New analysis finds scant evidence for fibromyalgia treatments

Most therapies and treatment for fibromyalgia seem to lack effectiveness, according to a recent systematic review with meta-analysis published in JAMA Internal Medicine.

The study investigated different therapies for pain reduction and quality of life improvement for people with fibromyalgia. The National Institutes of Health defines fibromyalgia as a chronic disorder that causes muscle pain and fatigue with the cause still unknown. Individuals with the condition report generalized body pain, fatigue, sleep disturbance, impaired cognition, and anxiety.

Researchers of the study looked at 224 original trials where roughly 30,000 participants were included. The trials examined 65 different therapies, including single nonpharmacologic treatments, combinations of two or more nonpharmacologic treatments, pharmacologic treatments, a combination of two or more pharmacologic treatments, or a combination of pharmacologic and nonpharmacologic therapy.

Strong evidence seemed to support only cognitive behavioral therapy for pain, as well as antidepressants and central nervous system depressants for pain and quality of life. However, the associations were small, researchers note. Evidence was lacking for most other therapies. Specifically, researchers found high-quality evidence supporting the use of cognitive behavioral therapy for pain in the short-term; central nervous system depressants and antidepressants for pain in the medium-term; antidepressants for quality of life in the short-term; and antidepressants and central nervous system depressants for quality of life in the medium-term. They also found high-quality evidence that antiemetics were no better than placebo for pain in the short-term.

“We did not find any high- or moderate-quality evidence supporting any therapy for pain or QOL [quality of life] in people with fibromyalgia in the long-term,” the authors write. They advised clinicians and patients to choose therapies by considering other important outcomes in addition to those presented in this review, such as adverse effects, out-of-pocket costs, and patient preference.