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Fibromyalgia Pain Management Update

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December 16, 2013

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Nearly 600 scientific papers related to fibromyalgia have been published in 2013.  Most of this research focused on the management of pain.  The abstracts below from the last 90 days support a number of treatment strategies.  These strategies had only a mild to moderate ability to modulate pain.  Among the abstracts below are studies using alternative or complementary therapies like massage and manual therapy.   Several new studies further support exercise for both pain reduction and improving symptoms of depression.  Other interventions addressed in the literature include the use of alcohol as a potential therapy, vitamin D, cognitive therapy, cranial electrical stimulation, and gluten free diets.  At this point, fibromyalgia remains a complex issue with a weak understanding of its etiology, diagnosis, effective palliative management or cure.

Note:  These mini-reviews are designed as updates and direct the reader to the full text of current research.  The abstracts presented here are no substitute for reading and critically reviewing the full text of the original research.  Where permitted we will direct the reader to that full text.

A survey of conventional and complementary therapies used by youth with juvenile-onset fibromyalgia.  [Link]

Pain Manag Nurs. 2013 Dec;14(4):e244-50.

Verkamp EK, Flowers SR, Lynch-Jordan AM, Taylor J, Ting TV, Kashikar-Zuck S.
Division of Behavioral Medicine and Clinical Psychology, Cincinnati Children's Hospital Medical Center, Cincinnati, Ohio. Electronic address:

Little is known regarding treatment choices of youth diagnosed with juvenile-onset fibromyalgia (JFM) as they move into young adulthood. Additionally, there is little empirical evidence to guide youth with FM into appropriate treatment options, leading to a variety of therapies used to manage FM symptoms. The purpose of this descriptive study was to examine all therapies used by individuals with JFM as they entered young adulthood and the perceived effectiveness of these treatments. As part of a larger follow-up study, participants completed a web-based survey of all current and past treatments received for FM symptoms 2 years after their initial presentation and diagnosis at a pediatric rheumatology clinic. One hundred ten out of 118 eligible patients participated in the follow-up assessment as young adults (mean age 18.97 years; 93.6% female). A majority of participants reported use of conventional medications (e.g., antidepressants, anticonvulsants) and nondrug therapies (e.g., psychotherapy). Currently and within the past 2 years, antidepressant medications were the most commonly used to manage FM. Complementary treatments were used less often, with massage being the most popular choice. Although currently used treatments were reported as being effective, past treatments, especially medications, were viewed as being more variably effective. This is a potential reason why young adults with JFM might try more complementary and alternative approaches to managing their symptoms. More controlled studies are needed to investigate the effectiveness of these complementary methods to assist treatment providers in giving evidence-based treatment recommendations.

Copyright © 2013 American Society for Pain Management Nursing. Published by Elsevier Inc. All rights reserved.

Fibromyalgia syndrome: is it related to vitamin d deficiency in premenopausal female patients?  [Link]

Pain Manag Nurs. 2013 Dec;14(4):e156-63.

Okumus M, Koybasi M, Tuncay F, Ceceli E, Ayhan F, Yorgancioglu R, Borman P.
Ankara Training and Research Hospital, Department of Physical Medicine and Rehabilitation, Ankara, Turkey. Electronic address:

