Epistemonikos: Database of the best Evidence-Based Health Care

Objective: To determine the results of a stress-reduction, cognitive behavioral treatment [SR-CBT] program in fibromyalgia. Methods: Seventy-nine patients with fibromyalgia completed a 10 week meditation based SR-CBT program that met once weekly for 2 hours per session. Controls consisted of 42 fibromyalgia patients, 18 of whom had been placed on a waiting list for the treatment program and 24 randomly selected patients who had not expressed an interest in enrolling in the program. Medications and other treatments were not altered during the 10 week study. Fibromyalgia symptoms were evaluated at the beginning and at the end of the study in patients and controls by self-administered visual analog scales [VAS] for global well-being, pain, sleep, fatigue, and tiredness upon awakening. Functional status was evaluated by the Fibromyalgia Impact Questionnaire [FIQ], and psychological status by the SCL-90-R. Participants and controls were comparable at study entry. Results: Fibromyalgia symptoms improved in 67% of the participants in the SR-CBT program compared to 40% of the controls [P =. 006]. The mean VAS, adjusted for baseline, was decreased 16% in the participants compared to controls [P = 0.01]. The mean FIQ score in the participants decreased 11% compared to the control group baseline [P = 0.05]. Most impressively, the global severity index of the SCL-90-R improved by 32% [P = 0.0001]. Conclusion: A SR-CBT program is a useful adjunct in the treatment of patients with fibromyalgia.

Buckelew SP

This thread includes 2 references

Double-blind, placebo-controlled cross-over study of intravenous S-adenosyl-L-methionine in patients with fibromyalgia.

Authors » Volkmann H , Nørregaard J , Jacobsen S , Danneskiold-Samsøe B , Knoke G , Nehrdich D

Journal » Scandinavian journal of rheumatology

Year » 1997

Links » Pubmed DOI

This article is included in 2 Systematic reviews Systematic reviews (2 references) 1 Broad synthesis Broad syntheses (1 reference)

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The objective of this study was to test the efficacy of intravenously administered S-adenosyl-L-methionine (SAMe) in patients with fibromyalgia (FM). Thirty-four out-patients with fibromyalgia symptoms received SAMe 600 mg i.v. or placebo daily for 10 days in a cross-over trial. There was no significant difference in improvement in the primary outcome: tender point change between the two treatment groups. There was a tendency towards statistical significance in favour of SAMe on subjective perception of pain at rest (p = 0.08), pain on movement (p = 0.11), and overall well-being (p = 0.17) and slight improvement only on fatigue, quality of sleep, morning stiffness, and on the Fibromyalgia Impact Questionnaire for pain. No effect could be observed on isokinetic muscle strength, Zerrsen self-assessment questionnaire, and the face scale. No effect of SAMe in patients with FM was found in this short term study.

A randomized, double-blind crossover trial of fluoxetine and amitriptyline in the treatment of fibromyalgia.

Authors » Goldenberg D , Mayskiy M , Mossey C , Ruthazer R , Schmid C

Journal » Arthritis and rheumatism

Year » 1996

Links » Pubmed DOI

This article is included in 12 Systematic reviews Systematic reviews (12 references) 1 Broad synthesis Broad syntheses (1 reference)

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OBJECTIVE: To study the effect of fluoxetine (FL) and amitriptyline (AM), alone and in combination, in patients with fibromyalgia (FM). METHODS: Nineteen patients with FM completed a randomized, double-blind crossover study, which consisted of 4 6-week trials of FL (20 mg), AM (25 mg), a combination of FL and AM, or placebo. Patients were evaluated on the first and last day of each trial period. Outcome measures included a tender point score, the Fibromyalgia Impact Questionnaire (FIQ), the Beck Depression Inventory (BDI) scale, and visual analog scales (VAS) for global well-being (1 completed by the physician and 1 by the patient), pain, sleep trouble, fatigue, and feeling refreshed upon awakening. RESULTS: Both FL and AM were associated with significantly improved scores on the FIQ and on the VAS for pain, global well-being, and sleep disturbances. When combined, the 2 treatments worked better than either medication alone. Similar, but nonsignificant, improvement occurred in the BDI scale, the physician global VAS, and the VAS for fatigue and feeling refreshed upon awakening. Trends were less clear for the tender point score. CONCLUSION: Both FL and AM are effective treatments for FM, and they work better in combination than either medication alone.

The effect of zolpidem in patients with fibromyalgia: a dose ranging, double blind, placebo controlled, modified crossover study.

