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Cited by 48Fibromyalgia and Chronic Fatigue Syndrome ResearchMyofascial pain diagnosis and treatmentMusculoskeletal pain and rehabilitation

Effectiveness of non-pharmacological conservative therapies in adults with fibromyalgia: A systematic review of high-quality clinical trials

Open access
Hernando-Garijo, Ignacio, Jiménez-del-Barrio, Sandra, Mingo-Gómez, Teresa, Medrano-de-la-Fuente, Ricardo, Ceballos-Laita, Luis·2022·Journal of Back and Musculoskeletal Rehabilitation
DOI 10.3233/bmr-200282
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Abstract

BACKGROUND: Fibromyalgia is a chronic condition characterized by generalized pain. Several studies have been conducted to assess the effects of non-pharmacological conservative therapies in fibromyalgia. OBJECTIVE: To systematically review the effects of non-pharmacological conservative therapies in fibromyalgia patients. METHODS: We searched MEDLINE, Cochrane library, Scopus and PEDro databases for randomized clinical trials related to non-pharmacological conservative therapies in adults with fibromyalgia. The PEDro scale was used for the methodological quality assessment. High-quality trials with a minimum score of 7 out of 10 were included. Outcome measures were pain intensity, pressure pain threshold, physical function, disability, sleep, fatigue and psychological distress. RESULTS: Forty-six studies met the inclusion criteria. There was strong evidence about the next aspects. Combined exercise, aquatic exercise and other active therapies improved pain intensity, disability and physical function in the short term. Multimodal therapies reduced pain intensity in the short term, as well as disability in the short, medium and long term. Manual therapy, needling therapies and patient education provided benefits in the short term. CONCLUSIONS: Strong evidence showed positive effects of non-pharmacological conservative therapies in the short term in fibromyalgia patients. Multimodal conservative therapies also could provide benefits in the medium and long term. © 2022 - IOS Press. All rights reserved.

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Registry

Crossref · 10.3233/bmr-200282

Cites

85 of 87 references verified0 citation errors · 2 not checkable

Statistics

Nothing to recompute.

Claims the paper makes

90 of 283 cited sources checked · 23 supported · 6 flagged · accuracy not yet measured

  • Study design and conductcitation

    Only RCTs scoring at least 7 on the PEDro scale, indicating high methodological quality, were included.

    “High-quality trials with a minimum score of 7 out of 10 were included.”
    • Also stated in: § 2.2. The review question · plain
      “Study design: RTCs with a minimum score of 7 in the PEDro scale, corresponding to high methodological quality [21].”
    Quote in the paperSubstantial claim1 of 1 sources checked
    • cites [21] Walser, 2009, The effectiveness of thoracic spine manipulation for the management of musculoskeletal conditions: a systematic review and meta-analysis of randomized clinical trials, J Man Manip Ther. source

      The Methodological Quality section (p. 241) reports PEDro scores from 4 to 9 and says that only seven studies were high quality; four were fair quality and two were poor quality. The Methodological Quality Assessment section defines 7 or higher as high quality, but not as an inclusion threshold. (LLM, conf=0.93)

      Checked by a reasoning model — may be wrong.

      Experimental — accuracy not yet measured
  • Findingcitation

    Strong evidence indicated that neural therapy reduces disability in adults with fibromyalgia in the medium term.

    “However, strong evidence showed that NT were effective in the medium term [34,35].”
    Quote in the paperSubstantial claim1 of 2 sources checked
    • cites [34] Mist, 2018, Randomized controlled trial of acupuncture for women with fibromyalgia: group acupuncture with traditional chinese medicine diagnosis-based point selection, Pain Med. source

      The Results (Primary Outcome Analysis—FIQR Total; page unavailable) report improved fibromyalgia impact after group acupuncture, not neural therapy. The Discussion (page unavailable) calls the evidence preliminary and says follow-up lasted only four weeks, contrary to the attribution of strong evidence for a medium-term effect. (LLM, conf=0.88)

      Checked by a reasoning model — may be wrong.

      Experimental — accuracy not yet measured
    • cites [35] Karatay, 2018, Effects of acupuncture treatment on fibromyalgia symptoms, serotonin, and substance p levels: a randomized sham and placebo-controlled clinical trial, Pain Med. source
  • Findingown data

    Moderate evidence from this review indicates that active therapies improve disability in adults with fibromyalgia in the long term.