There are a number of studies that have evaluated the relationship between fibromyalgia (FM) and vitamin D deficiency with conflicting results. The aim of this study was to assess vitamin D deficiency in patients with FM and to evaluate the relationship with the common symptoms of FM and levels of serum vitamin D. Forty premenopausal female fibromyalgia patients and 40 age- and sex-matched control subjects were included in the study. The demographic characteristics of all subjects, including age, sex, and body mass index, were recorded. The number of tender points was recorded, and the intensity of the widespread pain of the subjects was measured by the visual analog scale. The activities of daily living component of the Fibromyalgia Impact Questionnaire (FIQ-ADL), was used to assess physical functional capacity. Serum vitamin D was measured in both groups, and vitamin D levels <37.5 nmol/L were accepted as vitamin D deficiency. The vitamin D levels and clinical and laboratory characteristics of the patient and control groups were comparatively analyzed. The relationship between vitamin D levels and clinical findings of the FM patients were also determined. The mean age was 41.23 ± 4.8 and 39.48 ± 4.08 years for the patient and control groups, respectively. The pain intensity, number of tender points, and FIQ-ADL scores were higher in FM patients than in control subjects. The mean levels of vitamin D in the patient and control groups were determined to be 31.97 ± 15.50 and 28.97 ± 13.31 nmol/L, respectively (p > .05). The incidence of vitamin D deficiency was similar between the patient and control groups (67.5% vs. 70%). Vitamin D levels significantly correlated with pain intensity (r = -0.653; p = .001) and FIQ-ADL scores in the FM group (r = -0.344; p = .030). In conclusion, the results of this study indicate that deficiency of vitamin D is not more common in premenopausal female patients with FM than in control subjects without FM. However, the association between pain and vitamin D levels in FM patients emphasizes that hypovitaminosis of vitamin D in the FM syndrome may have an augmenting impact on pain intensity and functional status. Future studies are needed to show the effect of vitamin D supplementation in the reduction of pain intensity and disability in patients suffering from this chronic condition.

Copyright © 2013 American Society for Pain Management Nursing. Published by Elsevier Inc. All rights reserved.

Cranial electrical stimulation improves symptoms and functional status in individuals with fibromyalgia.  [Link]

Pain Manag Nurs. 2013 Dec;14(4):327-35.

Taylor AG, Anderson JG, Riedel SL, Lewis JE, Kinser PA, Bourguignon C.
Center for the Study of Complementary and Alternative Therapies, University of Virginia, Charlottesville. Electronic address:

To investigate the effects of microcurrent cranial electrical stimulation (CES) therapy on reducing pain and its associated symptoms in fibromyalgia (FM), we conducted a randomized, controlled, three-group (active CES device, sham device, and usual care alone [UC]), double-blind study to determine the potential benefit of CES therapy for symptom management in FM. Those individuals using the active CES device had a greater decrease in average pain (p = .023), fatigue (p = .071), and sleep disturbance (p = .001) than individuals using the sham device or those receiving usual care alone over time. Additionally, individuals using the active CES device had improved functional status versus the sham device and UC groups over time (p = .028).

Copyright © 2013 American Society for Pain Management Nursing. Published by Elsevier Inc. All rights reserved.

Early experience with a brief, multimodal, multidisciplinary treatment program for fibromyalgia.  [Link]

Pain Manag Nurs. 2013 Dec;14(4):228-35.

Vincent A, Whipple MO, Oh TH, Guderian JA, Barton DL, Luedtke CA.
Division of General Internal Medicine, Mayo Clinic, Rochester, Minnesota. Electronic address:

Fibromyalgia is a complex heterogeneous disorder for which a multidisciplinary individualized approach is currently advocated. We executed a 1-week multidisciplinary fibromyalgia clinical program with seven patients, based on our experience with our existing 1.5-day multidisciplinary fibromyalgia program that has demonstrated both short- and long-term benefits. The current expanded program was not designed as a clinical study, but rather as a clinical feasibility assessment, and it was multidisciplinary in nature, with cognitive behavioral therapy, activity pacing, and graded exercise therapy as major components. We assessed changes in individual patients at 1 week and 3 months after the program with the use of validated self-report measures of pain, fatigue, and self-efficacy. All patients indicated at least small improvements in pain and physical symptoms at both 1 week and 3 months, and all but one patient showed improvement in self-efficacy at 1 week and 3 months. Similar trends were observed for fatigue. Based on our early clinical experience, we conclude that the 1-week multidisciplinary fibromyalgia program is logistically feasible and has potential for clinical efficacy. Further research is needed and is planned to test the clinical efficacy of this program and compare it with other interventions.

Copyright © 2013 American Society for Pain Management Nursing. Published by Elsevier Inc. All rights reserved.

The 6-minute walk test in female fibromyalgia patients: relationship with tenderness, symptomatology, quality of life, and coping strategies.  [Link]

Pain Manag Nurs. 2013 Dec;14(4):193-9.

