medwireNews: The results of a systematic review and meta-analysis do not support the effectiveness of most therapies for reducing pain and improving quality of life (QoL) in people with fibromyalgia.
Therapies such as cognitive behavioral therapy (CBT) and antidepressants “may reduce pain and improve QOL in the short to medium term, although the effect size of the associations might not be clinically important to patients,” Vinícius Oliveira (Universidade Federal dos Vales do Jequitinhonha e Mucuri, Diamantina, Brazil) and co-authors write in JAMA Internal Medicine.
Oliveira and team reviewed data from 224 randomized or quasi-randomized clinical trials that investigated fibromyalgia therapies among 29,962 participants.
The studies included 65 different therapies that fell into the categories of single nonpharmacologic treatments (n=36), combinations of two or more nonpharmacologic treatments (n=8), pharmacologic treatments (n=17), combinations of two or more pharmacologic treatments (n=3), or a combination of pharmacologic and nonpharmacologic therapy (n=1).
Among them, only CBT met the GRADE criteria for high-quality evidence of short-term pain reduction. Individuals who received CBT had a weighted mean reduction in visual analog scale pain score (graded on a scale of 0–10) that was a significant 0.9 points greater than that achieved by individuals in the corresponding control group.
However, the researchers note that this difference did not exceed the minimal clinically important difference (MCID) of 2 points.
For medium-term pain, there was high-quality evidence of an effect with central nervous system depressants and antidepressants, but again the significant weighted mean differences (WMDs) between the two groups, at 1.2 and 0.5 points, respectively, did not exceed the threshold for an MCID.
Antidepressants were also backed by high-quality evidence for short- and medium-term improvements in QoL, when assessed using the 101-point Fibromyalgia Impact Questionnaire scale, but as with the pain outcomes, the significant WMDs of 6.8 and 3.5 points, respectively, did not reach a MCID of 14.0 points in this case.
As with pain, central nervous system depressants were associated with medium-term improvements in QoL (WMD=8.7 points) versus control treatments, but the difference did not reach clinical significance, despite the high-quality evidence of an effect.
Furthermore, the researchers found no high- or moderate-quality evidence to support the use of any therapy for pain or QoL in the long term.
Oliveira et al conclude: “Clinicians should be aware that current evidence for most of the available therapies for the management of fibromyalgia is limited to small trials of low methodological quality.”
They add: “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.”
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JAMA Intern Med 2020; doi:10.1001/jamainternmed.2020.5651