    “Our results also showed moderate evidence that active therapies improved pain intensity, disability and physical function in the long term, and sleep quality, anxiety and depression in the short term [11,44,45,47,48,51,52,54,55,57,58].”
    Quote in the paperSubstantial claim4 of 10 sources checked
    • cites [11] Andrade, 2019, Effects of aquatic training and detraining on women with fibromyalgia: controlled randomized clinical trial, Eur J Phys Rehabil Med. source
    • cites [44] Wang, 2018, Effect of tai chi versus aerobic exercise for fibromyalgia: comparative effectiveness randomized controlled trial, BMJ. source

      The Results (page unavailable) report sustained improvement in fibromyalgia impact scores after tai chi and aerobic exercise, which supports a long-term benefit from these active therapies. But the paper is a trial, not the citing authors’ review, and its 52-week disability-measure comparisons were not statistically significant. It therefore does not establish the stated level of evidence for improved disability. (LLM, conf=0.83)

      Experimental — accuracy not yet measured
    • cites [45] Baptista, 2012, Effectiveness of dance in patients with fibromyalgia: a randomised, single-blind, controlled study, Clin Exp Rheumatol.
    • cites [47] Assis, 2006, A randomized controlled trial of deep water running: clinical effectiveness of aquatic exercise to treat fibromyalgia, Arthritis Care Res. source
    • cites [48] Gowans, 2001, Effect of a randomized, controlled trial of exercise on mood and physical function in individuals with fibromyalgia, Arthritis Rheum. source
    • cites [51] Mannerkorpi, 2010, Does moderate-to-high intensity Nordic walking improve functional capacity and pain in fibromyalgia? A prospective randomized controlled trial, Arthritis Res Ther. source

      The Six-month follow-up of NW section reports no significant improvement in FIQ Physical, the study’s measure of activity limitations (disability). The paper is a randomized trial, not a review assessing the strength of evidence across active therapies; its reported long-term disability result is contrary to the attributed claim. (LLM, conf=0.88)

      Checked by a reasoning model — may be wrong.

      Experimental — accuracy not yet measured
    • cites [52] Da Costa, 2005, A randomized clinical trial of an individualized home-based exercise programme for women with fibromyalgia, Rheumatology (Oxford). source

      The Results (p. 1) report improved functional capacity at 3 and 9 months after treatment among women with fibromyalgia who were more functionally disabled at baseline. This supports a long-term benefit for that group, but the source is a single exercise trial, not a review grading the evidence as moderate for active therapies broadly or for all adults with fibromyalgia. (LLM, conf=0.87)

      Experimental — accuracy not yet measured
    • cites [54] Ide, 2008, Effect of aquatic respiratory exercise-based program in patients with fibromyalgia, Int J Rheum Dis. source
    • cites [55] de Carvalho, 2006, Hydrotherapy and conventional physiotherapy improve total sleep time and quality of life of fibromyalgia patients: randomized clinical trial, Sleep Med. source
    • cites [57] Ang, 2011, Research to encourage exercise for fibromyalgia (REEF): use of motivational interviewing design and method, Contemp Clin Trials. source

      The Introduction says supervised exercise improves physical function in people with fibromyalgia and that those who continue exercising are most likely to maintain its benefits. But this paper describes a trial design, not a review; it does not grade the evidence as moderate or establish a long-term improvement in disability from active therapies generally. No page number was available in our copy. (LLM, conf=0.84)

      Experimental — accuracy not yet measured
  • Findingown data

    Moderate evidence from this review indicates that active therapies improve pain intensity in adults with fibromyalgia in the long term.

    “Our results also showed moderate evidence that active therapies improved pain intensity, disability and physical function in the long term, and sleep quality, anxiety and depression in the short term [11,44,45,47,48,51,52,54,55,57,58].”
    Quote in the paperSubstantial claim4 of 10 sources checked
    • cites [11] Andrade, 2019, Effects of aquatic training and detraining on women with fibromyalgia: controlled randomized clinical trial, Eur J Phys Rehabil Med. source
    • cites [44] Wang, 2018, Effect of tai chi versus aerobic exercise for fibromyalgia: comparative effectiveness randomized controlled trial, BMJ. source

      The Discussion (page unavailable) says continuing exercise maintains positive effects on pain, and the Results report improvement at 52 weeks in this fibromyalgia trial. But this paper is a randomized trial of tai chi versus aerobic exercise, not a review grading the evidence as moderate for active therapies generally; the cited results also do not establish a long-term improvement in pain intensity specifically. (LLM, conf=0.84)

      Experimental — accuracy not yet measured
    • cites [45] Baptista, 2012, Effectiveness of dance in patients with fibromyalgia: a randomised, single-blind, controlled study, Clin Exp Rheumatol.
    • cites [47] Assis, 2006, A randomized controlled trial of deep water running: clinical effectiveness of aquatic exercise to treat fibromyalgia, Arthritis Care Res. source
    • cites [48] Gowans, 2001, Effect of a randomized, controlled trial of exercise on mood and physical function in individuals with fibromyalgia, Arthritis Rheum. source
    • cites [51] Mannerkorpi, 2010, Does moderate-to-high intensity Nordic walking improve functional capacity and pain in fibromyalgia? A prospective randomized controlled trial, Arthritis Res Ther. source

      This source is a randomized trial, not a review. Its Six-month follow-up of NW section reports no significant improvement in pain (FIQ Pain, P = 0.879), and the Discussion says pain did not significantly decrease in either exercise group. It therefore does not support the attributed long-term pain improvement. (LLM, conf=0.90)

      Checked by a reasoning model — may be wrong.