Carbonell-Baeza A, Ruiz JR, Aparicio VA, Ortega FB, Delgado-Fernández M.
Department of Physical Education and Sport, School of Physical Activity and Sports Sciences, University of Granada, Granada, Spain; Department of Physical Education and Sport, School of Education Sciences, University of Seville, Spain. Electronic address:

The purpose of this study was to examine the relationship between the 6-minute walk test (6-MWT) and tenderness, symptomatology, quality of life, and coping strategies in women with fibromyalgia. One hundred eighteen women with fibromyalgia aged 51.9 ± 7.3 years participated in the study. The examination included the 6-MWT, tender points, and the following questionnaires: Fibromyalgia Impact Questionnaire (FIQ), Short-Form Health Survey 36 (SF-36), and Vanderbilt Pain Management Inventory. Fair correlations between the 6-MWT and the subscales of physical impairment (FIQ) and physical function (SF-36) were observed (? -0.365 and 0.347, respectively, both p < .001). The 6-MWT showed a weak relationship with tenderness (? 0.201 and -0.191 for algometer score and tender points count, respectively, both p < .05). The relationship between the 6-MWT and global score of FIQ, and FIQ subscales of pain and fatigue were weak (? -0.201, -0.211, and -0.226, respectively, all p < .05). The 6-MWT showed a weak relationship with bodily pain and vitality scales of SF-36 (? 0.256 and 0.258, respectively, both p = .005) and with passive and active coping strategies (? -0.255 and 0.223, both p < .05). This study in women with fibromyalgia shows significant relationships, ranging from weak to fair, between the 6-MWT and tenderness, symptomatology, quality of life, and coping strategies. These findings indicate that functional capacity, as assessed by the distance walked in 6 minutes, might be important when planning the assessment, treatment, and monitoring of patients with fibromyalgia.

Copyright © 2013 American Society for Pain Management Nursing. Published by Elsevier Inc. All rights reserved.

A systematic review and meta-analysis of mindfulness-based stress reduction for the fibromyalgia syndrome.  [Link]

J Psychosom Res. 2013 Dec;75(6):500-10.

Lauche R, Cramer H, Dobos G, Langhorst J, Schmidt S.
Department of Internal and Integrative Medicine, Kliniken Essen-Mitte, Faculty of Medicine, University of Duisburg-Essen, Essen, Germany. Electronic address:

OBJECTIVES: This paper presents a systematic review and meta-analysis of the effectiveness of mindfulness-based stress reduction (MBSR) for FMS.

METHODS: The PubMed/MEDLINE, Cochrane Library, EMBASE, PsychINFO and CAMBASE databases were screened in September 2013 to identify randomized and non-randomized controlled trials comparing MBSR to control interventions. Major outcome measures were quality of life and pain; secondary outcomes included sleep quality, fatigue, depression and safety. Standardized mean differences and 95% confidence intervals were calculated.

RESULTS: Six trials were located with a total of 674 FMS patients. Analyses revealed low quality evidence for short-term improvement of quality of life (SMD=-0.35; 95% CI -0.57 to -0.12; P=0.002) and pain (SMD=-0.23; 95% CI -0.46 to -0.01; P=0.04) after MBSR, when compared to usual care; and for short-term improvement of quality of life (SMD=-0.32; 95% CI -0.59 to -0.04; P=0.02) and pain (SMD=-0.44; 95% CI -0.73 to -0.16; P=0.002) after MBSR, when compared to active control interventions. Effects were not robust against bias. No evidence was further found for secondary outcomes or long-term effects of MBSR. Safety data were not reported in any trial.

CONCLUSIONS: This systematic review found that MBSR might be a useful approach for FMS patients. According to the quality of evidence only a weak recommendation for MBSR can be made at this point. Further high quality RCTs are required for a conclusive judgment of its effects.

© 2013.

Can alcohol consumption be an alternative treatment for fibromyalgia?  [Link]

Arthritis Res Ther. 2013 Nov 29;15(6):126. [Epub ahead of print]

Chung M, Wang C.
Division of Rheumatology, Tufts Medical Center, Tufts University School of Medicine, Box 406, Boston, MA 02111, USA.

