1. Qualitative systemic review of randomized controlled trials on complementary and alternative medicine treatments in fibromyalgia.

Baranowsky J, Klose P, Musial F, Häuser W, Dobos G, Langhorst J.




Department of Internal Medicine, Complementary and Integrative Medicine, Kliniken Essen-Mitte, University Duisburg-Essen, Essen, Germany.

Erratum in

  • Rheumatol Int. 2009 Nov;30(1):23. Haeuser, Winfried [corrected to Häuser, Winfried]..


The objectives of the study were identification, quality evaluation and summary of RCTs on complementary and alternative medicine as defined by the National Institute of Health with the exception of dietary and nutritional supplements. A computerized search of databases from 1990 (year of publication of the ACR criteria for fibromyalgia) to July 2007 was performed. The RCTs were assessed by a methodological quality score. A total of 23 RCTs issued from 1992 to 2007 on acupuncture, balneotherapy, thermotherapy, magnetic therapy, homeopathy, manual manipulation, mind-body medicine, diet therapy and music therapy were identified. The RCTs had an average group size of 25 with the number of groups ranging from two to four. The quality score assessment of the RCTs yielded a mean score of 51 out of 100. The average methodological quality of the identified studies was fairly low. Best evidence was found for balneotherapy/hydrotherapy in multiple studies. Positive results were also noted for homeopathy and mild infrared hyperthermia in 1 RCT in each field. Mindfulness meditation showed mostly positive results in two trials and acupuncture mixed results in multiple trials with a tendency toward positive results. Tendencies for improvement were furthermore noted in single trials of the Mesendieck system, connective tissue massage and to some degree for osteopathy and magnet therapy. No positive evidence could be identified for Qi Gong, biofeedback, and body awareness therapy.

PMID: 19672601

[PubMed - indexed for MEDLINE]


2. Effects of reflexology on fibromyalgia symptoms: a multiple case study.

Gunnarsdottir TJ, Peden-McAlpine C.




Faculty of Nursing, University of Iceland, Reykjavik, Iceland. stalolaz@logosnet.cy.net



To explore the effects of reflexology on pain and other symptoms in women with fibromyalgia syndrome [FM].


Multiple case study method as developed by Stake was used to investigate the effects of reflexology on six cases of women with FM which were given ten sessions of weekly reflexology. Data were collected with observation, interviews and diary and then analyzed within cases and across cases.


Reflexology affected the symptom of pain in multiple areas such as head, neck and arms. Pain started to isolate and decrease.


Reflexology may be helpful to decrease fibromyalgia symptoms. Qualitative research methods and individually tailored interventions are important when researching complementary and alternative therapies.

Copyright 2010 Elsevier Ltd. All rights reserved.

PMID: 20621279

[PubMed - indexed for MEDLINE]


3. Fibromyalgic syndrome: new perspectives in rehabilitation and management. A review.

[Article in Italian]

Melillo N, Corrado A, Quarta L, D'Onofrio F, Trotta A, Cantatore FP.




Clinica Reumatologica Mario Carrozzo, Università degli Studi di Foggia, Foggia.


Fibromyalgia is a chronic syndrome, characterized by widespread body pain and pain at specific tender points, whose etiology and pathogenesis is still unknown. Patient can also exhibit a range of other symptoms including irritable bowel syndrome, chest pain, anxiety, fatigue, sleep disturbance, headache. The prevalence of fibromyalgia ranges from 1-3% in the general population, and the condition is more common among female than males. Contrary to the situation a few years ago, the most widely accepted hypothesis now evoke central nervous system mechanisms, whose local functions could influence also periferical microvascular activity at tender points. There are many findings supporting the hypothesis of different endogenic and exogenic factors that lead to chronic local hypoxia in muscle tissue. Currently, therapy is polipragmatic and is aimed at reducing the pain. A range of medical treatment had been used to treat fibromyalgia. Pharmacological therapy aims to enhance the pain threshold and to support sleep. Nonpharmaceutical treatment modalities, such as exercise, massage, idrotherapy can be helpful. Future studies should investigate the possible benefits of new strategies that may combine the effects of hot pool water, stretching exercises, massage and relaxation benefits of balneotherapy.

