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Meta-Analysis
. 2015 Apr 9;2015(4):CD001980.
doi: 10.1002/14651858.CD001980.pub3.

Mind and body therapy for fibromyalgia

Alice Theadom  1 , Mark Cropley, Helen E Smith, Valery L Feigin, Kathryn McPherson
Affiliations
Meta-Analysis

Mind and body therapy for fibromyalgia

Alice Theadom et al. Cochrane Database Syst Rev. .

Abstract

Background: Mind-body interventions are based on the holistic principle that mind, body and behaviour are all interconnected. Mind-body interventions incorporate strategies that are thought to improve psychological and physical well-being, aim to allow patients to take an active role in their treatment, and promote people's ability to cope. Mind-body interventions are widely used by people with fibromyalgia to help manage their symptoms and improve well-being. Examples of mind-body therapies include psychological therapies, biofeedback, mindfulness, movement therapies and relaxation strategies.

Objectives: To review the benefits and harms of mind-body therapies in comparison to standard care and attention placebo control groups for adults with fibromyalgia, post-intervention and at three and six month follow-up.

Search methods: Electronic searches of the Cochrane Central Register of Controlled Trials (CENTRAL), MEDLINE (Ovid), EMBASE (Ovid), PsycINFO (Ovid), AMED (EBSCO) and CINAHL (Ovid) were conducted up to 30 October 2013. Searches of reference lists were conducted and authors in the field were contacted to identify additional relevant articles.

Selection criteria: All relevant randomised controlled trials (RCTs) of mind-body interventions for adults with fibromyalgia were included.

Data collection and analysis: Two authors independently selected studies, extracted the data and assessed trials for low, unclear or high risk of bias. Any discrepancy was resolved through discussion and consensus. Continuous outcomes were analysed using mean difference (MD) where the same outcome measure and scoring method was used and standardised mean difference (SMD) where different outcome measures were used. For binary data standard estimation of the risk ratio (RR) and its 95% confidence interval (CI) was used.

Main results: Seventy-four papers describing 61 trials were identified, with 4234 predominantly female participants. The nature of fibromyalgia varied from mild to severe across the study populations. Twenty-six studies were classified as having a low risk of bias for all domains assessed. The findings of mind-body therapies compared with usual care were prioritised.There is low quality evidence that in comparison to usual care controls psychological therapies have favourable effects on physical functioning (SMD -0.4, 95% CI -0.6 to -0.3, -7.5% absolute change, 2 point shift on a 0 to 100 scale), pain (SMD -0.3, 95% CI -0.5 to -0.2, -3.5% absolute change, 2 point shift on a 0 to 100 scale) and mood (SMD -0.5, 95% CI -0.6 to -0.3, -4.8% absolute change, 3 point shift on a 20 to 80 scale). There is very low quality evidence of more withdrawals in the psychological therapy group in comparison to usual care controls (RR 1.38, 95% CI 1.12 to 1.69, 6% absolute risk difference). There is lack of evidence of a difference between the number of adverse events in the psychological therapy and control groups (RR 0.38, 95% CI 0.06 to 2.50, 4% absolute risk difference).There was very low quality evidence that biofeedback in comparison to usual care controls had an effect on physical functioning (SMD -0.1, 95% CI -0.4 to 0.3, -1.2% absolute change, 1 point shift on a 0 to 100 scale), pain (SMD -2.6, 95% CI -91.3 to 86.1, -2.6% absolute change) and mood (SMD 0.1, 95% CI -0.3 to 0.5, 1.9% absolute change, less than 1 point shift on a 0 to 90 scale) post-intervention. In view of the quality of evidence we cannot be certain that biofeedback has a little or no effect on these outcomes. There was very low quality evidence that biofeedback led to more withdrawals from the study (RR 4.08, 95% CI 1.43 to 11.62, 20% absolute risk difference). No adverse events were reported.There was no advantage observed for mindfulness in comparison to usual care for physical functioning (SMD -0.3, 95% CI -0.6 to 0.1, -4.8% absolute change, 4 point shift on a scale 0 to 100), pain (SMD -0.1, CI -0.4 to 0.3, -1.3% absolute change, less than 1 point shift on a 0 to 10 scale), mood (SMD -0.2, 95% CI -0.5 to 0.0, -3.7% absolute change, 2 point shift on a 20 to 80 scale) or withdrawals (RR 1.07, 95% CI 0.67 to 1.72, 2% absolute risk difference) between the two groups post-intervention. However, the quality of the evidence was very low for pain and moderate for mood and number of withdrawals. No studies reported any adverse events.Very low quality evidence revealed that movement therapies in comparison to usual care controls improved pain (MD -2.3, CI -4.2 to -0.4, -23% absolute change) and mood (MD -9.8, 95% CI -18.5 to -1.2, -16.4% absolute change) post-intervention. There was no advantage for physical functioning (SMD -0.2, 95% CI -0.5 to 0.2, -3.4% absolute change, 2 point shift on a 0 to 100 scale), participant withdrawals (RR 1.95, 95% CI 1.13 to 3.38, 11% absolute difference) or adverse events (RR 4.62, 95% CI 0.23 to 93.92, 4% absolute risk difference) between the two groups, however rare adverse events may include worsening of pain.Low quality evidence revealed that relaxation based therapies in comparison to usual care controls showed an advantage for physical functioning (MD -8.3, 95% CI -10.1 to -6.5, -10.4% absolute change) and pain (SMD -1.0, 95% CI -1.6 to -0.5, -3.5% absolute change, 2 point shift on a 0 to 78 scale) but not for mood (SMD -4.4, CI -14.5 to 5.6, -7.4% absolute change) post-intervention. There was no difference between the groups for number of withdrawals (RR 4.40, 95% CI 0.59 to 33.07, 31% absolute risk difference) and no adverse events were reported.

