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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.


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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CME Disclosure Statement: Unless noted, all individuals in control of content reported no relevant financial relationships. If applicable, all relevant financial relationships have been mitigated.

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 (

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.

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