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Association of Therapies With Reduced Pain and Improved Quality of Life in Patients With FibromyalgiaA Systematic Review and Meta-analysis

Educational Objective
To investigate the effectiveness of therapies for reducing pain and improving quality of life in people with fibromyalgia.
1 Credit CME
Key Points

Question  What is the association of therapies with reduced pain and improved quality of life in patients with fibromyalgia?

Findings  In this systematic review, the effectiveness of most therapies for fibromyalgia was not supported. Strong evidence supported only cognitive behavioral therapy for pain, as well as antidepressants and central nervous system depressants for pain and quality of life, but these associations were small.

Meaning  Some therapies may be associated with small reductions in pain and improvements in quality of life in people with fibromyalgia; however, current evidence is lacking for most therapies.

Abstract

Importance  Fibromyalgia is a chronic condition that results in a significant burden to individuals and society.

Objective  To investigate the effectiveness of therapies for reducing pain and improving quality of life (QOL) in people with fibromyalgia.

Data Sources  Searches were performed in the MEDLINE, Cochrane, Embase, AMED, PsycInfo, and PEDro databases without language or date restrictions on December 11, 2018, and updated on July 15, 2020.

Study Selection  All published randomized or quasi-randomized clinical trials that investigated therapies for individuals with fibromyalgia were screened for inclusion.

Data Extraction and Synthesis  Two reviewers independently extracted data and assessed risk of bias using the 0 to 10 PEDro scale. Effect sizes for specific therapies were pooled using random-effects models. The quality of evidence was assessed using the Grading of Recommendations Assessment (GRADE) approach.

Main Outcomes and Measures  Pain intensity measured by the visual analog scale, numerical rating scales, and other valid instruments and QOL measured by the Fibromyalgia Impact Questionnaire.

Results  A total of 224 trials including 29 962 participants were included. High-quality evidence was found in favor of cognitive behavioral therapy (weighted mean difference [WMD], −0.9; 95% CI, −1.4 to −0.3) for pain in the short term and was found in favor of central nervous system depressants (WMD, −1.2 [95% CI, −1.6 to −0.8]) and antidepressants (WMD, −0.5 [95% CI, −0.7 to −0.4]) for pain in the medium term. There was also high-quality evidence in favor of antidepressants (WMD, −6.8 [95% CI, −8.5 to −5.2]) for QOL in the short term and in favor of central nervous system depressants (WMD, −8.7 [95% CI, −11.3 to −6.0]) and antidepressants (WMD, −3.5 [95% CI, −4.5 to −2.5]) in the medium term. However, these associations were small and did not exceed the minimum clinically important change (2 points on an 11-point scale for pain and 14 points on a 101-point scale for QOL). Evidence for long-term outcomes of interventions was lacking.

Conclusions and Relevance  This systematic review and meta-analysis suggests that most of the currently available therapies for the management of fibromyalgia are not supported by high-quality evidence. Some therapies may reduce pain and improve QOL in the short to medium term, although the effect size of the associations might not be clinically important to patients.

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Article Information

Accepted for Publication: August 22, 2020.

Corresponding Author: Vinícius Cunha Oliveira, PhD, Postgraduate Program in Rehabilitation and Functional Performance, Universidade Federal dos Vales do Jequitinhonha e Mucuri (UFVJM), Campus JK–Rodovia MGT 367, Km 583, No. 5000, Alto da Jacuba, Diamantina, MG 39100-000, Brazil (vcunhaoliveira@gmail.com).

Published Online: October 26, 2020. doi:10.1001/jamainternmed.2020.5651

Author Contributions: Mr Mascarenhas and Dr V. C. Oliveira had full access to all of the data in the study and take responsibility for the integrity of the data and the accuracy of the data analysis.

Concept and design: Mascarenhas, Henschke, V. C. Oliveira.

Acquisition, analysis, or interpretation of data: All authors.

Drafting of the manuscript: Mascarenhas, Souza, M. X. Oliveira, V. C. Oliveira.

Critical revision of the manuscript for important intellectual content: Mascarenhas, Lacerda, Mendonça, Henschke, V. C. Oliveira.

