Most fibromyalgia treatments not supported by high-quality evidence: JAMA

The study is published in the JAMA Internal Medicine Network

In this systematic review, the effectiveness of most therapies for fibromyalgia was not supported. However, 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.

Fibromyalgia is a chronic condition that results in a significant burden on individuals and society. It is a debilitating and often unrecognized syndrome. It affects 2% of the population with a peak incidence in middle-aged women. Despite an incomplete understanding of its pathogenesis, there is increasing evidence for mechanism-based management approaches to this syndrome. These are likely to be more effective if introduced early, making a timely diagnosis in general practice even more important.

Therefore, Rodrigo Oliveira Mascarenhas, and associates from the Department of Physiotherapy, Universidade Federal dos Vales do Jequitinhonha e Mucuri, Diamantina, Brazil conducted this study to investigate the effectiveness of therapies for reducing pain and improving quality of life (QOL) in people with fibromyalgia on a total of 29 962 participants from 224 trials.

All published randomized or quasi-randomized clinical trials that investigated therapies for individuals with fibromyalgia were screened for inclusion. The data were extracted by two independent reviewers and the risk assessed. The intensity of pain was measured by the visual analog scale, numerical rating scales, and other valid instruments, and QOL measured by the Fibromyalgia Impact Questionnaire.

The following findings were highlighted-

1. High-quality evidence was found in favor of cognitive-behavioral therapy for pain in the short term and was found in favor of central nervous system depressants and antidepressants for pain in the medium term.
2. There was also high-quality evidence in favor of antidepressants for QOL in the short term and in favor of central nervous system depressants and antidepressants in the medium term.
3. However, these associations were small and did not exceed the minimum clinically important change.

Evidence for long-term outcomes of interventions was lacking.

Based on the findings, the authors concluded that "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."