      Experimental — accuracy not yet measured
    • cites [52] Da Costa, 2005, A randomized clinical trial of an individualized home-based exercise programme for women with fibromyalgia, Rheumatology (Oxford). source

      The Discussion (p. 5) reports that moderate-intensity exercise reduced upper-body pain in women with fibromyalgia, with the improvement maintained nine months after treatment. It also says the reduction in lower-body pain was not significant. This trial therefore supports a long-term pain benefit for a specific exercise intervention and pain location, but not the broader claim about active therapies or pain intensity generally; the review’s evidence rating is not a finding of this trial. (LLM, conf=0.87)

      Experimental — accuracy not yet measured
    • cites [54] Ide, 2008, Effect of aquatic respiratory exercise-based program in patients with fibromyalgia, Int J Rheum Dis. source
    • cites [55] de Carvalho, 2006, Hydrotherapy and conventional physiotherapy improve total sleep time and quality of life of fibromyalgia patients: randomized clinical trial, Sleep Med. source
    • cites [57] Ang, 2011, Research to encourage exercise for fibromyalgia (REEF): use of motivational interviewing design and method, Contemp Clin Trials. source

      The Introduction says supervised exercise improves fibromyalgia symptoms and that people who continue exercising are most likely to maintain those benefits; the Discussion describes pain reduction as a clinical benefit of exercise. But this design-and-method paper does not report a review finding of moderate evidence that active therapies generally improve long-term pain intensity. (LLM, conf=0.83)

      Experimental — accuracy not yet measured
  • Findingown data

    Moderate evidence from this review indicates that active therapies improve depression in adults with fibromyalgia in the short term.

    “Our results also showed moderate evidence that active therapies improved pain intensity, disability and physical function in the long term, and sleep quality, anxiety and depression in the short term [11,44,45,47,48,51,52,54,55,57,58].”
    Quote in the paperSubstantial claim4 of 10 sources checked
    • cites [11] Andrade, 2019, Effects of aquatic training and detraining on women with fibromyalgia: controlled randomized clinical trial, Eur J Phys Rehabil Med. source
    • cites [44] Wang, 2018, Effect of tai chi versus aerobic exercise for fibromyalgia: comparative effectiveness randomized controlled trial, BMJ. source
    • cites [45] Baptista, 2012, Effectiveness of dance in patients with fibromyalgia: a randomised, single-blind, controlled study, Clin Exp Rheumatol.
    • cites [47] Assis, 2006, A randomized controlled trial of deep water running: clinical effectiveness of aquatic exercise to treat fibromyalgia, Arthritis Care Res. source
    • cites [48] Gowans, 2001, Effect of a randomized, controlled trial of exercise on mood and physical function in individuals with fibromyalgia, Arthritis Rheum. source
    • cites [51] Mannerkorpi, 2010, Does moderate-to-high intensity Nordic walking improve functional capacity and pain in fibromyalgia? A prospective randomized controlled trial, Arthritis Res Ther. source

      The Study design describes a 15-week walking trial in women with fibromyalgia, and Table 1 reports depression scores only at baseline. The reported post-test outcomes do not include a change in depression, so this paper does not establish the claimed short-term improvement or the review’s strength-of-evidence assessment. (LLM, conf=0.76)

      Experimental — accuracy not yet measured
    • cites [52] Da Costa, 2005, A randomized clinical trial of an individualized home-based exercise programme for women with fibromyalgia, Rheumatology (Oxford). source

      This source is a randomized trial, not the review described in the claim. Its Results (p. 4) report no statistically significant effect of home-based exercise on psychological distress, and its Discussion (p. 5) says participants’ psychological distress did not change. It does not report a short-term improvement in depression. (LLM, conf=0.85)

      Checked by a reasoning model — may be wrong.

      Experimental — accuracy not yet measured
    • cites [54] Ide, 2008, Effect of aquatic respiratory exercise-based program in patients with fibromyalgia, Int J Rheum Dis. source
    • cites [55] de Carvalho, 2006, Hydrotherapy and conventional physiotherapy improve total sleep time and quality of life of fibromyalgia patients: randomized clinical trial, Sleep Med. source
    • cites [57] Ang, 2011, Research to encourage exercise for fibromyalgia (REEF): use of motivational interviewing design and method, Contemp Clin Trials. source

      The Results section reports enrollment and baseline characteristics for an ongoing trial, not treatment effects. The Methods and Design section describes depression measures, but neither it nor the other passages found reports moderate evidence that active therapies improve depression in the short term (searched: depression, exercise, short-term improvement). (LLM, conf=0.76)

      Experimental — accuracy not yet measured
  • Classified as probably not a substantial claim. 17
  • May combine two claims. 19
  • The quote only partly states this claim. 3

  • Classified as probably not a substantial claim.

    Premisecitation

    Current clinical guidelines recommend multimodal conservative treatments to improve pain-related symptoms, physical function, and quality of life in fibromyalgia patients.

