Table 59Fibromyalgia: effects of nonpharmacological interventions compared with usual care, placebo, sham, attention control, or waitlista

Intervention

Function

Short-Term

Effect Size SOE

Function

Intermediate-Term

Effect Size SOE

Function

Long-Term

Effect Size SOE

Pain

Short-Term

Effect Size SOE

Pain

Intermediate-Term

Effect Size SOE

Pain

Long-Term

Effect Size SOE

Exercise

small

+

small

++

none

+

small

++

none

++

none

++

Psychological Therapies: CBT

noneb

+

moderatec

+

insufficient evidence

smalld

+

smallc

+

insufficient evidence
Psychological Therapies: Biofeedback, Imageryinsufficient evidenceinsufficient evidenceinsufficient evidenceinsufficient evidenceinsufficient evidenceinsufficient evidence
Physical Modalities: Magnetic Padsinsufficient evidence

none

+

no evidenceinsufficient evidence

none

+

no evidence
Manual Therapies: Massage (Myofascial Release)no evidence

small

+

none

+

insufficient evidenceinsufficient evidence

small

+

Mindfulness Practices: MBSR, MAT

none

++

smalle

+

no evidence

none

++

smalle

+

no evidence
Mind-Body Practices: Qigong, Tai Chi

small

+

no evidenceno evidence

moderate

+

no evidenceno evidence
Acupuncture

smalld

++

small

++

no evidence

noned

+

none

+

no evidence
Multidisciplinary Rehabilitation

small

+

small

+

small

+

none

+

small

+

none

+

Short-Term: 1 to <6 months; Intermediate-Term: ≥6 to <12 months; Long-Term: ≥12 months

Effect Size: none, small, moderate, or large improvement

Strength of Evidence: + = low, ++ = moderate, +++ = high

CBT = cognitive-behavioral therapy; MAT = meditation awareness training; MBSR = mindfulness-based stress reduction; none = no effect/no statistically significant effect; SOE = strength of evidence

a

SOE and effect size based on totality of evidence from prior report and new trials

b

Effect size downgraded one level from prior report

c

Effect size upgraded one level from prior report

d

New trial(s) did not change effect size or SOE

e

New trial reporting intermediate term effects

From: Discussion

Cover of Noninvasive Nonpharmacological Treatment for Chronic Pain: A Systematic Review Update
Noninvasive Nonpharmacological Treatment for Chronic Pain: A Systematic Review Update [Internet].
Comparative Effectiveness Review, No. 227.
Skelly AC, Chou R, Dettori JR, et al.

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