Efficacy of multicomponent treatment in fibromyalgia syndrome: A meta‐analysis of randomized controlled clinical trials
Abstract
Objective: To systematically review the efficacy of multicomponent treatment of fibromyalgia syndrome (FMS). Methods: We screened Medline, PsychINFO, Scopus, and the Cochrane Library (through December 2007), as well as reference sections of original studies, reviews, and evidence‐based guidelines. Randomized controlled trials (RCTs) on the multicomponent treatment (at least 1 educational or other psychological therapy with at least 1 exercise therapy) of FMS were analyzed. Results: We included 9 (of 14) RCTs with 1,119 subjects (median treatment time 24 hours) in the meta‐analysis. Effects were summarized using standardized mean differences (SMDs) or weighted mean differences (WMDs). There was strong evidence that multicomponent treatment reduces pain (SMD −0.37; 95% confidence interval [95% CI] −0.62, −0.13), fatigue (WMD −0.85; 95% CI −1.50, −0.20), depressive symptoms (SMD −0.67; 95% CI −1.08, −0.26), and limitations to health‐related quality of life (HRQOL) (SMD −0.59; 95% CI −0.90, −0.27) and improves self‐efficacy pain (SMD 0.54; 95% CI 0.26, 0.82) and physical fitness (SMD 0.30; 95% CI 0.02, 0.57) at posttreatment. There was no evidence of its efficacy on pain, fatigue, sleep disturbances, depressive symptoms, HRQOL, or self‐efficacy pain in the long term. There was strong evidence that positive effects on physical fitness (SMD 0.30; 95% CI 0.09, 0.51) can be maintained in the long term (median followup 7 months). Conclusions: There is strong evidence that multicomponent treatment has beneficial short‐term effects on the key symptoms of FMS. Strategies to maintain the benefits of multicomponent treatment in the long term need to be developed.
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Aerobic exercise, hydrotherapy, and multicomponent therapy have shown efficacy in alleviating fibromyalgic symptoms without harms.
“Aerobic exercise, hydrotherapy, and multicomponent therapy have shown efficacy in alleviating fibromyalgic symptoms without harms, and can be offered to the patient either as alternative or used adjunctively with pharmacological therapy.7,8,30,33,41”
From Comparative Efficacy and Harms of Duloxetine, Milnacipran, and Pregabalin in Fibromyalgia Syndrome (2010) · cites this paper as [30]
Short-term effects of multidimensional rehabilitation are well established, but concerns about long-term effects have been raised.
“The short-term effects are well established, but concerns about the long-term effects have been raised [7-11].”
Medications, education, CBT, and physical exercises are among the recommended treatment options for individuals with CWP and fibromyalgia.
“Medications, education, CBT, and physical exercises are among the recommended treatment options for individuals with CWP and fibromyalgia [7,9].”
A key element of chronic pain management is self-management, eg, balancing activity and rest, stress management, emotion regulation, and doing appropriate physical exercises.
“A key element is self-management, eg, balancing activity and rest, stress management, emotion regulation, and doing appropriate physical exercises [6-10].”
Multidimensional rehabilitation, including physical exercise and cognitive behavioral therapy (CBT), is recommended as treatment for chronic widespread pain.
“Multidimensional rehabilitation, including physical exercise and cognitive behavioral therapy (CBT), is recommended as treatment [7-8].”
Relapse of symptoms is not uncommon because self-management can be challenging due to the nature of the symptoms.
“However, relapse of symptoms is not uncommon [8,11,12] because self-management can be challenging due to the nature of the symptoms.”
The results of the long-term effects of multidimensional pain programs are inconclusive and the need for maintenance support has been clearly stated.
“Nevertheless, the results of the long-term effects of multidimensional pain programs are inconclusive and the need for maintenance support has been clearly stated [65,8,11,12].”
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- Authors
- Häuser, W., Bernardy, K., Arnold, B., Offenbächer, M., & Schiltenwolf, M.
- Affiliations
- Klinikum Saarbrücken (DE)
- Saarland University (DE)
- Helios Amper-Klinikum Dachau (DE)
- Ludwig-Maximilians-Universität München (DE)
- Heidelberg University (DE)
- Venue
- Arthritis Care & Research
- Publisher
- Wiley
- Published
- 2009-01-29
- Volume
- 61
- Issue
- 2
- Pages
- 216-224
- ISSN
- 0893-7524 (ISSN-L)
- 1529-0123
- OpenAlex
- W2019047778
- Cited by
- 378
- References
- 42
- Citations by year
- 2026: 7 · 2025: 12 · 2024: 31 · 2023: 25 · 2022: 14 · 2021: 21 · 2020: 27 · 2019: 15 · 2018: 17 · 2017: 15 · 2016: 18 · 2015: 28 · 2014: 21 · 2013: 33 · 2012: 29
- FWCI
- 3.91
- Type
- journal article
- Language
- en
- Open access
- closed
- Locations
- Arthritis Care & Research (publishedVersion)
- PubMed (publishedVersion)
- mediaTUM – the media and publications repository of the Technical University Munich (Technical University Munich) (submittedVersion)
- Topics
- Health Sciences › Medicine › Psychiatry and Mental health › Fibromyalgia and Chronic Fatigue Syndrome Research
- Health Sciences › Medicine › Pharmacology › Musculoskeletal pain and rehabilitation
- Life Sciences › Biochemistry, Genetics and Molecular Biology › Cell Biology › Myofascial pain diagnosis and treatment
- Keywords
- fibromyalgia, multicomponent intervention, exercise therapy, psychotherapy, pain, fatigue, depressive symptoms, health-related quality of life, pain self-efficacy, physical fitness
- MeSH terms
- Adult, Combined Modality Therapy, Female, Fibromyalgia, Humans, Male, Middle Aged, Randomized Controlled Trials as Topic, Treatment Outcome
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