    “Current clinical guidelines for the management of patients with FM recommended multimodal conservative treatments to improve the pain-related symptoms, the physical function and the quality of life [9,10].”
    Quote in the paperSubstantial claim2 of 2 sources checked
    • cites [9] Macfarlane, 2017, EULAR revised recommendations for the management of fibromyalgia, Ann Rheum Dis. source

      The EULAR revised recommendations section (page not provided) recommends starting with non-pharmacological care and aims to improve health-related quality of life. It also recommends multimodal rehabilitation, but only weakly and for patients with severe disability after earlier approaches have not worked; the claim presents multimodal conservative treatment as a general recommendation for fibromyalgia patients. (LLM, conf=0.86)

      Experimental — accuracy not yet measured
    • cites [10] Fitzcharles, 2013, 2012 Canadian guidelines for the diagnosis and management of fibromyalgia syndrome: executive summary, Pain Res Manag. source

  • Probably not a substantial claim: may not pass S3 (load-bearing).

    Study design and conductcitation

    The review followed PRISMA guidelines.

    “A systematic review of high-quality RCT was carried out following the Preferred Reporting Items for Systematic Reviews and Meta-Analysis (PRISMA) guidelines [20].”
    Quote in the paperNot a substantial claim1 of 1 sources checked
    • cites [20] Shamseer, 2015, Preferred reporting items for systematic review and meta-analysis protocols (prisma-p) 2015: elaboration and explanation, BMJ. source

      The paper’s title and Discussion identify it as guidance for PRISMA-P, which concerns systematic review protocols. Its References list the separate PRISMA statement for reporting systematic reviews. This source therefore supports the connection to PRISMA guidance, but not the claim that the citing authors’ completed review followed the PRISMA guidelines. (LLM, conf=0.84)

      Experimental — accuracy not yet measured

  • Probably not a substantial claim: may not pass S3 (load-bearing). May combine two claims.

    Premisecitation

    Fibromyalgia is a chronic pain condition with widespread musculoskeletal pain, hyperalgesia, allodynia, and is often accompanied by fatigue, poor sleep, anxiety, and depression.

    “Fibromyalgia (FM) is a chronic pain condition characterized by generalized musculoskeletal pain, hyper-algesia and allodynia, commonly associated with other symptoms, such as fatigue, poor sleep quality, anxiety and depression [1,2].”
    Quote in the paperNot a substantial claim1 of 2 sources checked
    • cites [1] Bennett, 2016, Pain management in fibromyalgia, Pain Manag. source

      The opening section describes fibromyalgia as a pain syndrome involving widespread pain, tenderness, fatigue, nonrefreshing sleep, and mood disorders (page not provided). It does not specifically identify hyperalgesia, allodynia, anxiety, or depression; the latter two are covered only at the broader level of mood disorders. (LLM, conf=0.85)

      Experimental — accuracy not yet measured
    • cites [2] Cabo-Meseguer, 2017, Fibromyalgia: prevalence, epidemiologic profiles and economic costs, Med Clin (Barc). source

  • Classified as probably not a substantial claim.

    Premisecitation

    Guidelines list non-pharmacological therapies such as exercise therapy, mind-body therapies, patient education, manual therapy, needling therapies, balneotherapy, and multimodal therapies as conservative treatments.

    “Among the conservative treatments, clinical guidelines include non-pharmacological therapies such as Exercise Therapy (ET), mind-body therapies, Patient Education (PE), Manual Therapy (MT), Needling Therapies (NT), balneotherapy and multimodal therapies [9,10].”
    Quote in the paperSubstantial claim2 of 2 sources checked
    • cites [9] Macfarlane, 2017, EULAR revised recommendations for the management of fibromyalgia, Ann Rheum Dis. source

      The EULAR revised recommendations section supports exercise, meditative movement and mindfulness therapies, acupuncture, and hydrotherapy; it also calls for patient information and considers multimodal rehabilitation. The Hydrotherapy/spa therapy section discusses balneotherapy. However, the guideline does not recommend the manual therapies it evaluates: massage receives a weak-against evaluation and chiropractic a strong-against evaluation, so the list overstates their inclusion as recommended treatments. No page numbers are available in our copy. (LLM, conf=0.88)

      Experimental — accuracy not yet measured
    • cites [10] Fitzcharles, 2013, 2012 Canadian guidelines for the diagnosis and management of fibromyalgia syndrome: executive summary, Pain Res Manag. source

      The nonpharmacological overview and physical activity sections recommend active nonpharmacological care and exercise; the psychological interventions and management sections also support cognitive behavioural and multimodal approaches (pages not supplied). But the guidelines do not list manual or needling therapies and balneotherapy as recommended treatments. The complementary and alternative medicine section instead says evidence is insufficient to recommend such treatments. (LLM, conf=0.88)

      Experimental — accuracy not yet measured

  • Probably not a substantial claim: may not pass S3 (load-bearing). May combine two claims.

    Premisecitation

    These symptoms affect patients' quality of life and social environment.

    “These clinical manifestations have an impact on the quality of life and social environment of the patients [3].”
    Quote in the paperNot a substantial claim1 of 1 sources checked
    • cites [3] Verbunt, 2008, Disability and quality of life in patients with fibromyalgia, Health Qual Life Outcomes. source

  • May combine two claims.

    Findingcitation

    Aquatic exercise therapy, combined types of exercise therapy, and exercise therapy combined with patient education and manual therapy were effective in the medium and long term.

