Background/Purpose: Approximately one-quarter of the UK population uses complementary or alternative treatments (CAM) each year, and this is higher among persons with pain, or musculoskeletal conditions such as arthritis.  A recent review has summarised the evidence relating to the use of CAM medicines (anything taken orally or applied topically) in the treatment of fibromyalgia.  The aim of the current study was to review the evidence relating to CAM therapies (treatments delivered by a practitioner).

Methods: Randomised controlled trials (RCTs), published in English up to May 2011, were identified using systematic searches of bibliographic databases and searching of reference lists.  Data were extracted by a single reviewer, and checked by a second, and the Jadad (J) score was used to assess methodological quality of the RCTs (0=poor; 5=high quality).  All outcomes were considered but with a focus on patient global assessment and pain reporting.

Results:

From 525 articles, 25 RCTs were identified, examining 14 therapies.  The effectiveness of biofeedback has been tested in five RCTs (median J = 3), ranging from 30 to 143 patients.  One RCT that compared biofeedback against anti-depression medication reported positive findings in terms of pain and fatigue.  However, four RCTs comparing biofeedback with sham biofeedback, usual care or fitness training found no significant difference in the same outcomes.  Three RCTs examined progressive muscle relaxation (median J = 3) ranging from 24 to 45 patients.  In two RCTs, no significant benefit was observed, compared to hydro-galvanic bath therapy or hypnotherapy, and one RCT demonstrated progressive muscle relaxation to be inferior to massage therapy in terms of pain, stiffness, fatigue and a number of other outcomes.

Aromatherapy, chiropractic, healing therapy, hypnotherapy, imagery and qigong were each examined in two RCTs (median J = 4.5; 2.5; 3.5; 1.5; 2.0 and 3.5 respectively).  With the exception of hypnotherapy, there was generally no improvement in outcome in the intervention group, compared to various control treatments.  In hypnotherapy, in one RCT patients receiving hypnotherapy reported significantly greater improvements in pain, fatigue, sleep and general health compared to those receiving in physical therapy; and in the second RCT, patients receiving hypnotherapy with analgesia suggestions reported improvements in pain intensity compared to those receiving hypnotherapy with relaxation suggestions, or relaxation alone.

Finally, one RCT each examined the effectiveness of autogenic training (J=3), craniosacral therapy (J=5), music therapy (J=3), static magnet therapy (J=4), meditation (J=5) and Tai-chi (J=4).  Only in Tai chi was there evidence of positive effect of treatment: patients in this group reported significantly greater improvements in health, disease impact, mental health and sleep compared to a control group who received wellness education and stretching exercises.

Conclusion: The major limitation in reviewing the evidence for practitioner-based CAM therapies in the treatment of FM is the paucity of RCTs.  The available studies provide no consistent evidence that these treatments are effective, but the lack of RCTs means that it is hard to reach firm conclusions.

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ACR Meeting Abstracts - https://acrabstracts.org/abstract/a-systematic-review-of-evidence-for-the-effectiveness-of-practitioner-based-complementary-and-alternative-therapies-in-the-management-of-fibromyalgia/