Authors' conclusions: Psychological interventions therapies may be effective in improving physical functioning, pain and low mood for adults with fibromyalgia in comparison to usual care controls but the quality of the evidence is low. Further research on the outcomes of therapies is needed to determine if positive effects identified post-intervention are sustained. The effectiveness of biofeedback, mindfulness, movement therapies and relaxation based therapies remains unclear as the quality of the evidence was very low or low. The small number of trials and inconsistency in the use of outcome measures across the trials restricted the analysis.

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Conflict of interest statement

Alice Theadom is a psychologist who specialises in conducting research of psychological interventions in health care.

Figures

1
1
Study flow diagram.
2
2
Risk of bias graph: review authors' judgements about each risk of bias item presented as percentages across all included studies.
3
3
Risk of bias summary: review authors' judgements about each risk of bias item for each included study.
1.1
1.1. Analysis
Comparison 1 Psychological therapies versus usual care, Outcome 1 Functioning as assessed post‐intervention.
1.2
1.2. Analysis
Comparison 1 Psychological therapies versus usual care, Outcome 2 Functioning as assessed at 3 month follow‐up.
1.3
1.3. Analysis
Comparison 1 Psychological therapies versus usual care, Outcome 3 Functioning as assessed at 6 month follow‐up.
1.4
1.4. Analysis
Comparison 1 Psychological therapies versus usual care, Outcome 4 Pain as assessed post‐intervention.
1.5
1.5. Analysis
Comparison 1 Psychological therapies versus usual care, Outcome 5 Pain as assessed at 3 month follow‐up.
1.6
1.6. Analysis
Comparison 1 Psychological therapies versus usual care, Outcome 6 Pain as assessed at 6 month follow‐up.
1.7
1.7. Analysis
Comparison 1 Psychological therapies versus usual care, Outcome 7 Mood as assessed post‐intervention.
1.8
1.8. Analysis
Comparison 1 Psychological therapies versus usual care, Outcome 8 Mood as assessed at 3 month follow‐up.
1.9
1.9. Analysis
Comparison 1 Psychological therapies versus usual care, Outcome 9 Mood as assessed at 6 month follow‐up.
1.10
1.10. Analysis
Comparison 1 Psychological therapies versus usual care, Outcome 10 All cause attrition post‐intervention.
1.11
1.11. Analysis
Comparison 1 Psychological therapies versus usual care, Outcome 11 Adverse events post‐intervention.
1.12
1.12. Analysis
Comparison 1 Psychological therapies versus usual care, Outcome 12 Fatigue as assessed post‐intervention.
1.13
1.13. Analysis
Comparison 1 Psychological therapies versus usual care, Outcome 13 Fatigue as assessed at 6 months post‐intervention.
1.14
1.14. Analysis
Comparison 1 Psychological therapies versus usual care, Outcome 14 Self‐efficacy as assessed post‐intervention.
1.15
1.15. Analysis
Comparison 1 Psychological therapies versus usual care, Outcome 15 Tender point count as assessed at 6 month follow‐up.
1.16
1.16. Analysis
Comparison 1 Psychological therapies versus usual care, Outcome 16 Quality of life as assessed post‐intervention.
1.17
1.17. Analysis
Comparison 1 Psychological therapies versus usual care, Outcome 17 Quality of life as assessed at 3 month follow‐up.
1.18
1.18. Analysis
Comparison 1 Psychological therapies versus usual care, Outcome 18 Quality of life as assessed at 6 month follow‐up.
1.19
