Background/Purpose:

Fibromyalgia syndrome (FMS) is a common, chronic pain condition with complex multiple symptoms. Combinations of therapies in a multidisciplinary pain rehabilitation program (MPRP) are recommended by several international guidelines for the management of FMS. A number of primary research studies have evaluated the impact of MPRPs. However, no study has evaluated the totality of evidence regarding the effectiveness of MPRP’s for FMS.

The aim of this systematic review with meta-analysis was to examine the impact of MPRP’s  on levels of impairment, activity limitation and participation restriction in people with FMS. 

Methods:

An electronic search was conducted and included PubMed (1950 to present)

EMBASE (1980 to present), CINAHL (1982 to present), Science Direct (1985 and Databases of existing reviews such as The Cochrane Database of Systematic Reviews (The Cochrane Library, latest issue) The Cochrane Central Register of Controlled Trials (CENTRAL) (The Cochrane Library, latest issue) as well as electronic dissertation/theses databases and a grey literature search. The references of identified articles and reviews were checked, clinical trial registers and the Science Citation Index searched. Content experts were also contacted for additional or unpublished studies. 

Studies were considered eligible for inclusion if they met the following inclusion criteria: study design; randomized controlled trials (RCTs),  population; individuals with FMS, intervention; MPRP with involvement from a physician and two other health professionals, comparison; less intensive MPRP or no intervention, outcomes;impairment, activity limitation and participation restriction.

Studies were screened based on title/abstract and irrelevant studies eliminated. Two reviewers extracted the data and assessed the methodological quality of the studies using the Cochrane risk of bias tool. Finally, both a meta-analysis and a narrative synthesis were performed to evaluate the level of scientific evidence for the effectiveness of MPRP’s. 

Results:

After screening 11,280 abstracts, nine RCT’s (1216 patients) met the inclusion criteria. The mean age of participants was 47.1 years, the mean duration FMS was 10.29 years and the population was 90.4% female. All MPRP’s consisted of both a physical and a psychological intervention. Comparison groups included waiting list control with exercise, pharmacological treatment, less intensive MPRP’s, and no intervention. The methodological quality of the studies was variable. A meta-analysis revealed that MPRP’s are effective in the long term at reducing to pain levels ([FEM, SMD=-0.27 (95% CI -0.45, -0.10), p<0.01 I²=45%]) and disease impact [FEM, MD=-6.24 (95% CI -9.32, -5.95), p<0.01 I²=47%]. The narrative synthesis revealed moderate to low quality evidence in support of MPRP’s FMS. 

Conclusion:

These findings suggest that MPRP have a positive impact on long-term pain levels and disease impact in people with FMS. There is also some indication that the tailoring of treatments to specific subgroups of patients may be the most effective method of delivery. Future research should be directed towards analyzing such sub-groups analysis.

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ACR Meeting Abstracts - https://acrabstracts.org/abstract/effectiveness-of-multidisciplinary-pain-rehabilitation-programs-for-patients-with-fibromyalgia-syndrome-a-systematic-review/