Authors » Moldofsky H , Lue FA , Mously C , Roth-Schechter B , Reynolds WJ

Journal » The Journal of rheumatology

Year » 1996

Links » Pubmed

This article is included in 2 Systematic reviews Systematic reviews (2 references) 1 Broad synthesis Broad syntheses (1 reference)

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OBJECTIVE: This dose ranging, double blind, placebo controlled, modified crossover study examined whether zolpidem would improve the disturbed sleep, fatigue, mood and pain symptoms in patients with fibromyalgia (FM). METHODS: All symptoms were rated over 4 nights and 4 conditions for 16 consecutive nights during which 19 patients (mean age 42 years) randomly received placebo or zolpidem 5 mg, 10 mg, or 15 mg at bedtime. RESULTS: The 16 patients who completed the study reported no significant differences in ratings of pain, number of tender points, mood, sleep quality, morning fatigue, morning sleepiness or ability to concentrate. Compared to the placebo group, patients treated with zolpidem recorded significantly reduced time to fall asleep, increased sleep time, reduced awakenings, overall improvement in sleep and daytime energy, but a lower rating for evening energy. Zolpidem at the 10 mg dose was rated most acceptable for sleep. Adverse incidence rates were highest in the placebo group and lowest in the zolpidem 10 mg group. One person withdrew because of migraine while taking zolpidem 10 mg. CONCLUSION: Short term treatment with zolpidem (5 to 15 mg) does not affect the pain of FM, but is useful for sleep and daytime energy in this patient population.

Effects of aerobic exercise versus stress management treatment in fibromyalgia. A 4.5 year prospective study.

Authors » Wigers SH , Stiles TC , Vogel PA

Journal » Scandinavian journal of rheumatology

Year » 1996

Links » Pubmed DOI informahealthcare.com

This article is included in 16 Systematic reviews Systematic reviews (16 references) 1 Broad synthesis Broad syntheses (1 reference)

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To determine and compare short- and long-term effects of aerobic exercise (AE), stress management treatment (SMT), and treatment-as-usual (TAU) in fibromyalgia, 60 patients were randomized to 14 weeks of treatment by either AE, SMT or TAU. Outcome measures at baseline, midway through treatment, at treatment completion, and at 4 year follow up included a patient made drawing of pain distribution, dolorimetry of tender points, ergometer cycle test, global subjective improvement, and VAS registrations of: pain, disturbed sleep, lack of energy, and depression. Both AE and SMT showed positive short-term effects. AE was the overall most effective treatment, despite being subject to the most sceptical patient attitude prior to the study. At follow up, there were no obvious group differences in symptom severity, which for AE seemed to be due to a considerable compliance problem.

An exercise program in the treatment of fibromyalgia.

Authors » Martin L , Nutting A , MacIntosh BR , Edworthy SM , Butterwick D , Cook J

Journal » The Journal of rheumatology

Year » 1996

Links » Pubmed

This article is included in 6 Systematic reviews Systematic reviews (6 references)

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OBJECTIVE: To assess the utility of an exercise program, which included aerobic, flexibility and strengthening elements, in the treatment of fibromyalgia (FM). FM is a chronic musculoskeletal condition characterized by diffuse musculoskeletal pain and aching. It has been suggested that aerobic exercise is helpful in its treatment. METHODS: We studied 60 patients who met American College of Rheumatology criteria for FM and had no significant comorbidities. Measurements performed on each patient at the pre and poststudy assessment included the number of tender points (TP), total myalgic scores (TM), aerobic fitness (AF), flexibility and isokinetic strength. After initial evaluation patients were randomly assigned to either an exercise or a relaxation group. Each group met 3 times per week for 6 weeks for 1 h of supervised exercise or relaxation. All patients data were stored in a computerized database and statistical analysis was performed on all pre and poststudy assessments. RESULTS: Thirty-eight patients (18 exercise and 20 relaxation) completed the study. Analysis of our data showed no significant difference between the groups in their prestudy assessment. Poststudy assessments, however, showed a significant improvement between the exercise and relaxation groups in TP (p < 0.05), TM (p < 0.05), and AF (p < 0.05). Similar improvements were also found when the pre and poststudy assessment of the exercise group were compared. CONCLUSION: Exercise is helpful in the management of FM in the short term. It also shows that FM patients can undertake an exercise program which includes aerobic, flexibility, and strength training exercises without adverse effects. The long term utility of this type of exercise requires further evaluation.

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Primary studies included in this systematic review