The majority of treatment options for fibromyalgia are not supported by high-quality evidence, according to the findings of a systematic review and meta-analysis recently published in JAMA Internal Medicine.

To assess the effectiveness of these therapies on pain reduction and quality of life improvement, study authors searched various databases for randomized or quasi-randomized clinical trials that evaluated these outcomes in fibromyalgia patients. Pain intensity was assessed using the visual analog scale or numerical rating scales, while QOL was evaluated using the Fibromyalgia Impact Questionnaire.

Data was extracted by 2 independent reviewers and the 0 to 10 PEDro scale was utilized to assess the risk of bias. Random-effects models were used to pool effect sizes for specific therapies. Additionally, the Grading of Recommendations Assessment approach was used to assess the quality of evidence.

The review included 224 trials with a total of 29,962 patients. Findings of the study revealed high-quality evidence favoring the short-term use of cognitive behavioral therapy (weighted mean difference [WMD], −0.9; 95% CI, −1.4, −0.3) as well as the medium-term use of both central nervous system depressants (WMD, −1.2; 95% CI, −1.6, −0.8) and antidepressants (WMD, −0.5; 95% CI:,−0.7, −0.4) for pain. Study results also showed that high-quality evidence favored the short-term use of antidepressants (WMD, −6.8; 95% CI, −8.5, −5.2) as well as medium-term use of both central nervous system depressants (WMD, −8.7; 95% CI, −11.3, −6.0) and antidepressants (WMD, −3.5; 95% CI, −4.5, −2.5) for QOL.

“However, these associations were small and did not exceed the minimum clinically important change (2 points on an 11-point scale for pain and 14 points on a 101-point scale for QOL),” the study authors noted. Additionally, evidence surrounding the long-term outcomes of these therapies was found to be lacking.

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Based on these findings, the study authors concluded that “Clinicians and patients should choose therapies by considering other important outcomes in addition to those presented in this review, such as adverse effects, out-of-pocket costs, and patient preferences.”


Mascarenhas RO, Souza MB, Oliveria MX, et al. Association of therapies with reduced pain and improved quality of life in patients with fibromyalgia: a systematic review and meta-analysis [published online October 26, 2020]. JAMA Intern Med. doi: 10.1001/jamainternmed.2020.5651