    “Aquatic ET, combined types of ET and the combination of ET with PE and MT were effective in the medium and long term [11,52,58].”
    Quote in the paperSubstantial claim1 of 3 sources checked
    • cites [11] Andrade, 2019, Effects of aquatic training and detraining on women with fibromyalgia: controlled randomized clinical trial, Eur J Phys Rehabil Med. source
    • cites [52] Da Costa, 2005, A randomized clinical trial of an individualized home-based exercise programme for women with fibromyalgia, Rheumatology (Oxford). source

      The Intervention (p. 2) describes a home-based programme prescribing aerobic, stretching and strength exercises, and the Discussion (p. 5) reports benefits maintained at nine months after treatment. This supports the claim about combined types of exercise over the medium and longer term, but the paper does not establish effectiveness for aquatic exercise or for exercise combined with patient education and manual therapy. (LLM, conf=0.88)

      Experimental — accuracy not yet measured
    • cites [58] Lemstra, 2005, The effectiveness of multidisciplinary rehabilitation in the treatment of fibromyalgia: a randomized controlled trial, Clin J Pain. source

  • The quote only partly states this claim.

    Findingcitation

    Moderate evidence indicated that fibromyalgia education reduces disability in adults with fibromyalgia in the short term.

    “Moderate evidence showed that FM education and motivational interviewing to encourage exercise reduced significantly disability in the short term [38,57].”
    Quote in the paperSubstantial claim1 of 2 sources checked
    • cites [38] Bağdatlı, 2015, Does addition of “mud-pack and hot pool treatment” to patient education make a difference in fibromyalgia patients? A randomized controlled single blind study, Int J Biometeorol. source
    • cites [57] Ang, 2011, Research to encourage exercise for fibromyalgia (REEF): use of motivational interviewing design and method, Contemp Clin Trials. source

      The Methods and Design section (2.4; page unavailable) describes fibromyalgia education as the attention-control intervention. The paper reports baseline data and says outcome assessments will test effects later; it does not report a short-term reduction in disability from education. Searches for education, disability improvement, and short-term outcomes found no such result. (LLM, conf=0.76)

      Experimental — accuracy not yet measured

  • May combine two claims.

    Interpretationcitation

    Manual therapy effects could involve biomechanical mediators such as the therapeutic procedure and tissue adaptations, and neurophysiological mediators including decreased inflammatory environment, sympathetic nervous system excitation, and modulation of afferent nerve fibers.

    “MT effects could involve biomechanical mediators, such as the therapeutic procedure and the tissue adaptations, and neurophysiological mediators, including the decrease in the inflammatory environment, the excitation of the sympathetic nervous system and the modulation of afferent nerve fibers [72,73].”
    Quote in the paperNot a substantial claim1 of 2 sources checked
    • cites [72] Bialosky, 2018, Unraveling the mechanisms of manual therapy: modeling an approach, J Orthop Sports Phys Ther. source
    • cites [73] Bishop, 2015, What effect can manual therapy have on a patient’s pain experience, Pain Manag. source

      Split into 2 atoms — 1 confirmed, 1 partially supported, 0 disputed, 0 misattributed, 0 unverifiable. Expand the claim to see per-atom verdicts.

      Experimental — accuracy not yet measured

  • May combine two claims.

    Premisecitation

    Opioids produce an immediate decrease in pro-inflammatory cytokines and interleukins, neurotransmitters and neuromodulators, producing a strong analgesic effect.

    “Opioids produce an immediate decrease in the concentration of pro-inflammatory cytokines and interleukins, neurotransmitters and neuromodulators, producing a strong analgesic effect [78,79].”
    Quote in the paperNot a substantial claim1 of 2 sources checked
    • cites [78] Shah, 2008, Biochemicals associated with pain and inflammation are elevated in sites near to and remote from active myofascial trigger points, Arch Phys Med Rehabil. source
    • cites [79] Hsieh, 2012, Dry needling at myofascial trigger spots of rabbit skeletal muscles modulates the biochemicals associated with pain, inflammation, and hypoxia, Evidence-based Complement Altern Med. source

      Section 4.1 says endogenous opioids can inhibit release of the neuroinflammatory mediator substance P and produce analgesia. It does not report an immediate decrease in pro-inflammatory cytokines or interleukins caused by opioids. In its dry-needling experiment, TNF-α increased immediately even as substance P decreased; page numbers are unavailable in our copy. (LLM, conf=0.88)

      Experimental — accuracy not yet measured

  • Probably not a substantial claim: may not pass S3 (load-bearing).

    Interpretationcitation

    Opioid and serotonergic mechanisms could modulate pain-related symptoms through pain processing areas in the central nervous system.

    “Opioid and serotonergic mechanisms could modulate pain-related symptoms, through pain processing areas in the central nervous system [42,68,71].”
    Quote in the paperNot a substantial claim1 of 3 sources checked
    • cites [42] Collado-Mateo, 2017, Effects of exergames on quality of life, pain, and disease effect in women with fibromyalgia: a randomized controlled trial, Arch Phys Med Rehabil. source
    • cites [68] Lima, 2017, Does exercise increase or decrease pain? Central mechanisms underlying these two phe-nomena, J Physiol. source
    • cites [71] Porreca, 2002, Chronic pain and medullary descending facilitation, Trends Neurosci. source

  • May combine two claims.

