NCCIH Clinical Digest

for health professionals

Mind and Body Practices for Fibromyalgia: What the Science Says

September 2021

Clinical Guidelines, Scientific Literature, Info for Patients: 
Mind and Body Practices for Fibromyalgia

woman pain massage shoulder fibromyalgia

Recent systematic reviews and randomized clinical trials provide encouraging evidence that practices such as tai chi, acupuncture, mindfulness, and biofeedback may help relieve some fibromyalgia symptoms. There is insufficient evidence that any natural products can relieve fibromyalgia pain, with the possible exception of vitamin D supplementation, which may reduce pain in people with fibromyalgia who have vitamin D deficiencies.

Current diagnostic criteria are available from the American College of Rheumatology. Treatment often involves an individualized approach that may include both pharmacologic therapies (prescription drugs, analgesics, and NSAIDs) and nonpharmacologic interventions such as exercise, muscle strength training, cognitive behavioral therapy, movement/body awareness practices, massage, acupuncture, and balneotherapy.

Mindfulness Meditation

Mindfulness mediation may provide short-term improvements in pain and quality of life in patients with fibromyalgia; however, the evidence is limited by a small number of studies with low methodological quality.

What Does the Research Show?

  • 2015 Cochrane review of 61 trials involving 4,234 participants examined mind and body therapies for fibromyalgia. The review found no advantage observed for mindfulness compared to usual care (control) for physical functioning, pain, mood, or participant withdrawals post-intervention. However, the quality of the evidence was very low for pain and moderate for mood and number of withdrawals.
  • A 2019 randomized controlled trial involving 70 female participants found that mindfulness training was efficacious in reducing clinical severity of patients with fibromyalgia. The results of the trial also suggest that mindfulness-based stress reduction (MBSR) has significant immune regulatory effects in patients with fibromyalgia, while immune-inflammatory pathways may in part predict the clinical efficacy of MBSR.

Safety

  • Mindfulness and other forms of meditation are generally considered to be safe for healthy people. However, they may need to be modified to make them safe and comfortable for people with some health conditions.

Biofeedback

There is some low-quality evidence that biofeedback, compared to usual care, has an effect on physical functioning, pain, and mood in patients with fibromyalgia; however, due to the lack of quality evidence, it is unknown if biofeedback has any therapeutic effect on these outcomes.

What Does the Research Show?

  • A 2015 Cochrane review found very low-quality evidence that biofeedback in comparison to usual care controls had an effect on physical functioning, pain, and mood post-treatment. However, because of the lack of quality evidence the reviewers noted that they cannot be certain that biofeedback has little or no effect on these outcomes.

Safety

  • In studies of electromyograhic biofeedback for fibromyalgia, some participants reported that the procedure was stressful. No other side effects were reported.

Guided Imagery

Studies on the effects of guided imagery for fibromyalgia symptoms have had inconsistent results.

What Does the Research Show?

  • 2014 randomized controlled trial of 65 participants with fibromyalgia syndrome found no therapeutic effects of guided imagery on fibromyalgia symptoms.
  • 2014 randomized trial involving 72 women with fibromyalgia found that after 10 weeks of daily guided imagery use, participants reported statistically significant increases in self-efficacy and statistically significant decreases in stress, fatigue, pain, and depression, compared to usual care controls. No statistically significant changes were seen in participants’ biomarker levels between groups. Although there were no statistically significant changes over time in C-reactive protein levels, this systemic inflammation biomarker was elevated at all measurement time points before and during treatment, which supports the hypothesis that there may be an inflammatory component to fibromyalgia.
  • A 2018 randomized controlled trial involving 56 women aged 35 to 65 years found some preliminary evidence for the benefit of Group Music and Imagery intervention to improve well-being and reduce anxiety in women with fibromyalgia. Findings from the trial also suggest that Group Music and Imagery intervention may help diminish pain intensity, state depression, and the impact of fibromyalgia on functional capacity and health, but further studies are needed to establish efficacy.

Safety

  • Guided imagery is generally considered safe for healthy people. Occasionally, however, people report unpleasant experiences such as increased anxiety.

Tai Chi

Findings from some randomized controlled trials suggest that meditative movement therapies, such as tai chi, may provide modest relief of some fibromyalgia symptoms.

What Does the Research Show?

