Take Home Messages:

Exercise is the most beneficial stand-alone treatment for fibromyalgia. However if they are to persist with an exercise program, most patients will need ongoing support, encouragement and information about what to expect (ie a short term increase in pain and fatigue).

Combined treatments – incorporating education, medication, exercise and psychological therapies – can be effective, however these need to be suited to the individual. It is important to address both the physical and psychological state of the patient.

Why the study matters:

Fibromyalgia is a painful condition which can have a severe impact on both quality of life and ability to work. This study examines the effectiveness of the various treatments for fibromyalgia, both stand-alone and in combination.

What the study involved:

The article reviewed research papers which studied the effects of:

• Exercise;
• Psychological approaches;
• Self-management approaches;
• Complementary and alternative therapies; and
• A combination of the above approaches.

The effects of these interventions were measured by patients rating their wellbeing, both physically and psychologically.

Summary of study findings:

Reviewing all of the studies led the researchers to conclude that exercise was beneficial, and resulted in improvements to:

• Physical fitness;
• Psychological health; and
• Pain distribution and threshold.

Patients often reported fatigue and pain as barriers to exercise. It was pointed out patients often need encouragement to persevere with the program. In order to encourage perseverance the researchers suggested that exercise program coordinators:

• Start the exercise just below the patient's capacity and increase gradually; and
• Make patients aware of the short-term increase in pain and fatigue that can be expected.

Education and psychological treatments are aimed to decrease patient anxiety. It was found that although they are beneficial, more benefits can be seen when used in combination with physical exercise.

A program that combines treatments can help patients with fibromyalgia. The following treatments, when used in combination, are helpful:

• Patient education;
• Pain relief (physical);
• Pain relief (medication);
• Stress management;
• Aerobic exercise;
• Sleep therapy; and
• Psychological intervention (eg, coping skills training).

This combined approach is widely accepted, however needs to be tailored to each individual's needs.

Not many studies have been completed on the effects of complementary and alternative therapies.

Original research:

Rehabilitation approaches in Fibromyalgia

Adams N, Sim J.

Disability & Rehabilitation 2005;27:711-23.

Link to PubMed abstract