Statistical analysis: Mascarenhas, Souza, Henschke, V. Oliveira.

Administrative, technical, or material support: M. X. Oliveira, Mendonça.

Supervision: V. C. Oliveira.

Conflict of Interest Disclosures: None reported.

References
1.
Wolfe  F , Clauw  DJ , Fitzcharles  MA ,  et al.  The American College of Rheumatology preliminary diagnostic criteria for fibromyalgia and measurement of symptom severity.   Arthritis Care Res (Hoboken). 2010;62(5):600-610. doi:10.1002/acr.20140 PubMedGoogle ScholarCrossref
2.
Marques  AP , Santo  ASDE , Berssaneti  AA , Matsutani  LA , Yuan  SLK .  Prevalence of fibromyalgia: literature review update.   Rev Bras Reumatol Engl Ed. 2017;57(4):356-363. doi:10.1016/j.rbr.2016.10.004 PubMedGoogle ScholarCrossref
3.
Rivera  J , Rejas  J , Esteve-Vives  J , Vallejo  MA ; Groupo ICAF.  Resource utilisation and health care costs in patients diagnosed with fibromyalgia in Spain.   Clin Exp Rheumatol. 2009;27(5)(suppl 56):S39-S45.PubMedGoogle Scholar
4.
Sicras-Mainar  A , Rejas  J , Navarro  R ,  et al.  Treating patients with fibromyalgia in primary care settings under routine medical practice: a claim database cost and burden of illness study.   Arthritis Res Ther. 2009;11(2):R54. doi:10.1186/ar2673 PubMedGoogle ScholarCrossref
5.
Lacasse  A , Bourgault  P , Choinière  M .  Fibromyalgia-related costs and loss of productivity: a substantial societal burden.   BMC Musculoskelet Disord. 2016;17:168. doi:10.1186/s12891-016-1027-6 PubMedGoogle ScholarCrossref
6.
Wolfe  F , Smythe  HA , Yunus  MB ,  et al.  The American College of Rheumatology 1990 criteria for the classification of fibromyalgia: report of the Multicenter Criteria Committee.   Arthritis Rheum. 1990;33(2):160-172. doi:10.1002/art.1780330203 PubMedGoogle ScholarCrossref
7.
Wolfe  F , Clauw  DJ , Fitzcharles  MA ,  et al.  2016 Revisions to the 2010/2011 fibromyalgia diagnostic criteria.   Semin Arthritis Rheum. 2016;46(3):319-329. doi:10.1016/j.semarthrit.2016.08.012 PubMedGoogle ScholarCrossref
8.
Wolfe  F , Clauw  DJ , Fitzcharles  MA ,  et al.  Fibromyalgia criteria and severity scales for clinical and epidemiological studies: a modification of the ACR Preliminary Diagnostic Criteria for Fibromyalgia.   J Rheumatol. 2011;38(6):1113-1122. doi:10.3899/jrheum.100594 PubMedGoogle ScholarCrossref
9.
Jones  GT , Atzeni  F , Beasley  M , Flüß  E , Sarzi-Puttini  P , Macfarlane  GJ .  The prevalence of fibromyalgia in the general population: a comparison of the American College of Rheumatology 1990, 2010, and modified 2010 classification criteria.   Arthritis Rheumatol. 2015;67(2):568-575. doi:10.1002/art.38905 PubMedGoogle ScholarCrossref
10.
Kim  SY , Busch  AJ , Overend  TJ ,  et al.  Flexibility exercise training for adults with fibromyalgia.   Cochrane Database Syst Rev. 2019;9:CD013419. doi:10.1002/14651858.CD013419 PubMedGoogle Scholar
11.
Johnson  MI , Claydon  LS , Herbison  GP , Jones  G , Paley  CA .  Transcutaneous electrical nerve stimulation (TENS) for fibromyalgia in adults.   Cochrane Database Syst Rev. 2017;10:CD012172. doi:10.1002/14651858.CD012172.pub2 PubMedGoogle Scholar
12.
Welsch  P , Üçeyler  N , Klose  P , Walitt  B , Häuser  W .  Serotonin and noradrenaline reuptake inhibitors (SNRIs) for fibromyalgia.   Cochrane Database Syst Rev. 2018;2:CD010292. doi:10.1002/14651858.CD010292.pub2PubMedGoogle Scholar
