Treatment
A diagnosis of fibromyalgia alone may result in health benefits. In a year-long study published in 1986, Cathey et al reported that among 81 persons diagnosed with fibromyalgia, hospitalization rates decreased in the year following diagnosis (LOE: 2, case-control design).47
Treatments for fibromyalgia are numerous, ranging from balneotherapy (bathing) to low-energy laser therapy, and studies of interventions are often poorly designed, based on small numbers of patients, report nonstandardized outcomes, and yield conflicting results.48
Two interventions—aerobic exercise and antidepressant therapy—appear to improve fibromyalgia.
Aerobic exercise
Though pain relief is insignificant with aerobic exercise, other positive effects are significant (SOR: A). A 2003 Cochrane review identified 7 high-quality studies of aerobic training, defined as: 1) frequency of 2 days per week; 2) intensity sufficient to achieve 40% to 85% of heart rate reserve, or 55% to 90% of predicted maximum heart rate; 3) duration of sessions 20 to 60 minutes, either continuously or intermittently throughout the day, using any mode of aerobic exercise; and 4) a total exercise period of at least 6 weeks (Table 1).49
Improved functioning, tender-point threshold. Study subjects engaged in aerobic dancing, whole-body aerobics, stationary cycling, and walking. Persons who exercised improved in global well-being, physical function, and aerobic fitness (by about 17%), and raised the pain threshold of tender points (by about 35%).49 Four of the studies were similar enough to be combined for meta-analysis, showing a statistically robust but modest reduction in tender-point threshold (LOE: 1).
Although it seems likely that pain or fatigue might increase at least initially with exercise, participants in the exercise groups were not deterred; the researchers pointed out that reporting of adverse effects of aerobic exercise appeared incomplete, but there was no significant difference in drop-out rates between the exercise (25.1%) and control groups (12.5%).49
In the long-term studies (>6 months), improvements were noted up to 1 year after treatment ended but not after 4.5 years.49 This Cochrane review further supports aerobic exercise as bring beneficial for persons with fibromyalgia.50,51
Additional improvement measures. A similar systematic review concluded that although studies were too heterogeneous to draw final conclusions, preliminary data supported aerobic exercise (LOE: 2, with heterogeneous studies).50 In another comprehensive meta-analysis of all treatments for fibromyalgia, heterogeneous treatment studies ranging from exercise to physical therapy were identified as physically-based treatments. The analysis revealed a positive effect on physical status (including tender-point index, grip strength, and physician global rating of pain symptoms), fibromyalgia symptoms (including self-reported fatigue and pain using visual analog scales), and psychological status (including measurements of the Hamilton Depression and Anxiety Scales), with no effect on daily functioning (including outcome measures such as the Fibromyalgia Impact Questionnaire [FIQ]) (LOE: 2, with heterogeneous studies).51
The authors noted that the magnitude of the positive effects of physically-based treatments on fibromyalgia were comparable with drug treatment judged effective for arthritis.51
TABLE 1
Aerobic exercise for fibromyalgia: the evidence
| Aerobic exercise (SOR: A) | |||
|---|---|---|---|
| Study (LOE) | Treatment specifics | Results | Comments |
| Busch et al49(1) | Supervised aerobic training—eg, aerobic dancing, stationary cycling, walking: 1) frequency of 2 days per week, 2) intensity sufficient to achieve 40%–85% of heart rate reserve or 55%–90% predicted maximum heart rate, 3) duration of sessions of 20–60 minutes duration, either continuously or intermittently throughout the day, and using any mode of aerobic exercise, 4) total time period of at least 6 weeks, maximum 1 year in these studies. | Benefits over controls: improvements in aerobic performance, tender points, and global well-being. | 4 high-quality aerobic training studies included in meta-analysis. No significant improvements in pain intensity, fatigue, sleep, and psycho-logical function. |
| Adverse effects: poorly reported. | |||
| Sim et al50(2) | Not standardized, but 3 studies set exercise intensity at 60%–75% of max.heart rate.Duration 6 weeks to 20 weeks. | Benefits over controls: preliminary evidence for improvements in symptoms. | Heterogeneous studies. |
| Adverse effects: not reported. | |||
| Rossy et al51(2) | Loosely defined and heterogeneous, including “exercise, strengthening, walking, stretching, pool therapy, cycling, swimming, and aerobics.” | Benefits over controls: improvement in physical status, fibromyalgia symptoms, and psychological status with effectiveness comparable with pharmacologic treatment for arthritis pain. | Heterogeneous studies.No improvement in daily functioning. |
| Adverse effects: not reported. | |||
| SOR,strength of recommendation; LOE,level of evidence.For an explanation of these ratings | |||
Less certain nonpharmacologic therapies
Other nonpharmacologic treatments for fibromyalgia are educational interventions, relaxation therapy, cognitive-behavioral therapy, and acupuncture. These therapies have undergone rigorous analysis, but studies have been too heterogeneous to allow for strong conclusions across the studies.50
A recent Cochrane review concluded that although physical training plus education had a positive effect at long-term follow up, evidence is insufficient to recommend multidisciplinary rehabilitation, defined as the care of a physician plus psychological, social, and vocational interventions (SOR: C).52