Treatment of chronic pain conditions such as fibromyalgia is challenging due to limitations of drug therapies. An initial exploration into the relationships between self-reported alcohol consumption, symptom severity, and quality of life for individuals with fibromyalgia sheds new light on plausible hypotheses and potential mechanisms of action for future research. Evidence suggests that alcohol consumption may improve social and psychological factors because of activity in the ascending and descending pain pathways in modulating gamma-aminobutyric acid neurotransmission. Further methodologically rigorous studies in this field to improve well-being of individuals with fibromyalgia are warranted.

Short-Term Effects of a Manual Therapy Protocol on Pain, Physical Function, Quality of Sleep, Depressive symptoms and Pressure Sensitivity in Women and Men with Fibromyalgia Syndrome: A Randomized Controlled Trial.  [Link]

Clin J Pain. 2013 Nov 25. [Epub ahead of print]

Castro-Sánchez AM, Aguilar-Ferrándiz ME, Matarán-Peñarrocha GA, Sánchez-Joya MD, Arroyo-Morales M, Fernández-de-Las-Peñas C.
Department of Nursing, Physical Therapy and Medicine, Universidad de Almeria, Spain †Department of Physical Therapy, Universidad de Granada, Spain ‡Servicio Andaluz de Salud. Family Medicine Specialist. Granada. Spain §Department of Physical Therapy, Occupational Therapy, Rehabilitation and Physical Medicine, Universidad Rey Juan Carlos, Alcorcón, Madrid, Spain ?Esthesiology Laboratory of Universidad Rey Juan Carlos, Alcorcón, Spain.

OBJECTIVE: To investigate the therapeutic effects of a manual therapy protocol for improving pain, function, pressure pain thresholds, quality of sleep, and depressive symptoms in women and men with fibromyalgia syndrome (FMS).

MATERIAL AND METHODS: Eighty-nine patients were randomly assigned to experimental or control group. The experimental group (24 female, 21 male) received 5 sessions of manual therapy and the control group (24 female, 21 male) did not receive any intervention. Pressure pain thresholds (PPT), pain, impact of FMS symptoms, quality of sleep and depressive symptoms were assessed in both groups at baseline and after 48-hours of the last intervention in the experimental group.

RESULTS: The ANCOVA found significant Group* Time* Sex interactions for McGill PPI and CES-D (P<0.01) was also found: men exhibited a larger effect size for depressive symptoms than women whereas women exhibited a greater effect size than men in the McGill PPI. A significant Group* Time* Sex interaction for PPT over suboccipital, upper trapezius, supraspinatus, second rib, gluteal region and tibialis anterior muscle was also found: men included in the experimental group experienced significant greater improvements in PPT as compared to women with FMS in the experimental group.

CONCLUSIONS: Manual therapy protocol was effective for improving pain intensity, widespread pressure pain sensitivity, impact of FMS symptoms, sleep quality and depressive symptoms. In addition, sex differences were observed in response to treatment: women and men get similar improvements in quality of sleep and tender point count, whereas women showed a greater reduction in pain and impact of FMS symptoms than men, but men reported higher decreases in depressive symptoms and pressure hypersensitivity than women.

An exploratory study of the effect of regular aquatic exercise on the function of neutrophils from women with fibromyalgia: Role of IL-8 and noradrenaline.  [Link]

Brain Behav Immun. 2013 Nov 17. pii: S0889-1591(13)00540-0.

Bote ME, García JJ, Hinchado MD, Ortega E.
Immunophysiology Research Group, Department of Physiology, Science Faculty, University of Extremadura, Spain.