    Premisecitation

    Needle insertion provokes secretion of endogenous opioids and an increase in β-endorphin.

    “The insertion of the needle provokes the secretion of endogenous opioids and the increment of β-endorphin [78,79].”
    Quote in the paperSubstantial claim1 of 2 sources checked
    • cites [78] Shah, 2008, Biochemicals associated with pain and inflammation are elevated in sites near to and remote from active myofascial trigger points, Arch Phys Med Rehabil. source
    • cites [79] Hsieh, 2012, Dry needling at myofascial trigger spots of rabbit skeletal muscles modulates the biochemicals associated with pain, inflammation, and hypoxia, Evidence-based Complement Altern Med. source

      Results §3.2 reports that one dose of dry needling increased β-endorphin in rabbit muscle and serum immediately after treatment, but five doses decreased serum β-endorphin immediately afterward. Discussion §4.1 describes endogenous-opioid secretion as an effect of acupuncture reported in earlier studies; this study did not directly measure opioid secretion. The unqualified claim about needle insertion therefore goes beyond this paper’s dose-dependent findings. (LLM, conf=0.86)

      Experimental — accuracy not yet measured

  • The quote only partly states this claim.

    Findingcitation

    In Castro-Sanchez et al. (2017), the cross tape group improved on 22 of 26 pressure pain threshold points (P < 0.05).

    “G1 and G2 improved in VAS pain and 22 out of 26 points PPT (P < 0.05).”
    Quote in the paperNot a substantial claim1 of 1 sources checked
    • cites Castro-Sanchez et al. (2017) source

  • The quote only partly states this claim.

    Findingcitation

    In Castro-Sanchez et al. (2017), the dry needling group improved on 22 of 26 pressure pain threshold points (P < 0.05).

    “G1 and G2 improved in VAS pain and 22 out of 26 points PPT (P < 0.05).”
    Quote in the paperNot a substantial claim1 of 1 sources checked
    • cites Castro-Sanchez et al. (2017) source

  • May combine two claims.

    Interpretationcitation

    Modification of behaviors and adoption of coping strategies could reduce the negative impact of fibromyalgia, improving disability and depression.

    “The modification of behaviors and the adoption of coping strategies could reduce the negative impact of FM, improving disability and depression [13,27].”
    Quote in the paperSubstantial claim2 of 2 sources checked
    • cites [13] Simister, 2018, Randomized controlled trial of online acceptance and commitment therapy for fibromyalgia, J Pain. source
    • cites [27] Thieme, 2006, Psychological pain treatment in fibromyalgia syndrome: efficacy of operant behavioural and cognitive behavioural treatments, Arthritis Res Ther. source

      The Results (Physical impairment) report reduced functional limitations after behavioural treatments, and the Results (Affective distress) report reduced affective distress, particularly after cognitive behavioural therapy. The Discussion links improved coping strategies to reduced affective distress. The paper does not report a depression-specific treatment outcome, so the claim’s reference to improved depression is more specific than the evidence. (LLM, conf=0.86)

      Experimental — accuracy not yet measured

  • Probably not a substantial claim: may not pass S2 (checkable), S3 (load-bearing). May combine two claims.

    Interpretationreasoning

    This allows the patient to take more control and be an active participant in treatment.

    “This fact allows the patient to take more control and to be an active participant in the treatment [81,82].”
    Quote in the paperNot a substantial claim1 of 2 sources checked
    • cites [81] García-Ríos, 2019, Effectiveness of health education in patients with fibromyalgia: a systematic review, Eur J Phys Rehabil Med. source
    • cites [82] Van Koulil, 2011, Tailored cognitive-behavioural therapy and exercise training improves the physical fitness of patients with fibromyalgia, Ann Rheum Dis. source

  • May combine two claims.

    Findingown data

    Manual therapy, needling therapies, and patient education provided benefits in the short term.

    “Manual therapy, needling therapies and patient education provided benefits in the short term.”
    Quote in the paperSubstantial claim

  • Probably not a substantial claim: may not pass S3 (load-bearing).

    Findingown data

    Exercise therapy was the most frequently used intervention modality.

    “The most used modality of the intervention was ET.”
    Quote in the paperNot a substantial claim

  • Probably not a substantial claim: may not pass S3 (load-bearing).

    Findingown data

    A total of 3384 participants were examined across the trials.

    “In total, 3384 participants were examined in the trials.”
    Quote in the paperNot a substantial claim

  • May combine two claims.

    Findingown data

    From a clinical perspective, the results of this review showed that different types of active therapies seem to improve pain-related variables, physical function and disability in the short and long term.

    “From a clinical perspective, the results achieved in this systematic review showed that different types of active therapies seem to improve pain-related variables, physical function and disability in the short and long term.”
    Quote in the paperSubstantial claim

  • Probably not a substantial claim: may not pass S3 (load-bearing).