1.19. Analysis
Comparison 1 Psychological therapies versus usual care, Outcome 19 Sleep as assessed post‐intervention.
1.20
1.20. Analysis
Comparison 1 Psychological therapies versus usual care, Outcome 20 Sleep as assessed at 3 month follow‐up.
1.21
1.21. Analysis
Comparison 1 Psychological therapies versus usual care, Outcome 21 Sleep as assessed at 6 month follow‐up.
1.22
1.22. Analysis
Comparison 1 Psychological therapies versus usual care, Outcome 22 Self‐efficacy as assessed at 3 month follow‐up.
2.1
2.1. Analysis
Comparison 2 Psychological therapies versus usual care sensitivity analyses, Outcome 1 Mood as assessed post‐intervention.
2.2
2.2. Analysis
Comparison 2 Psychological therapies versus usual care sensitivity analyses, Outcome 2 Mood as assessed at 3 month follow‐up.
2.3
2.3. Analysis
Comparison 2 Psychological therapies versus usual care sensitivity analyses, Outcome 3 Fatigue as assessed post‐intervention.
2.4
2.4. Analysis
Comparison 2 Psychological therapies versus usual care sensitivity analyses, Outcome 4 Sleep as assessed post‐intervention.
2.5
2.5. Analysis
Comparison 2 Psychological therapies versus usual care sensitivity analyses, Outcome 5 Sleep as assessed at 6 month follow‐up.
3.1
3.1. Analysis
Comparison 3 Psychological therapies versus attention control, Outcome 1 Functioning as assessed post‐intervention.
3.2
3.2. Analysis
Comparison 3 Psychological therapies versus attention control, Outcome 2 Functioning as assessed at 3 month follow‐up.
3.3
3.3. Analysis
Comparison 3 Psychological therapies versus attention control, Outcome 3 Functioning as assessed at 6 month follow‐up.
3.4
3.4. Analysis
Comparison 3 Psychological therapies versus attention control, Outcome 4 Pain as assessed post‐intervention.
3.5
3.5. Analysis
Comparison 3 Psychological therapies versus attention control, Outcome 5 Pain as assessed at 3 month follow‐up.
3.6
3.6. Analysis
Comparison 3 Psychological therapies versus attention control, Outcome 6 Pain as assessed at 6 month follow‐up.
3.7
3.7. Analysis
Comparison 3 Psychological therapies versus attention control, Outcome 7 Mood as assessed post‐intervention.
3.8
3.8. Analysis
Comparison 3 Psychological therapies versus attention control, Outcome 8 Mood as assessed at 3 month follow‐up.
3.9
3.9. Analysis
Comparison 3 Psychological therapies versus attention control, Outcome 9 All cause attrition post‐intervention.
3.10
3.10. Analysis
Comparison 3 Psychological therapies versus attention control, Outcome 10 Fatigue as assessed post‐intervention.
3.11
3.11. Analysis
Comparison 3 Psychological therapies versus attention control, Outcome 11 Fatigue as assessed at 3 month follow‐up.
3.12
3.12. Analysis
Comparison 3 Psychological therapies versus attention control, Outcome 12 Self‐efficacy as assessed post‐intervention.
3.13
3.13. Analysis
Comparison 3 Psychological therapies versus attention control, Outcome 13 Self efficacy as assessed at 3 month follow‐up.
3.14
3.14. Analysis
Comparison 3 Psychological therapies versus attention control, Outcome 14 Self‐efficacy as assessed at 6 month follow‐up.
3.15
3.15. Analysis
Comparison 3 Psychological therapies versus attention control, Outcome 15 Tender point score as assessed post‐intervention.
3.16
3.16. Analysis
Comparison 3 Psychological therapies versus attention control, Outcome 16 Quality of life as assessed post‐intervention.
3.17
3.17. Analysis