13.
Bernardy  K , Klose  P , Welsch  P , Häuser  W .  Efficacy, acceptability and safety of cognitive behavioural therapies in fibromyalgia syndrome—a systematic review and meta-analysis of randomized controlled trials.   Eur J Pain. 2018;22(2):242-260. doi:10.1002/ejp.1121 PubMedGoogle ScholarCrossref
14.
Zhang  XC , Chen  H , Xu  WT , Song  YY , Gu  YH , Ni  GX .  Acupuncture therapy for fibromyalgia: a systematic review and meta-analysis of randomized controlled trials.   J Pain Res. 2019;12:527-542. doi:10.2147/JPR.S186227 PubMedGoogle ScholarCrossref
15.
Li  YH , Wang  FY , Feng  CQ , Yang  XF , Sun  YH .  Massage therapy for fibromyalgia: a systematic review and meta-analysis of randomized controlled trials.   PLoS One. 2014;9(2):e89304. doi:10.1371/journal.pone.0089304 PubMedGoogle Scholar
16.
Yuan  SL , Matsutani  LA , Marques  AP .  Effectiveness of different styles of massage therapy in fibromyalgia: a systematic review and meta-analysis.   Man Ther. 2015;20(2):257-264. doi:10.1016/j.math.2014.09.003 PubMedGoogle ScholarCrossref
17.
Yeh  SW , Hong  CH , Shih  MC , Tam  KW , Huang  YH , Kuan  YC .  Low-level laser therapy for fibromyalgia: a systematic review and meta-analysis.   Pain Physician. 2019;22(3):241-254.PubMedGoogle Scholar
18.
Häuser  W , Wolfe  F , Tölle  T , Uçeyler  N , Sommer  C .  The role of antidepressants in the management of fibromyalgia syndrome: a systematic review and meta-analysis.   CNS Drugs. 2012;26(4):297-307. doi:10.2165/11598970-000000000-00000 PubMedGoogle ScholarCrossref
19.
Lami  MJ , Martinez  M , Miro  E ,  et al.  Efficacy of combined cognitive-behavioral therapy for insomnia and pain in patients with fibromyalgia: a randomized controlled trial.   Cognitive Ther Res. 2018;42(1):63-79. doi:10.1007/s10608-017-9875-4 Google ScholarCrossref
20.
Arnold  LM , Whitaker  S , Hsu  C , Jacobs  D , Merante  D .  Efficacy and safety of mirogabalin for the treatment of fibromyalgia: results from three 13-week randomized, double-blind, placebo- and active-controlled, parallel-group studies and a 52-week open-label extension study.   Curr Med Res Opin. 2019;35(10):1825-1835. doi:10.1080/03007995.2019.1629757 PubMedGoogle ScholarCrossref
21.
Higgins  JPT , Thomas  J , Chandler  J ,  et al, eds.  Cochrane Handbook for Systematic Reviews of Interventions. 2nd ed. John Wiley & Sons; 2019. doi:10.1002/9781119536604
22.
Balshem  H , Helfand  M , Schünemann  HJ ,  et al.  GRADE guidelines, 3: Rating the quality of evidence.   J Clin Epidemiol. 2011;64(4):401-406. doi:10.1016/j.jclinepi.2010.07.015 PubMedGoogle ScholarCrossref
23.
Guyatt  GH , Oxman  AD , Vist  GE ,  et al; GRADE Working Group.  GRADE: an emerging consensus on rating quality of evidence and strength of recommendations.   BMJ. 2008;336(7650):924-926. doi:10.1136/bmj.39489.470347.AD PubMedGoogle ScholarCrossref
24.
Liberati  A , Altman  DG , Tetzlaff  J ,  et al.  The PRISMA statement for reporting systematic reviews and meta-analyses of studies that evaluate healthcare interventions: explanation and elaboration.   BMJ. 2009;339:b2700. doi:10.1136/bmj.b2700 PubMedGoogle ScholarCrossref
25.
Burckhardt  CS , Clark  SR , Bennett  RM .  The Fibromyalgia Impact Questionnaire: development and validation.   J Rheumatol. 1991;18(5):728-733.PubMedGoogle Scholar
