Systematic reviews included in this broad synthesis

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A systematic review of homoeopathy for the treatment of fibromyalgia

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Authors Perry R , Terry R , Ernst E
Journal Clinical rheumatology
Year 2010
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Homoeopathy is often advocated for fibromyalgia (FM) and many FM patients use it. To critically evaluate all randomised clinical trials (RCTs) of homoeopathy as a treatment for FM, six electronic databases were searched to identify all relevant studies. Data extraction and the assessment of the methodological quality of all included studies were done by two independent reviewers. Four RCTs were found, including two feasibility studies. Three studies were placebo-controlled. None of the trials was without serious flaws. Invariably, their results suggested that homoeopathy was better than the control interventions in alleviating the symptoms of FM. Independent replications are missing. Even though all RCTs suggested results that favour homoeopathy, important caveats exist. Therefore, the effectiveness of homoeopathy as a symptomatic treatment for FM remains unproven. © 2010 Clinical Rheumatology.

Systematic review

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Efficacy of acupuncture in fibromyalgia syndrome--a systematic review with a meta-analysis of controlled clinical trials.

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Journal Rheumatology (Oxford, England)
Year 2010
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OBJECTIVE: To systematically review the efficacy of acupuncture in fibromyalgia syndrome (FMS). METHODS: MEDLINE, PsychInfo, EMBASE, CAMBASE and the Cochrane Library were screened (through July 2009). The reference sections of original studies and systematic reviews for randomized controlled trials (RCTs) on acupuncture in FMS were searched. RESULTS: Seven RCTs with a median treatment time of 9 (range 6-25) sessions and 385 patients were included. Outcomes of interest were key symptoms of FMS, namely pain, fatigue, sleep disturbances, reduced physical function and side effects at post-treatment. Follow-up of two RCTs with a median follow-up of 26 weeks was available. Standardized mean differences (SMDs) comparing verum and control acupuncture were calculated. Strong evidence for the reduction of pain (SMD -0.25; 95% CI -0.49, -0.02; P = 0.04) was found at post-treatment. There was no evidence for the reduction of fatigue and sleep disturbances, or the improvement of physical function at post-treatment. There was no evidence for the reduction of pain and improvement of physical function at the latest follow-up. Subgroup analyses resulted in moderate evidence for a significant and small reduction of pain at post-treatment in studies with electro-stimulation and individualized acupuncture. Stratifying the type of controls (penetrating vs non-penetrating control acupuncture) did not change the results. Significant reduction of pain was only present in studies with risk of bias. Side effects were inconsistently reported. CONCLUSION: A small analgesic effect of acupuncture was present, which, however, was not clearly distinguishable from bias. Thus, acupuncture cannot be recommended for the management of FMS.

Systematic review

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Massage therapy for fibromyalgia symptoms

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Authors Kalichman L
Journal Rheumatology international
Year 2010
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Massage therapy is widely used by patients with fibromyalgia seeking symptom relief. We performed a review of all available studies with an emphasis on randomized controlled trials to determine whether massage therapy can be a viable treatment of fibromyalgia symptoms. Extensive narrative review. PubMed, PsychInfo, CINAHL, PEDro, ISI Web of Science, and Google Scholar databases (inception-December 2009) were searched for the key words "massage", "massotherapy", "self-massage", "soft tissue manipulation", "soft tissue mobilization", "complementary medicine", "fibromyalgia" "fibrositis", and "myofascial pain". No language restrictions were imposed. The reference lists of all articles retrieved in full were also searched. The effects of massage on fibromyalgia symptoms have been examined in two single-arm studies and six randomized controlled trials. All reviewed studies showed short-term benefits of massage, and only one single-arm study demonstrated long-term benefits. All reviewed studies had methodological problems. The existing literature provides modest support for use of massage therapy in treating fibromyalgia. Additional rigorous research is needed in order to establish massage therapy as a safe and effective intervention for fibromyalgia. In massage therapy of fibromyalgia, we suggest that massage will be painless, its intensity should be increased gradually from session to session, in accordance with patient's symptoms; and the sessions should be performed at least 1-2 times a week. © Springer-Verlag 2009.

Systematic review

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Chiropractic treatment for fibromyalgia: A systematic review

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Authors Ernst E
Journal Clinical rheumatology
Year 2009
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Many patients use chiropractic as a treatment of fibromyalgia, and many chiropractors seem to be convinced that it is effective for that condition. The aim of the study was to conduct a systematic review of randomised clinical trials testing the effectiveness of chiropractic care for fibromyalgia. Six electronic literature searches were conducted. No language restrictions were applied. Data extraction and validation were carried out by two independent reviewers. Three studies met the inclusion criteria. Their methodological quality was poor. They generated no evidence to suggest that chiropractic care is effective for fibromyalgia. Currently, there is insufficient evidence to conclude that chiropractic is an effective treatment for fibromyalgia. © Clinical Rheumatology 2009.

Systematic review

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Efficacy of hydrotherapy in fibromyalgia syndrome-a meta-analysis of randomized controlled clinical trials

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Journal Rheumatology (Oxford, England)
Year 2009
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Objective: To systematically review the efficacy of hydrotherapy in FM syndrome (FMS). Methods: We screened MEDLINE, PsychInfo, EMBASE, CAMBASE and CENTRAL (through December 2008) and the reference sections of original studies and systematic reviews on hydrotherapy in FMS. Randomized controlled trials (RCTs) on the treatment of FMS with hydrotherapy (spa-, balneo-and thalassotherapy, hydrotherapy and packing and compresses) were analysed. Methodological quality was assessed by the van Tulder score. Effects were summarized using standardized mean differences (SMDs). Results: Ten out of 13 RCTs with 446 subjects, with a median sample size of 41 (range 24-80) and a median treatment time of 240 (range 200-300) min, were included into the meta-analysis. Only three studies had a moderate quality score. There was moderate evidence for reduction of pain (SMD -0.78; 95% CI -1.42, -0.13; P<0.0001) and improved health-related quality of life (HRQOL) (SMD -1.67; 95% CI -2.91, -0.43; P=0.008) at the end of therapy. There was moderate evidence that the reduction of pain (SMD -1.27; 95% CI -2.15, -0.38; P=0.005) and improvement of HRQOL (SMD -1.16; 95% CI -1.96, -0.36; P=0.005) could be maintained at follow-up (median 14 weeks). Conclusions: There is moderate evidence that hydrotherapy has short-term beneficial effects on pain and HRQOL in FMS patients. There is a risk to over-estimate the effects of hydrotherapy due to methodological weaknesses of the studies and to small trials included in meta-analysis. © The Author 2009. Published by Oxford University Press on behalf of the British Society for Rheumatology. All rights reserved.