    Findingcitation

    In Castro-Sanchez et al. (2011), the craniosacral therapy group improved more than the disconnected magnetotherapy group on 4 of 18 pressure pain threshold points at 17 months.

    “G1 improved compared to G2 in 4 out of 18 points at 17 months.”
    Quote in the paperNot a substantial claim0 of 1 sources checked
    • cites Castro-Sanchez et al. (2011) source

  • May combine two claims.

    Findingown data

    This systematic review of high-quality clinical trials provides moderate to strong evidence that active therapies such as water-based and land-based aerobic exercise therapy, strengthening, exergames and multimodal active therapies improve pain intensity, disability and physical function in the long term in adults with fibromyalgia.

    “The result of this systematic review of high-quality clinical trials provides moderate to strong evidence that active therapies such as water-based and land-based aerobic ET, strengthening, exergames and multimodal active therapies, improved pain intensity, disability and physical function in the long term, and sleep quality, anxiety and depression in the short term in patients with FM.”
    Quote in the paperSubstantial claim

  • Probably not a substantial claim: may not pass S3 (load-bearing).

    Study design and conductown data

    The study protocol was registered on PROSPERO with ID CRD42020154111.

    “The study protocol has been recorded on the International Prospective Register of Systematic Reviews (PROSPERO) with ID CRD42020154111.”
    Quote in the paperNot a substantial claim

  • May combine two claims.

    Premisecitation

    Previous systematic reviews either ignored methodological quality or included low-quality RCTs, resulting in weak or biased conclusions.

    “However, these systematic reviews did not consider methodological quality or included RCTs with low methodological quality, which leads to weak or biased conclusions [9,[17][18][19].”
    Quote in the paperSubstantial claim0 of 1 sources checked
    • cites [9,[17][18][19]

      Couldn’t be matched to a paper in Crossref, so it can’t be checked.

  • Classified as probably not a substantial claim.

    Study design and conductown data

    The PEDro scale was used to assess the methodological quality of included studies.

    “Methodological quality of studies was evaluated using PEDro scale checklist.”
    Quote in the paperSubstantial claim

  • May combine two claims.

    Study design and conductown data

    Most studies satisfied criteria for random allocation, similar baseline characteristics, blinded assessors, and between-group statistical comparisons.

    “Most of the studies met the criteria for random allocation, similar baseline characteristics between groups, blinded assessors and between-group statistical comparisons.”
    Quote in the paperSubstantial claim

  • Classified as probably not a substantial claim.

    Study design and conductcitation

    Evidence was classified into four levels based on scientific evidence levels.

    “Qualitative analysis of this review is based on the scientific evidence levels for the results classification [25].”
    Quote in the paperSubstantial claim0 of 1 sources checked
    • cites [25] van Tulder, 2003, Updated method guidelines for systematic reviews in the cochrane collaboration back review group, Spine (Phila Pa 1976). source

  • Classified as probably not a substantial claim. May combine two claims.

    Study design and conductnone given

    Two independent reviewers screened studies and extracted data, and a third reviewer resolved disagreements.

    “Data extraction and methodological quality analysis of the selected studies were carried out by two independent reviewers following the same methodology and a third reviewer outside of the first process decided in case of disagreement.”
    Quote in the paperSubstantial claim

  • May combine two claims.

    Study design and conductown data

    Twenty-four studies scored 7, twenty-two scored 8, and none scored 9 or 10 on the PEDro scale.

    “Twenty-four studies showed a score of 7 [15,[28][29][30][32][33][34][35][36]38,[41][42][43][44]48,49,53,54,56,57,62,63,65], 22 showed a score of 8 [11][12][13][14]16,26,31,37,40,[45][46][47][50][51][52]55,[58][59][60][61]64] and no one presented a score of 9 or 10.”
    Quote in the paperSubstantial claim

  • May combine two claims.

    Interpretationcitation

    The improvement in disability may be related to a decrease in pain intensity, allowing patients with less pain to adopt a more active lifestyle, increasing physical function and avoiding disability.

    “The improvement on disability may be related to the decrease on pain intensity.Therefore, patients with less pain could adopt a more active lifestyle increasing physical function and avoiding disability [42].”
    Quote in the paperNot a substantial claim0 of 1 sources checked
    • cites [42] Collado-Mateo, 2017, Effects of exergames on quality of life, pain, and disease effect in women with fibromyalgia: a randomized controlled trial, Arch Phys Med Rehabil. source

  • May combine two claims.

    Interpretationcitation

    Reduced peripheral nociception would decrease neuron activity in the dorsal horn of the spinal cord, which may explain improvements in pain-related variables and other symptoms.