Fibromyalgia (FM) syndrome is associated with elevated systemic inflammatory and stress biomarkers, and an elevated innate cellular response mediated by monocytes and neutrophils. Exercise is accepted as a good non-pharmacological therapy for FM. We have previously found that regular aquatic exercise decreases the release of inflammatory cytokines by monocytes from FM patients. However, its effects on the functional capacity of neutrophils have not been studied. The aim of the present exploratory study was to evaluate, in 10 women diagnosed with FM, the effect of an aquatic exercise program (8months, 2sessions/week, 60min/session) on their neutrophils' function (phagocytic process), and on IL-8 and NA as potential inflammatory and stress mediators, respectively. A control group of 10 inactive FM patients was included in the study. After 4months of the exercise program, no significant changes were observed in neutrophil function (chemotaxis, phagocytosis, or fungicidal capacity) or in IL-8 and NA. However, at the end of the exercise program (8months), a neuro-immuno-endocrine adaptation was observed, manifested by a significant decrease to values below those in the basal state in neutrophil chemotaxis, IL-8, and NA. No significant seasonal changes in these parameters were observed during the same period in the group of non-exercised FM patients. After the 8months of the exercise program, the FM patients had lower concentrations of IL-8 and NA together with reduced chemotaxis of neutrophils compared with the values determined in the same month in the control group of non-exercised FM women. These results suggest that "anti-inflammatory" and "anti-stress" adaptations may be contributing to the symptomatic benefits that have been attributed to regular aquatic exercise in FM syndrome, as was corroborated in the present study by the scores on the Fibromyalgia Impact Questionnaire.

Copyright © 2013 Elsevier Inc. All rights reserved.

Safety and effectiveness of vibration massage by deep oscillations: a prospective observational study.  [Link]

Evid Based Complement Alternat Med. 2013;2013:679248.

Kraft K, Kanter S, Janik H.
Chair of Complementary Medicine, Center of Internal Medicine, Rostock University Medicine, Ernst-Heydemann-Straße 6, 18057 Rostock, Germany.

The objective of this study is to assess the safety of treatment with vibration massage using a deep oscillation device and the effects on symptom severity and quality of life in patients with primary fibromyalgia syndrome (FMS). Outpatients with FMS performed an observational prospective study with visits 2-4 weeks after the last treatment (control) and after further 2 months (follow-up). Patients were treated with 10 sessions of 45?min deep oscillation massage, 2/week. Primary outcome parameters were safety and tolerability (5-level Likert scale (1 = very good)) (after each treatment session and at control visit). Secondary outcome parameters were symptom severity (Fibromyalgia Impact Questionnaire (FIQ), pain) and quality of life (SF-36). Seventy patients (97.1% females) were included. At control visit, 41 patients (58.6%) reported 63 mild and short-lasting adverse events, mainly worsening of prevalent symptoms such as pain and fatigue. Tolerability was rated as 1.8 (95% confidence interval: 1.53; 2.07). Symptoms and quality of life were significantly improved at both control and follow-up visits (at least P < 0.01). In conclusion, deep oscillation massage is safe and well tolerated in patients with FMS and might improve symptoms and quality of life rather sustained.

Clinical impact of a gluten-free diet on health-related quality of life in seven fibromyalgia syndrome patients with associated celiac disease.  [Link]

BMC Gastroenterol. 2013 Nov 9;13(1):157.

Rodrigo L, Blanco I, Bobes J, de Serres FJ.

BACKGROUND: Celiac disease (CD) is an autoimmune disorder, characterized by the presence of gastrointestinal and multisystem symptoms, which occasionally mimic those of Irritable Bowel Syndrome (IBS) and Fibromyalgia Syndrome (FMS). To assess the effectiveness of a Gluten-Free Diet (GFD) in seven adult female screening-detected CD subjects, categorized as severe IBS and FMS patients.

METHODS: All subjects showed villous atrophy in duodenal biopsies, were HLA-DQ2/DQ8-positive, and fulfilled the Rome III and ACR 1990 criteria respectively for IBS and FMS classification. GFD effectiveness was assessed at baseline and after 1 year, examining the score changes in the Tender Points (TPs) test, Fibromyalgia Impact Questionnaire (FIQ), Health Assessment Questionnaire (HAQ), Short Form Health Survey (SF-36), Visual Analogue Scales (VAS) for gastrointestinal complaints, pain and tiredness, drug prescriptions and tissue-Trans-Glutaminase (tTG) serum levels.

