Mind and Body Practices for Fibromyalgia: What the Science Says
Clinical Guidelines, Scientific Literature, Info for Patients:
Mind and Body Practices for Fibromyalgia
Recent systematic reviews and randomized clinical trials provide encouraging evidence that practices such as tai chi, qi gong, yoga, 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.
Tai Chi, Qi Gong, Yoga
Findings from some randomized controlled trials suggest that meditative movement therapies such as tai chi, qi gong, and yoga may provide modest relief of some fibromyalgia symptoms.
- A 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.
- A 2013 systematic review of two randomized controlled trials on fibromyalgia syndrome found very low evidence for yoga’s effects on pain and low evidence for yoga’s effects on disability.
- 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
Results of a recent systematic review and meta-analysis concluded that massage therapy with a duration of 5 weeks or longer had beneficial immediate effects on improving pain, anxiety, and depression.
- A 2014 systematic review and meta-analysis of nine 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.
- A 2015 systematic review and meta-analysis of 10 randomized and non-randomized controlled trials involving a total of 145 participants concluded that overall, most styles of massage therapy consistently improved the quality of life of patients with fibromyalgia syndrome.
- 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.
- A 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.
- A 2010 systematic review included data from seven randomized controlled trials evaluating acupuncture for fibromyalgia, involving a total of 385 participants. The investigators reported evidence of a small analgesic effect of acupuncture. However, the effect was not clearly distinguishable from bias, and they concluded that acupuncture cannot be recommended for the management of fibromyalgia symptoms.
- 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 qualitative evidence that suggests that balneotherapy (hydrotherapy) may provide small improvement in pain and health-related quality of life for patients with fibromyalgia syndrome.
- A 2014 qualitative systematic review and meta-analysis found moderate-to-strong evidence for a small reduction in pain (from eight randomized controlled trials involving 462 participants and three low-risk studies involving 223 participants) and moderate-to-strong evidence for a small improvement in health-related quality of life (from seven randomized controlled trials involving 398 participants, and three low-risk studies involving 223 participants). However, the study authors concluded that high-quality studies with larger sample sizes are needed to confirm the therapeutic benefits of balneotherapy or hydrotherapy for patients with fibromyalgia syndrome.
- Balneotherapy is generally considered safe. A few mild side effects (i.e., slight flushing) have been reported.
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.
- A 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 2015 randomized prospective controlled trial of mindfulness-based stress reduction (MBSR) in 91 women with fibromyalgia syndrome found that MBSR relieved some of the major symptoms of fibromyalgia and reduced subjective illness burden.
- 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.
- 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 of evidence the reviewers noted that they cannot be certain that biofeedback has a little or no effect on these outcomes.
- 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.
- A 2014 randomized controlled trial of 65 participants with fibromyalgia syndrome found no therapeutic effects of guided imagery on fibromyalgia symptoms.
- A 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, however, total group C-reactive protein was elevated at the start of the study.
- Guided imagery is generally considered safe for healthy people. Occasionally, however, people report unpleasant experiences such as increased anxiety.
- Baranowsky J, Klose P, Musial F, et al. Qualitative systemic review of randomized controlled trials on complementary and alternative medicine treatments in fibromyalgia. Rheumatology International. 2009;30(1):1–21.
- Cao H, Liu JP, Lewith GT, et al. Traditional Chinese medicine for treatment of fibromyalgia: a systematic review of randomized controlled trials. Journal of Alternative and Complementary Medicine. 2010;16(4):397–409.
- De Silva V, El-Metwally A, Ernst E, et al. Evidence for the efficacy of complementary and alternative medicines in the management of fibromyalgia: a systematic review. Rheumatology. 2010;49(6):1063–1068.
- Ekici G, Bakar Y, Akbayrak T, et al. Comparison of manual lymph drainage therapy and connective tissue massage in women with fibromyalgia: a randomized controlled trial. Journal of Manipulative and Physiological Therapeutics. 2009;32(2):127–133.
- Hassett AL, Gevirtz RN. Nonpharmacologic treatment for fibromyalgia: patient education, cognitive-behavioral therapy, relaxation techniques, and complementary and alternative medicine. Rheumatic Diseases Clinics of North America. 2009;35(2):393–407.
- Kozasa EH, Tanaka LH, Monson C, et al. The effects of meditation-based interventions on the treatment of fibromyalgia. Current Pain and Headache Reports. June 21, 2012. Epub ahead of print.
- Langhorst J, Klose P, Musial F, et al. Efficacy of acupuncture in fibromyalgia syndrome—a systematic review with a meta-analysis of controlled clinical trials. Rheumatology. 2010;49(4):778–788.
- Nahin RL, Boineau R, Khalsa PS, et al. Evidence-based evaluation of complementary health approaches for pain management in the United States. Mayo Clinic Proceedings. September 2016;91(9):1292-1306.
- National Institute of Arthritis and Musculoskeletal and Skin Diseases. Questions and Answers About Fibromyalgia. National Institute of Arthritis and Musculoskeletal and Skin Diseases Web site. Accessed at https://www.niams.nih.gov/health-topics/fibromyalgia on April 3, 2012.
- Perry R, Terry R, Ernst E. A systematic review of homoeopathy for the treatment of fibromyalgia. Clinical Rheumatology. 2010;29(5):457–464.
- Porter NS, Jason LA, Boulton A, et al. Alternative medical interventions used in the treatment and management of myalgic encephalomyelitis/chronic fatigue syndrome and fibromyalgia. Journal of Alternative and Complementary Medicine. 2010;16(3):235–249.
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- Schneider M, Vernon H, Ko G, et al. Chiropractic management of fibromyalgia syndrome: a systematic review of the literature. Journal of Manipulative and Physiological Therapeutics. 2009;32(1):25–40.
- Tsao JC. Effectiveness of massage therapy for chronic, non-malignant pain: a review. Evidence-Based Complementary and Alternative Medicine. 2007;4(2):165–179.
- Wang C, Schmid CH, Rones R, et al. A randomized trial of tai chi for fibromyalgia. New England Journal of Medicine. 2010;363(8):743–754.
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NCCIH Clinical Digest is a monthly e-newsletter that offers evidence-based information on complementary and integrative health practices.