PMID: 16518304

[PubMed - indexed for MEDLINE]


4. Complementary and alternative medical therapies in fibromyalgia.

Sarac AJ, Gur A.




Department of Physical Medicine and Rehabilitation, Medical Faculty, Dicle University, 21280 Diyarbakir, Turkey. alig@dicle.edu.tr


This article describes the studies that have been performed evaluating complementary or alternative medical (CAM) therapies for efficacy and some adverse events fibromyalgia (FM). There is no permanent cure for FM; therefore, adequate symptom control should be goal of treatment. Clinicians can choose from a variety of pharmacologic and nonpharmacologic modalities. Unfortunately, controlled studies of most current treatments have failed to demonstrate sustained, clinically significant responses. CAM has gained increasing popularity, particularly among individuals with FM for which traditional medicine has generally been ineffective. Some herbal and nutritional supplements (magnesium, S- adenosylmethionine) and massage therapy have the best evidence for effectiveness with FM. Other CAM therapies such as chlorella, biofeedback, relaxation have either been evaluated in only one randomised controlled trials (RCT) with positive results, in multiple RCTs with mixed results (magnet therapies) or have positive results from studies with methodological flaws (homeopathy, botanical oils, balneotherapy, anthocyanidins and dietary modifications). Another CAM therapy such as chiropractic care has neither well-designed studies nor positive results and is not currently recommended for FM treatment. Once CAM therapies have been better evaluated for safety and long-term efficacy in randomised, placebo-controlled trials, they may prove to be beneficial in treatments for FM. It would then be important to assess studies assessing cost-benefit analyses comparing conventional therapies and CAM.

PMID: 16454724

[PubMed - indexed for MEDLINE]


5. Integrative therapy for fibromyalgia: possible strategies for an individualized treatment program.

Morris CR, Bowen L, Morris AJ.




Arthritis Associates, Kingsport, TN, USA. arthritis@charter.net


One of the most complex patient treatment situations encountered by the clinician is the patient who presents with the cluster of signs and symptoms that lead to the diagnosis of fibromyalgia syndrome. While physicians focus primarily on pharmacologic treatment, a number of nonpharmacologic modalities have been shown to benefit patients as well. No one therapy is uniformly effective in every patient; treatment programs consisting of a combination of pharmacologic and nonpharmacologic therapies must be individualized to the patient, and the clinician may have to try several different modalities before reaching an optimal improvement in the patient's symptoms.

PMID: 15759948

[PubMed - indexed for MEDLINE]


6. Use of complementary and alternative medical therapies by patients referred to a fibromyalgia treatment program at a tertiary care center.

Wahner-Roedler DL, Elkin PL, Vincent A, Thompson JM, Oh TH, Loehrer LL, Mandrekar JN, Bauer BA.




Department of Internal Medicine and Division of General Internal Medicine, Mayo Clinic College of Medicine, Rochester, Minn 55905, USA. wahnerroedler.dietlind@mayo.edu



To evaluate the frequency and pattern of complementary and alternative medicine (CAM) use in patients referred to a fibromyalgia treatment program at a tertiary care center.


Patients referred to the Mayo Fibromyalgia Treatment Program between February 2003 and July 2003 were invited on their initial visit to participate in a survey regarding CAM use during the previous 6 months. An 85-question survey that addressed different CAM domains was used.


Of the 304 patients invited to participate, 289 (95%) completed the survey (263 women and 26 men). Ninety-eight percent of the patients had used some type of CAM therapy during the previous 6 months. The 10 most frequently used CAM treatments were exercise for a specific medical problem (48%), spiritual healing (prayers) (45%), massage therapy (44%), chiropractic treatments (37%), vitamin C (35%), vitamin E (31%), magnesium (29%), vitamin B complex (25%), green tea (24%), and weight-loss programs (20%).


CAM use is common in patients referred to a fibromyalgia treatment program.

Comment in

PMID: 15667030

[PubMed - indexed for MEDLINE]

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