Evidence-Based Non-Pharmacological Therapies for Fibromyalgia

Abstract

Cognitive behavioral therapy continues to play a significant role in the non-medical therapy of FM. It is especially helpful in high catastrophizing patients as evidenced by recent studies that note changes in the brain on functional magnetic resonance imaging. Mindfulness meditation can be helpful in improving pain symptoms and pain perception. No particular diet is found to have a meaningful impact in FM; however, various diets including low fermentable oligo- di -monosaccharides and polyols diet, gluten free, and hypocaloric may be helpful in ameliorating gastrointestinal distress in select patient populations. Current literature does not support the routine use of acupuncture for improving pain or quality of life in FM; however, given its benign side effect profile, it should not be discouraged. Goals for symptom management and pain control should be set early, and patient engagement remains critical in the management of this complex pain presentation. While low quality evidence exists for most non-pharmacologic treatment modalities for FM, CBT and mindfulness meditation show promise for future investigation.

Nutritional Interventions in the Management of Fibromyalgia Syndrome

“…FM patients often have gastrointestinal symptoms that significantly overlap with various gluten-related disorders such as nausea, abdominal pain, fatigue, tiredness, chronic pain and mood disturbance, suggesting a possible coexistence of noncoeliac gluten sensitivity in such patients [18]. This has led many investigators to hypothesize that a gluten-free diet could be beneficial for patients with FM.…”

“…To date, optimal management of FM requires a timely diagnosis, together with a comprehensive assessment of pain, function and psychosocial context. Effective treatment is not available, and experts recommend nonpharmacological therapy as a first-line strategy, with the pharmacological option to be chosen only in case of lack of effect [17,18]. Among the nonpharmacological treatment options, nutrition has shown increasing interest in the literature in recent years [19][20][21].…”

Dietary Patterns and Interventions to Alleviate Chronic Pain

“…Optimal combinations for increased efficacy to alleviate pain are pharmacological and nonpharmacological, diet being mentioned as an important tool for pain improvement [113,114]. The irritable bowel syndrome associated to fibromyalgia can be addressed by a gluten-free diet [59,61], as observed by Aman et al [115], while neck and shoulder stiffness responds to probiotics [79].…”

Assessing the benefits on quality of life of a multicomponent intervention for fibromyalgia syndrome in primary care: patients’ and health professionals’ appraisals: a qualitative study protocol

“…Physical exercise, psychological approaches such as cognitive-behavioural therapy (CBT), health education and complementary medicine have demonstrated some clinical improvement in symptom control. [22][23][24][25][26][27] Nevertheless, the evidence remains uncertain, and there is scope for further research to determine the best treatment option. In this context, users' and professionals' opinions become a strategic resource for the design of treatments tailored to health needs.…”