RESULTS: At baseline, all patients had poor Quality of Life and VAS scores, a high number of TPs and drug prescriptions, and increased tTG levels. After 1 year of GFD, all outcome measures significantly improved, with a decrease of 51-60% in TPs, FIQ, HAQ, and VAS scales, and in the number of prescribed drugs, accompanied by an increase of 48-60% in SF-36 Physical and Mental Component Summary scores, and a decrease of tTG to normal values.

CONCLUSION: Results of this pilot study show that the adherence to a GFD by CD-related IBS/FMS patients can simultaneously improve CD and IBS/FMS symptoms, and indicate the merit of further research on a larger cohort.

Effectiveness of Tai-Chi for Decreasing Acute Pain in Fibromyalgia Patients.  [Link]

Int J Sports Med. 2013 Nov 7.

Segura-Jiménez V, Romero-Zurita A, Carbonell-Baeza A, Aparicio VA, Ruiz JR, Delgado-Fernández M.
Department of Physical Education and Sports, School of Sport Sciences, University of Granada, Spain.

Tai-Chi has shown benefits in physical and psychological outcomes in diverse populations. We aimed to determine the changes elicited by a Tai-Chi program (12 and 24 weeks) in acute pain (before vs. after session) in fibromyalgia patients. We also assessed the cumulative changes in pain brought about by a Tai-Chi program. Thirty-six patients (29 women) with fibromyalgia participated in a low-moderate intensity Tai-Chi program for 12 weeks (3 sessions/week). Twenty-eight patients (27 women) continued the program for an additional 12 weeks (i.?e., 24 weeks). We assessed pain by means of a Visual Analogue Scale (VAS) before and after each single session (i.?e., 72 sessions). We observed significant immediate changes (P-values from 0.037 to 0.0001) with an approximately 12% mean decrease of acute pain in the comparison of VAS-values before and after each session (72 sessions in total), with the exception of 4 sessions. We observed significant changes in cumulative pain pre-session (95% CI=-0.019; -0.014; P<0.001) and cumulative pain post-session (95% CI=-0.021; -0.015; P<0.001) along the 24-week intervention only. In conclusion, a low-moderate intensity Tai-Chi program for 12 weeks (3 times/week) decreased levels of acute pain in fibromyalgia patients. A longer period is necessary (e.?g. 24 weeks) for observing cumulative changes in pain.

Fibromyalgia: anti-inflammatory and stress responses after acute moderate exercise.  [Link]

PLoS One. 2013 Sep 4;8(9):e74524.

Bote ME, Garcia JJ, Hinchado MD, Ortega E.
Department of Physiology, University of Extremadura, Badajoz, Spain.

Fibromyalgia (FM) is characterized in part by an elevated inflammatory status, and "modified exercise" is currently proposed as being a good therapeutic help for these patients. However, the mechanisms involved in the exercise-induced benefits are still poorly understood. The objective was to evaluate the effect of a single bout of moderate cycling (45 min at 55% VO2 max) on the inflammatory (serum IL-8; chemotaxis and O2 (-) production by neutrophils; and IL-1ß, TNF-a, IL-6, IL-10, and IL-18 release by monocytes) and stress (cortisol; NA; and eHsp72) responses in women diagnosed with FM compared with an aged-matched control group of healthy women (HW). IL-8, NA, and eHsp72 were determined by ELISA. Cytokines released by monocytes were determined by Bio-Plex® system (LUMINEX). Cortisol was determined by electrochemoluminiscence, chemotaxis was evaluated in Boyden chambers and O2 (-) production by NBT reduction. In the FM patients, the exercise induced a decrease in the systemic concentration of IL-8, cortisol, NA, and eHsp72; as well as in the neutrophil's chemotaxis and O2 (-) production and in the inflammatory cytokine release by monocytes. This was contrary to the completely expected exercise-induced increase in all those biomarkers in HW. In conclusion, single sessions of moderate cycling can improve the inflammatory status in FM patients, reaching values close to the situation of aged-matched HW at their basal status. The neuroendocrine mechanism seems to be an exercise-induced decrease in the stress response of these patients.