26.
Wan  X , Wang  W , Liu  J , Tong  T .  Estimating the sample mean and standard deviation from the sample size, median, range and/or interquartile range.   BMC Med Res Methodol. 2014;14:135. doi:10.1186/1471-2288-14-135 PubMedGoogle ScholarCrossref
27.
de Morton  NA .  The PEDro scale is a valid measure of the methodological quality of clinical trials: a demographic study.   Aust J Physiother. 2009;55(2):129-133. doi:10.1016/S0004-9514(09)70043-1 PubMedGoogle ScholarCrossref
28.
Yamato  TP , Maher  C , Koes  B , Moseley  A .  The PEDro scale had acceptably high convergent validity, construct validity, and interrater reliability in evaluating methodological quality of pharmaceutical trials.   J Clin Epidemiol. 2017;86:176-181. doi:10.1016/j.jclinepi.2017.03.002 PubMedGoogle ScholarCrossref
29.
Gross  A , Kay  TM , Paquin  JP ,  et al; Cervical Overview Group.  Exercises for mechanical neck disorders.   Cochrane Database Syst Rev. 2015;1:CD004250. doi:10.1002/14651858.CD004250.pub5PubMedGoogle Scholar
30.
Cooper  TE , Wiffen  PJ , Heathcote  LC ,  et al.  Antiepileptic drugs for chronic non-cancer pain in children and adolescents.   Cochrane Database Syst Rev. 2017;8:CD012536. doi:10.1002/14651858.CD012536.pub2 PubMedGoogle Scholar
31.
Urquhart  DM , Hoving  JL , Assendelft  WW , Roland  M , van Tulder  MW .  Antidepressants for non-specific low back pain.   Cochrane Database Syst Rev. 2008;(1):CD001703. doi:10.1002/14651858.CD001703.pub3PubMedGoogle Scholar
32.
Kamper  SJ .  Showing confidence (intervals).   Braz J Phys Ther. 2019;23(4):277-278. doi:10.1016/j.bjpt.2019.01.003 PubMedGoogle ScholarCrossref
33.
Mease  PJ , Spaeth  M , Clauw  DJ ,  et al.  Estimation of minimum clinically important difference for pain in fibromyalgia.   Arthritis Care Res (Hoboken). 2011;63(6):821-826. doi:10.1002/acr.20449 PubMedGoogle ScholarCrossref
34.
Bennett  RM , Bushmakin  AG , Cappelleri  JC , Zlateva  G , Sadosky  AB .  Minimal clinically important difference in the Fibromyalgia Impact Questionnaire.   J Rheumatol. 2009;36(6):1304-1311. doi:10.3899/jrheum.081090 PubMedGoogle ScholarCrossref
35.
Ioannidis  JP , Trikalinos  TA .  The appropriateness of asymmetry tests for publication bias in meta-analyses: a large survey.   CMAJ. 2007;176(8):1091-1096. doi:10.1503/cmaj.060410PubMedGoogle ScholarCrossref
36.
Mueller  PS , Montori  VM , Bassler  D , Koenig  BA , Guyatt  GH .  Ethical issues in stopping randomized trials early because of apparent benefit.   Ann Intern Med. 2007;146(12):878-881. doi:10.7326/0003-4819-146-12-200706190-00009 PubMedGoogle ScholarCrossref
37.
Foley  NC , Teasell  RW , Bhogal  SK , Speechley  MR .  Stroke rehabilitation evidence-based review: methodology.   Top Stroke Rehabil. 2003;10(1):1-7. doi:10.1310/Y6TG-1KQ9-LEDQ-64L8 PubMedGoogle ScholarCrossref
38.
Egger  M , Davey Smith  G , Schneider  M , Minder  C .  Bias in meta-analysis detected by a simple, graphical test.   BMJ. 1997;315(7109):629-634. doi:10.1136/bmj.315.7109.629 PubMedGoogle ScholarCrossref
39.
Munguía-Izquierdo  D , Legaz-Arrese  A .  Assessment of the effects of aquatic therapy on global symptomatology in patients with fibromyalgia syndrome: a randomized controlled trial.   Arch Phys Med Rehabil. 2008;89(12):2250-2257. doi:10.1016/j.apmr.2008.03.026 PubMedGoogle ScholarCrossref
