989; 299: 365-6.
7. Colquhoun D. Re-analysis of clinical trial of homoeopathic treatment in fibrositis. Lancet 1990; 336: 441-2.
8. Bell I, Lewis D, Brooks A et al. Improved clinical status in fibromyalgia patients treated with individualized homeopathic remedies versus placebo. Rheumatology 2004; 43: 577-82.
9. Tsao J. Effectiveness of massage therapy for chronic, non-malignant pain: a review. Evid Based Complement Altern Med 2007; 4: 165-79.
10. Karjalainen K, Malmivaara A, van Tulder M et al. Multidisciplinary rehabilitation for fibromyalgia and musculoskeletal pain in working age adults. Cochrane Database Syst Rev 2000; 2: CD001984.
11. Abeles M, Solitar B, Pillinger M, Abeles A. Update on fibromyalgia therapy. Am J Med 2008; 121: 555-61.
12. Elkins G, Jensen M, Patterson D. Hypnotherapy for the management of chronic pain. Int J Clin Exp Hypn 2007; 55: 275-87.
13. Astin J, Berman B, Bausell B et al. The efficacy of mindfulness meditation plus Qigong movement therapy in the treatment of fibromyalgia. J Rheumatol 2003: 30: 2,257-62.