Comparison 3 Psychological therapies versus attention control, Outcome 17 Quality of life as assessed at 3 month follow‐up.
3.18
3.18. Analysis
Comparison 3 Psychological therapies versus attention control, Outcome 18 Quality of life as assessed at 6 month follow‐up.
3.19
3.19. Analysis
Comparison 3 Psychological therapies versus attention control, Outcome 19 Sleep as assessed post‐intervention.
3.20
3.20. Analysis
Comparison 3 Psychological therapies versus attention control, Outcome 20 Sleep as assessed at 3 month follow‐up.
4.1
4.1. Analysis
Comparison 4 Psychological therapies versus attention control sensitivity analyses, Outcome 1 Functioning as assessed post‐intervention.
4.2
4.2. Analysis
Comparison 4 Psychological therapies versus attention control sensitivity analyses, Outcome 2 Functioning as assessed at 6 month follow‐up.
4.3
4.3. Analysis
Comparison 4 Psychological therapies versus attention control sensitivity analyses, Outcome 3 Pain as assessed post‐intervention.
4.4
4.4. Analysis
Comparison 4 Psychological therapies versus attention control sensitivity analyses, Outcome 4 Sleep as assessed post‐intervention.
5.1
5.1. Analysis
Comparison 5 Biofeedback versus usual care, Outcome 1 Functioning as assessed post‐intervention.
5.2
5.2. Analysis
Comparison 5 Biofeedback versus usual care, Outcome 2 Functioning as assessed at 3 month follow‐up.
5.3
5.3. Analysis
Comparison 5 Biofeedback versus usual care, Outcome 3 Pain as assessed post‐intervention.
5.4
5.4. Analysis
Comparison 5 Biofeedback versus usual care, Outcome 4 Mood as assessed post‐intervention.
5.5
5.5. Analysis
Comparison 5 Biofeedback versus usual care, Outcome 5 Mood as assessed at 3 month follow‐up.
5.6
5.6. Analysis
Comparison 5 Biofeedback versus usual care, Outcome 6 All cause attrition post‐intervention.
5.7
5.7. Analysis
Comparison 5 Biofeedback versus usual care, Outcome 7 Tender point score as assessed post‐intervention.
5.8
5.8. Analysis
Comparison 5 Biofeedback versus usual care, Outcome 8 Tender point score as assessed at 3 month follow‐up.
5.9
5.9. Analysis
Comparison 5 Biofeedback versus usual care, Outcome 9 Quality of life (Physical functioning) as assessed post‐intervention.
5.10
5.10. Analysis
Comparison 5 Biofeedback versus usual care, Outcome 10 Quality of life (Role‐Physical) as assessed post‐intervention.
5.11
5.11. Analysis
Comparison 5 Biofeedback versus usual care, Outcome 11 Quality of life (Bodily Pain) as assessed post‐intervention.
5.12
5.12. Analysis
Comparison 5 Biofeedback versus usual care, Outcome 12 Quality of life (General Health) as assessed post‐intervention.
5.13
5.13. Analysis
Comparison 5 Biofeedback versus usual care, Outcome 13 Quality of life (Vitality) as assessed post‐intervention.
5.14
5.14. Analysis
Comparison 5 Biofeedback versus usual care, Outcome 14 Quality of life (Social Functioning) as assessed post‐intervention.
5.15
5.15. Analysis
Comparison 5 Biofeedback versus usual care, Outcome 15 Quality of life (Role‐Emotional) as assessed post‐intervention.
5.16
5.16. Analysis
Comparison 5 Biofeedback versus usual care, Outcome 16 Quality of life (Mental Health) as assessed post‐intervention.
5.17
5.17. Analysis
Comparison 5 Biofeedback versus usual care, Outcome 17 Quality of life (Physical functioning) as assessed at 3 month follow‐up.
5.18
5.18. Analysis
Comparison 5 Biofeedback versus usual care, Outcome 18 Quality of life (Role‐Physical) as assessed at 3 month follow‐up.
5.19
5.19. Analysis
