Most fibromyalgia therapies lack high-quality evidence supporting their use
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Most fibromyalgia therapies lack strong evidence, according to a systematic review and meta-analysis published in JAMA Internal Medicine.
Rodrigo Oliveira Mascarenhas, MSc, an associate professor in the department of physiotherapy at the Federal University of Vales do Jequitinhonha e Mucuri in Brazil, and colleagues reviewed 224 studies that measured pain intensity of 29,962 patients with fibromyalgia using several methods, including visual analog scales and numerical rating scales. Quality of life (QOL) was measured using the Fibromyalgia Impact Questionnaire.
Some of the therapies in their analysis included antidepressants, antiemetics, central nervous system depressants, cognitive behavioral therapy, exercise, massage and transcutaneous electrical nerve stimulation. The quality of the evidence was based on the Grading of Recommendations Assessment, Development and Evaluation system.
They found that high-quality evidence supported CBT for short-term pain relief (weighted mean difference [WMD] = –0.9; 95% CI, –1.4 to –0.3). High-quality evidence also supported central nervous system depressants (WMD = –1.2; 95% CI, –1.6 to –0.8) and antidepressants (WMD = –0.5; 95% CI, –0.7 to –0.4) for medium-term pain relief. There was also high-quality evidence in favor of antidepressants (WMD = –6.8; 95% CI, –8.5 to –5.2) for QOL in the short term, and central nervous system depressants (WMD = –8.7; 95% CI, –11.3 to –6) and antidepressants (WMD = –3.5; 95% CI, –4.5 to –2.5) for QOL in the medium term. However, Mascarenhas and colleagues added that the associations were small and did not exceed the minimum clinically important change (two points on an 11-point scale for pain and 14 points on a 101-point scale for QOL). Evidence for long-term outcomes of interventions was lacking.
“Clinicians should be aware that current evidence for most of the available therapies for the management of fibromyalgia is limited to small trials of low methodological quality,” the researchers wrote. “We found high certainty only for the effectiveness of CBT for pain and antidepressants for QOL in the short term and that antidepressants and central nervous system depressants are effective for both pain and QOL in the medium term. However, the effect sizes of these interventions alone might not be clinically meaningful.”