40.
Munguía-Izquierdo  D , Legaz-Arrese  A .  Exercise in warm water decreases pain and improves cognitive function in middle-aged women with fibromyalgia.   Clin Exp Rheumatol. 2007;25(6):823-830.PubMedGoogle Scholar
41.
Taylor  AG , Anderson  JG , Riedel  SL , Lewis  JE , Bourguignon  C .  A randomized, controlled, double-blind pilot study of the effects of cranial electrical stimulation on activity in brain pain processing regions in individuals with fibromyalgia.   Explore (NY). 2013;9(1):32-40. doi:10.1016/j.explore.2012.10.006 PubMedGoogle ScholarCrossref
42.
Taylor  AG , Anderson  JG , Riedel  SL , Lewis  JE , Kinser  PA , Bourguignon  C .  Cranial electrical stimulation improves symptoms and functional status in individuals with fibromyalgia.   Pain Manag Nurs. 2013;14(4):327-335. doi:10.1016/j.pmn.2011.07.002 PubMedGoogle ScholarCrossref
43.
Gendreau  RM , Thorn  MD , Gendreau  JF ,  et al.  Efficacy of milnacipran in patients with fibromyalgia.   J Rheumatol. 2005;32(10):1975-1985.PubMedGoogle Scholar
44.
Vitton  O , Gendreau  M , Gendreau  J , Kranzler  J , Rao  SG .  A double-blind placebo-controlled trial of milnacipran in the treatment of fibromyalgia.   Hum Psychopharmacol. 2004;19(suppl 1):S27-S35. doi:10.1002/hup.622 PubMedGoogle ScholarCrossref
45.
Izquierdo-Alventosa  R , Inglés  M , Cortés-Amador  S ,  et al.  Low-intensity physical exercise improves pain catastrophizing and other psychological and physical aspects in women with fibromyalgia: a randomized controlled trial.   Int J Environ Res Public Health. 2020;17(10):3634. doi:10.3390/ijerph17103634 PubMedGoogle ScholarCrossref
46.
Izquierdo-Alventosa  R , Inglés  M , Cortés-Amador  S ,  et al.  Comparative study of the effectiveness of a low-pressure hyperbaric oxygen treatment and physical exercise in women with fibromyalgia: randomized clinical trial.   Ther Adv Musculoskelet Dis. 2020;12:X20930493. doi:10.1177/1759720X20930493 PubMedGoogle Scholar
47.
Russell  IJ , Perkins  AT , Michalek  JE ; Oxybate SXB-26 Fibromyalgia Syndrome Study Group.  Sodium oxybate relieves pain and improves function in fibromyalgia syndrome: a randomized, double-blind, placebo-controlled, multicenter clinical trial.   Arthritis Rheum. 2009;60(1):299-309. doi:10.1002/art.24142 PubMedGoogle ScholarCrossref
48.
Russell  IJ , Mease  PJ , Smith  TR ,  et al.  Efficacy and safety of duloxetine for treatment of fibromyalgia in patients with or without major depressive disorder: results from a 6-month, randomized, double-blind, placebo-controlled, fixed-dose trial.   Pain. 2008;136(3):432-444. doi:10.1016/j.pain.2008.02.024 PubMedGoogle ScholarCrossref
49.
Hunter  AM , Leuchter  AF , Cook  IA ,  et al.  Brain functional changes and duloxetine treatment response in fibromyalgia: a pilot study.   Pain Med. 2009;10(4):730-738. doi:10.1111/j.1526-4637.2009.00614.x PubMedGoogle ScholarCrossref
50.
Moldofsky  H , Inhaber  NH , Guinta  DR , Alvarez-Horine  SB .  Effects of sodium oxybate on sleep physiology and sleep/wake-related symptoms in patients with fibromyalgia syndrome: a double-blind, randomized, placebo-controlled study.   J Rheumatol. 2010;37(10):2156-2166. doi:10.3899/jrheum.091041 PubMedGoogle ScholarCrossref
51.