    “The reduction of peripheral nociception would decrease the neuron activity in the dorsal horn of the spinal cord.This fact may explain the improvements in pain-related variables and other symptoms [12,80].”
    Quote in the paperSubstantial claim0 of 2 sources checked
    • cites [12] Castro Sánchez, 2019, Improvement in clinical outcomes after dry needling versus myofascial release on pain pressure thresholds, quality of life, fatigue, pain intensity, quality of sleep, anxiety, and depression in patients with fibromyalgia syndrome, Disabil Rehabil. source
    • cites [80] Hsieh, 2011, Spinal cord mechanism involving the remote effects of dry needling on the irritability of myofascial trigger spots in rabbit skeletal muscle, Arch Phys Med Rehabil. source

  • May combine two claims.

    Interpretationreasoning

    Neural therapy appears to reduce both peripheral and central sensitization.

    “NT appear to reduce both peripheral and central sensitization.”
    Quote in the paperSubstantial claim

  • Probably not a substantial claim: may not pass S3 (load-bearing).

    Premisecitation

    Exercise therapy promotes neuroplasticity mechanisms that enhance the ability to improve performance in different skills.

    “Moreover, ET promotes neuroplasticity mechanisms, and that enhances the ability to improve performance in different skills [69,70].”
    Quote in the paperNot a substantial claim0 of 2 sources checked
    • cites [69] Qaisar, 2016, Muscle fiber type diversification during exercise and regeneration, Free Radic Biol Med. source
    • cites [70] Hötting, 2013, Beneficial effects of physical exercise on neuroplasticity and cognition, Neurosci Biobehav Rev. source

  • Probably not a substantial claim: may not pass S3 (load-bearing). May combine two claims.

    Study design and conductnone given

    Only studies in English and Spanish were included, while studies in other languages were not considered, potentially excluding relevant evidence.

    “Finally, only studies in English and Spanish were included, while studies in other languages were not considered, potentially excluding relevant evidence.”
    Quote in the paperNot a substantial claim

  • Probably not a substantial claim: may not pass S3 (load-bearing).

    Study design and conductnone given

    The consistency of independent reviewers was not calculated during the systematic searches.

    “Another limitation is that the consistency of the independent reviewers was not calculated during the systematic searches.”
    Quote in the paperNot a substantial claim
34 of 34

  • The paper relies on this without support.

    No prior study provides a broad perspective of non-pharmacological conservative treatments for fibromyalgia management.

    “To the best of our knowledge, there are no studies that provide a broad perspective of non-pharmacological conservative treatments for the management of patients with FM.”
1 of 1

Self-check

Percentages, sums and reported differences re-computed from the paper’s own numbers.

Each contradiction between two passages listed here was confirmed by an independent check.

  • The stated duration range excludes a cited intervention

    Minor

    The review says the combined-therapy interventions in studies 55-58 lasted three to six weeks, but its entry for study 57 specifies 12 weeks.

1 of 1

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Authors
Hernando-Garijo, I., Jiménez-del-Barrio, S., Mingo-Gómez, T., Medrano-de-la-Fuente, R., & Ceballos-Laita, L.
Affiliations
  • Universidad de Valladolid (ES)
  • Independent Physical Therapist, Spain
Corresponding author
Hernando-Garijo, Ignacio
ORCID
Hernando-Garijo, Ignacio
Venue
Journal of Back and Musculoskeletal Rehabilitation
Publisher
SAGE Publications
Published
2022-01-12
Volume
35
Issue
1
Pages
3-20
ISSN
  • 1053-8127 (ISSN-L)
  • 1878-6324
DOI
10.3233/bmr-200282
OpenAlex
W3174782328
Cited by
48
References
81
Citations by year
2026: 2 · 2025: 9 · 2024: 13 · 2023: 15 · 2022: 9
FWCI
1.65
Type
journal article
Language
en
Open access
Locations
  • Journal of Back and Musculoskeletal Rehabilitation (publishedVersion)
  • PubMed (publishedVersion)
Topics
  • Health Sciences › Medicine › Psychiatry and Mental health › Fibromyalgia and Chronic Fatigue Syndrome Research
  • Life Sciences › Biochemistry, Genetics and Molecular Biology › Cell Biology › Myofascial pain diagnosis and treatment
  • Health Sciences › Medicine › Pharmacology › Musculoskeletal pain and rehabilitation
Keywords
fibromyalgia, exercise therapy, aquatic exercise, manual therapy, patient education, multimodal therapy, pain intensity, disability, physical function, fatigue, sleep, psychological distress, pressure pain threshold
MeSH terms
Conservative Treatment, Adult, Exercise Therapy, Fatigue, Fibromyalgia, Humans, Exercise

About these checks

Registry, retraction, Cites and statistics results are computed, not judged, with one exception: a printed reference that no index lists is read once by a model before it counts as a citation error. Claims are extracted by a model and kept only when their quote appears verbatim in the text; each cited source is then checked, with a model’s help, for whether it says what the claim relies on. Those verdicts can be wrong — read the claim’s quote and the cited source before relying on one.

Claims read under definition version 3 (extract-v3) on 2026-09-28.

Classified by jev-1.13-20260917 (gold-guideline-v0.2) on 2026-09-28.

Cited sources are checked by gpt-6-sol.

Statistics and arithmetic are recomputed, not judged.

Confidence bands are shown only for fields calibrated on our annotated test set. None is calibrated yet, so no band is shown.

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