Most Fibromyalgia Treatments Not Supported By High-Quality Evidence

Most therapies now available for fibromyalgia are not backed by high-quality evidence for their effectiveness in reducing pain or improving quality of life (QOL), according to a new research review.

"Out of 65 different therapies included in our review, we only found high-quality evidence supporting the effectiveness of cognitive-behavioral therapies, antidepressants and central nervous system depressants," Dr. Vinicius Cunha Oliveira of the Universidade Federal dos Vales do Jequitinhonha e Mucuri in Diamantina, Brazil, told Reuters Health by email.

"Although the certainty about the effectiveness of these therapies is high, their effect sizes may not be clinically meaningful to patients," he added. "It should be considered by clinicians in the decision-making process and discussed with their patients."

Dr. Oliveira and his team looked at 224 trials including nearly 30,000 patients. They found high-quality evidence for the effectiveness of cognitive-behavioral therapy for treating pain in the short term (weighted mean difference, -0.9), and central nervous system (CNS) depressants and antidepressants for medium-term pain treatment (WMDs -1.2, -0.5 respectively).

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For QOL, high-quality evidence supported short-term efficacy of antidepressants (WMD, -6.8), and medium-term efficacy of CNS depressants and antidepressants (WMDs, -8.7, -3.5), they report in JAMA Internal Medicine.

None of the effect sizes met the thresholds for minimally clinically important change of two points on the 11-point pain scale or 14 points on the 101-point QOL scale. The researchers also found little evidence for long-term effectiveness of any treatments.

"We found moderate-quality evidence supporting the efficacy of therapies such as acupuncture, exercises, manual therapy, transcranial magnetic stimulation, among others," Dr. Oliveira said. "The quality of this evidence is mainly limited by the small number of trials that leads to imprecise estimates, or by methodological issues of trials that decrease our confidence in their findings."

The findings don't rule out the possibility that some therapies included in the review are effective over a longer period of time, the researcher added.

Only a few studies looked at multimodal or combination therapies, Dr. Oliveira noted. "Given the complex nature and symptomatology of fibromyalgia, this form of intervention would offer more meaningful effect sizes than those we have found for single therapies," he said. "Our group is now interested in exploring the comparative effectiveness and acceptability of the non-pharmacological treatment options available for fibromyalgia by combining the direct and indirect evidence available."

—Anne Harding

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