Roizenblatt  S , Fregni  F , Gimenez  R ,  et al.  Site-specific effects of transcranial direct current stimulation on sleep and pain in fibromyalgia: a randomized, sham-controlled study.   Pain Pract. 2007;7(4):297-306. doi:10.1111/j.1533-2500.2007.00152.x PubMedGoogle ScholarCrossref
52.
Fregni  F , Gimenes  R , Valle  AC ,  et al.  A randomized, sham-controlled, proof of principle study of transcranial direct current stimulation for the treatment of pain in fibromyalgia.   Arthritis Rheum. 2006;54(12):3988-3998. doi:10.1002/art.22195 PubMedGoogle ScholarCrossref
53.
Sephton  SE , Salmon  P , Weissbecker  I ,  et al.  Mindfulness meditation alleviates depressive symptoms in women with fibromyalgia: results of a randomized clinical trial.   Arthritis Rheum. 2007;57(1):77-85. doi:10.1002/art.22478 PubMedGoogle ScholarCrossref
54.
Sañudo  B , Galiano  D , Carrasco  L , Blagojevic  M , de Hoyo  M , Saxton  J .  Aerobic exercise versus combined exercise therapy in women with fibromyalgia syndrome: a randomized controlled trial.   Arch Phys Med Rehabil. 2010;91(12):1838-1843. doi:10.1016/j.apmr.2010.09.006 PubMedGoogle ScholarCrossref
55.
Giordano  N , Geraci  S , Santacroce  C , Mattii  G , Battisti  E , Gennari  C .  Efficacy and tolerability of paroxetine in patients with fibromyalgia syndrome: a single-blind study.   Curr Ther Res Clin Exp. 1999;60(12):696-702. doi:10.1016/S0011-393X(99)90008-5 Google ScholarCrossref
56.
Jensen  KB , Petzke  F , Carville  S ,  et al.  Segregating the cerebral mechanisms of antidepressants and placebo in fibromyalgia.   J Pain. 2014;15(12):1328-1337. doi:10.1016/j.jpain.2014.09.011 PubMedGoogle ScholarCrossref
57.
Quijada-Carrera  J , Valenzuela-Castaño  A , Povedano-Gómez  J ,  et al.  Comparison of tenoxicam and bromazepan in the treatment of fibromyalgia: a randomized, double-blind, placebo-controlled trial.   Pain. 1996;65(2-3):221-225. doi:10.1016/0304-3959(95)00199-9 PubMedGoogle ScholarCrossref
58.
Crofford  LJ , Rowbotham  MC , Mease  PJ ,  et al; Pregabalin 1008-105 Study Group.  Pregabalin for the treatment of fibromyalgia syndrome: results of a randomized, double-blind, placebo-controlled trial.   Arthritis Rheum. 2005;52(4):1264-1273. doi:10.1002/art.20983 PubMedGoogle ScholarCrossref
59.
van de Donk  T , van Velzen  M , Dahan  A , Niesters  M .  Cornea nerve fibre state determines analgesic response to tapentadol in fibromyalgia patients without effective endogenous pain modulation.   Eur J Pain. 2019;23(9):1586-1595. doi:10.1002/ejp.1435 PubMedGoogle ScholarCrossref
60.
Friedberg  F , Adamowicz  JL , Caikauskaite  I .  Home-based pain and fatigue management in fibromyalgia: feasibility of a new intervention.   Fatigue. 2019;7(3):153-165. doi:10.1080/21641846.2019.1658988 Google Scholar
61.
Evcik  D , Kizilay  B , Gökçen  E .  The effects of balneotherapy on fibromyalgia patients.   Rheumatol Int. 2002;22(2):56-59. doi:10.1007/s00296-002-0189-8 PubMedGoogle ScholarCrossref
62.
Sañudo  B , Carrasco  L , de Hoyo  M , Figueroa  A , Saxton  JM .  Vagal modulation and symptomatology following a 6-month aerobic exercise program for women with fibromyalgia.   Clin Exp Rheumatol. 2015;33(1)(suppl 88):S41-S45.PubMedGoogle Scholar
63.