  • A 2018 prospective, randomized, 52-week, single-blind comparative effectiveness trial involving 226 participants found that tai chi resulted in similar or greater improvement in fibromyalgia symptoms than aerobic exercise. Longer duration of tai chi showed greater improvement.
  • A 2019 review concluded that tai chi is a cost-effective and efficacious method of symptom reduction and is a promising therapy that may result in being added to the first-line recommendations for patients with fibromyalgia pending further research.
  • A 2020 update to a systematic review by the Agency for Healthcare Research and Quality concluded that compared with exercise, tai chi conferred improvement in function in the short and intermediate term; however, the strength of evidence was considered low.
  • 2013 systematic review and meta-analysis of 7 studies involving 362 participants found evidence that meditative movement therapies such as tai chi, qi gong, and yoga resulted in modest improvements in sleep disturbances, fatigue, depressed mood, and health-related quality of life at the conclusion of the study treatment period. The investigators also found evidence of continued improvement in sleep disturbances and health-related quality of life 3 to 6 months later. The investigators concluded that high-quality studies with larger sample sizes are needed to confirm these results.

Safety

  • Tai chi and qi gong are generally regarded as safe practices. However, people who are pregnant, or who have a hernia, joint problems, back pain, fractures, or severe osteoporosis should use caution and consult their health care provider.
  • Yoga is generally considered to be safe in healthy people when practiced appropriately. However, people with certain conditions such as high blood pressure, glaucoma, or sciatica, and women who are pregnant should modify or avoid some yoga poses.

Massage

There is limited evidence that massage can provide modest improvement in some fibromyalgia symptoms.

What Does the Research Show?

  • A 2020 review found that massage or myofascial release yields a small improvement in fibromyalgia symptoms.
  • A 2020 update to a systematic review by the Agency for Healthcare Research and Quality found that at intermediate term, there was functional improvement with myofascial release; however, the strength of evidence was considered low.
  • 2014 systematic review and meta-analysis of 9 randomized controlled trials involving 404 participants with fibromyalgia syndrome found that massage therapy with a duration of 5 weeks or longer had beneficial immediate effects on improving pain, anxiety, and depression.

Safety

  • Massage therapy appears to have few risks when performed by a trained practitioner. However, massage therapists should take precautions with certain health conditions.

Acupuncture

Limited evidence suggests that when compared to a control, acupuncture may help improve symptoms of fibromyalgia such as pain and stiffness.

What Does the Research Show?

  • A 2020 update to a systematic review by the Agency for Healthcare Research and Quality found that acupuncture was associated with a small improvement in function compared with sham acupuncture as evaluated by the Fibromyalgia Impact Questionnaire (FIQ) Total Score at short-term and intermediate-term follow-up. (The strength of evidence was considered moderate.) The updated review also found no effect of acupuncture versus sham acupuncture on pain in the short term or intermediate term. (The strength of evidence was considered low.)
  • 2013 Cochrane review of 9 studies involving a total of 395 participants found low-to-moderate evidence that acupuncture improves pain and stiffness in people with fibromyalgia, compared with no treatment and standard therapy. The reviewers also found moderate-level evidence that the effect of acupuncture does not differ from sham acupuncture in reducing pain or fatigue, or improving sleep or global well-being.

Safety

  • Acupuncture is generally considered safe when performed by an experienced practitioner using sterile needles. Relatively few complications from acupuncture have been reported.
  • Serious adverse events related to acupuncture are rare but include infections and punctured organs.
  • There are fewer adverse effects associated with acupuncture than with many standard drug treatments (such as anti-inflammatory medication and steroid injections) used to manage painful musculoskeletal conditions like fibromyalgia, myofascial pain, and osteoarthritis.

Balneotherapy (Hydrotherapy)

There is some limited evidence that suggests that balneotherapy (hydrotherapy) may provide small improvement in pain and health-related quality of life for patients with fibromyalgia.

What Does the Research Show?

  • A 2021 systematic review and meta-analysis of 11 randomized controlled trials involving 672 participants concluded that there is very low-to-moderate evidence that balneotherapy can benefit fibromyalgia symptoms in pain and quality-of-life improvement, whereas tenderness and depression improvement varies at time phases. The reviewers also noted that established balneotherapy regimens with a large sample size and longer observation are needed.
  • A 2018 prospective, randomized, controlled, double-blind trial of 100 participants with a 6-month follow-up found that there was a significant improvement of Visual Analogue Scale (VAS) and FIQ-Total at the end of the treatment that persisted until 6 months, while no significant differences were found in the control group.

Safety

  • Balneotherapy is generally considered safe. A few mild side effects (i.e., slight flushing) have been reported.

References

NCCIH Clinical Digest is a service of the National Center for Complementary and Integrative Health, NIH, DHHS. NCCIH Clinical Digest, a monthly e-newsletter, offers evidence-based information on complementary health approaches, including scientific literature searches, summaries of NCCIH-funded research, fact sheets for patients, and more.

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