Cognitive behavioural therapies for fibromyalgia.  [Link]

Cochrane Database Syst Rev. 2013 Sep 10;9:CD009796.

Bernardy K, Klose P, Busch AJ, Choy EH, Häuser W.
Department of Pain Medicine, BG University Hospital Bergmannsheil GmbH, Ruhr University Bochum, Cample-de-la Bürk Platz 1, Bochum, Germany, 44789.

BACKGROUND: Fibromyalgia (FM) is a clinically well-defined chronic condition of unknown aetiology characterized by chronic widespread pain that often co-exists with sleep disturbances, cognitive dysfunction and fatigue. Patients often report high disability levels and negative mood. Psychotherapies focus on reducing key symptoms, improving daily functioning, mood and sense of personal control over pain.

OBJECTIVES: To assess the benefits and harms of cognitive behavioural therapies (CBTs) for treating FM at end of treatment and at long-term (at least six months) follow-up.

SEARCH METHODS: We searched the Cochrane Central Register of Controlled Trials (CENTRAL) (The Cochrane Library 2013, Issue 8), MEDLINE (1966 to 28 August 2013), PsycINFO (1966 to 28 August 2013) and SCOPUS (1980 to 28 August 2013). We searched (web site of the US National Institutes of Health) and the World Health Organization Clinical Trials Registry Platform (ICTRP) ( for ongoing trials (last search 28 August,2013), and the reference lists of reviewed articles.

SELECTION CRITERIA: We selected randomised controlled trials of CBTs with children, adolescents and adults diagnosed with FM.

DATA COLLECTION AND ANALYSIS: The data of all included studies were extracted and the risks of bias of the studies were assessed independently by two review authors. Discrepancies were resolved by discussion.

MAIN RESULTS: Twenty-three studies with 24 study arms with CBTs were included. A total of 2031 patients were included; 1073 patients in CBT groups and 958 patients in control groups. Only two studies were without any risk of bias. The GRADE quality of evidence of the studies was low. CBTs were superior to controls in reducing pain at end of treatment by 0.5 points on a scale of 0 to 10 (standardised mean difference (SMD) - 0.29; 95% confidence interval (CI) -0.49 to -0.17) and by 0.6 points at long-term follow-up (median 6 months) (SMD -0.40; 95% CI -0.62 to -0.17); in reducing negative mood at end of treatment by 0.7 points on a scale of 0 to 10 (SMD - 0.33; 95% CI -0.49 to -0.17) and by 1.3 points at long-term follow-up (median 6 months) (SMD -0.43; 95% CI -0.75 to -0.11); and in reducing disability at end of treatment by 0.7 points on a scale of 0 to 10 (SMD - 0.30; 95% CI -0.51 to -0.08) and at long-term follow-up (median 6 months) by 1.2 points (SMD -0.52; 95% CI -0.86 to -0.18). There was no statistically significant difference in dropout rates for any reasons between CBTs and controls (risk ratio (RR) 0.94; 95% CI 0.65 to 1.35).

AUTHORS' CONCLUSIONS: CBTs provided a small incremental benefit over control interventions in reducing pain, negative mood and disability at the end of treatment and at long-term follow-up. The dropout rates due to any reason did not differ between CBTs and controls.
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Fibromyalgia Pain Management Update

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Re:Fibromyalgia Pain Management Update

by McGreen   (3/1/2017 5:21:16 AM)
Hi, I just want to ask is someone has any idea on which marijuana strain would be very effective when it comes with fibromyalgia. I've been suffering for almost 3 months now and mostly can't sleep properly at night. I refrain my self on taking meds coz they only take the pain for a minute or so and back again. So that's the reason I started my research on medical marijuana and found this along the way have no idea that marijuana now can ease the pain, cbd and thc are all new to me. I also read that drinking it as tea or as a muffin/cake is an option, but is the pain-relief effects the same? Why can't they simply make pills out of marijuana - or maybe there are that I am not aware of. I only tried smoking it a couple of times with some friends and occationally. If it's true that it can take away the pain, then I would very much appreciate any ideas and advice on what strain is good and how to use it medically. Thanks in advance to those who'll answer.