Späth  M , Stratz  T , Neeck  G ,  et al.  Efficacy and tolerability of intravenous tropisetron in the treatment of fibromyalgia.   Scand J Rheumatol. 2004;33(4):267-270. doi:10.1080/03009740410005818 PubMedGoogle ScholarCrossref
64.
Uğurlu  FG , Sezer  N , Aktekin  L , Fidan  F , Tok  F , Akkuş  S .  The effects of acupuncture versus sham acupuncture in the treatment of fibromyalgia: a randomized controlled clinical trial.   Acta Reumatol Port. 2017;42(1):32-37.PubMedGoogle Scholar
65.
Perrot  S , Russell  IJ .  More ubiquitous effects from non-pharmacologic than from pharmacologic treatments for fibromyalgia syndrome: a meta-analysis examining six core symptoms.   Eur J Pain. 2014;18(8):1067-1080. doi:10.1002/ejp.564 PubMedGoogle ScholarCrossref
66.
Fitzcharles  MA , Ste-Marie  PA , Goldenberg  DL ,  et al.  Canadian Pain Society and Canadian Rheumatology Association recommendations for rational care of persons with fibromyalgia: a summary report.   J Rheumatol. 2013;40(8):1388-1393. doi:10.3899/jrheum.130127 PubMedGoogle ScholarCrossref
67.
Häuser  W , Arnold  B , Eich  W ,  et al.  Management of fibromyalgia syndrome—an interdisciplinary evidence-based guideline.   Ger Med Sci. 2008;6:Doc14.PubMedGoogle Scholar
68.
Macfarlane  GJ , Kronisch  C , Dean  LE ,  et al.  EULAR revised recommendations for the management of fibromyalgia.   Ann Rheum Dis. 2017;76(2):318-328. doi:10.1136/annrheumdis-2016-209724 PubMedGoogle ScholarCrossref
69.
Burckhardt  C , Goldenberg  D , Crofford  L ,  et al.  Guideline for the Management of Fibromyalgia Syndrome Pain in Adults and Children. American Pain Society; 2005:109.
70.
Bidonde  J , Busch  AJ , Schachter  CL ,  et al.  Aerobic exercise training for adults with fibromyalgia.   Cochrane Database Syst Rev. 2017;6(6):CD012700. doi:10.1002/14651858.CD012700 PubMedGoogle Scholar
71.
Bidonde  J , Busch  AJ , Schachter  CL ,  et al.  Mixed exercise training for adults with fibromyalgia.   Cochrane Database Syst Rev. 2019;5(5):CD013340. doi:10.1002/14651858.CD013340 PubMedGoogle Scholar
72.
Busch  AJ , Webber  SC , Richards  RS ,  et al.  Resistance exercise training for fibromyalgia.   Cochrane Database Syst Rev. 2013;2013(12):CD010884. doi:10.1002/14651858.CD010884PubMedGoogle Scholar
73.
Bidonde  J , Busch  AJ , Webber  SC ,  et al.  Aquatic exercise training for fibromyalgia.   Cochrane Database Syst Rev. 2014;(10):CD011336. doi:10.1002/14651858.CD011336PubMedGoogle Scholar
74.
Heymann  RE , Paiva  ES , Martinez  JE ,  et al.  New guidelines for the diagnosis of fibromyalgia.   Rev Bras Reumatol Engl Ed. 2017;57(S2)(suppl 2):467-476. doi:10.1016/j.rbr.2017.05.006 PubMedGoogle ScholarCrossref
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  • Access free activities and track your credits
  • Personalize content alerts
  • Customize your interests
  • Fully personalize your learning experience
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With a personal account, you can:
  • Track your credits
  • Personalize content alerts
  • Customize your interests
  • Fully personalize your learning experience
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With a personal account, you can:
  • Access free activities and track your credits
  • Personalize content alerts
  • Customize your interests
  • Fully personalize your learning experience
Education Center Collection Sign In Modal Right
Close