Comparison 5 Biofeedback versus usual care, Outcome 19 Quality of life (Bodily Pain) as assessed at 3 month follow‐up.
5.20
5.20. Analysis
Comparison 5 Biofeedback versus usual care, Outcome 20 Quality of life (Social Functioning) as assessed at 3 month follow‐up.
5.21
5.21. Analysis
Comparison 5 Biofeedback versus usual care, Outcome 21 Quality of life (General Health) as assessed at 3 month follow‐up.
5.22
5.22. Analysis
Comparison 5 Biofeedback versus usual care, Outcome 22 Quality of life (Vitality) as assessed at 3 month follow‐up.
5.23
5.23. Analysis
Comparison 5 Biofeedback versus usual care, Outcome 23 Quality of life (Role‐Emotional) as assessed at 3 month follow‐up.
5.24
5.24. Analysis
Comparison 5 Biofeedback versus usual care, Outcome 24 Quality of life (Mental Health) as assessed at 3 month follow‐up.
6.1
6.1. Analysis
Comparison 6 Biofeedback versus attention control, Outcome 1 Functioning as assessed post‐intervention.
6.2
6.2. Analysis
Comparison 6 Biofeedback versus attention control, Outcome 2 Pain as assessed post‐intervention.
6.3
6.3. Analysis
Comparison 6 Biofeedback versus attention control, Outcome 3 All cause attrition post‐intervention.
6.4
6.4. Analysis
Comparison 6 Biofeedback versus attention control, Outcome 4 Tender point score as assessed post‐intervention.
7.1
7.1. Analysis
Comparison 7 Mindfulness versus usual care, Outcome 1 Functioning as assessed post‐intervention.
7.2
7.2. Analysis
Comparison 7 Mindfulness versus usual care, Outcome 2 Functioning assessed at 3 month follow‐up.
7.3
7.3. Analysis
Comparison 7 Mindfulness versus usual care, Outcome 3 Pain as assessed post‐intervention.
7.4
7.4. Analysis
Comparison 7 Mindfulness versus usual care, Outcome 4 Pain as assessed at 3 month follow‐up.
7.5
7.5. Analysis
Comparison 7 Mindfulness versus usual care, Outcome 5 Mood as assessed post‐intervention.
7.6
7.6. Analysis
Comparison 7 Mindfulness versus usual care, Outcome 6 Mood as assessed at 3 month follow‐up.
7.7
7.7. Analysis
Comparison 7 Mindfulness versus usual care, Outcome 7 All cause attrition post‐intervention.
7.8
7.8. Analysis
Comparison 7 Mindfulness versus usual care, Outcome 8 Sleep as assessed post‐intervention.
7.9
7.9. Analysis
Comparison 7 Mindfulness versus usual care, Outcome 9 Sleep as assessed at 3 month follow‐up.
8.1
8.1. Analysis
Comparison 8 Mindfulness versus usual care ‐ sensitivity analyses, Outcome 1 Mood as assessed at 3 month follow‐up.
9.1
9.1. Analysis
Comparison 9 Movement therapies versus usual care, Outcome 1 Functioning as assessed post‐intervention.
9.2
9.2. Analysis
Comparison 9 Movement therapies versus usual care, Outcome 2 Pain as assessed post‐intervention.
9.3
9.3. Analysis
Comparison 9 Movement therapies versus usual care, Outcome 3 Mood as assessed post‐intervention.
9.4
9.4. Analysis
Comparison 9 Movement therapies versus usual care, Outcome 4 All cause attrition post‐intervention.
9.5
9.5. Analysis
Comparison 9 Movement therapies versus usual care, Outcome 5 Adverse events post‐intervention.
9.6
9.6. Analysis
Comparison 9 Movement therapies versus usual care, Outcome 6 Fatigue as assessed post‐intervention.
9.7
9.7. Analysis
Comparison 9 Movement therapies versus usual care, Outcome 7 Tender point count as assessed post‐intervention.
9.8
9.8. Analysis
Comparison 9 Movement therapies versus usual care, Outcome 8 Sleep as assessed post‐intervention.
10.1
10.1. Analysis
Comparison 10 Movement therapies versus usual care ‐ sensitivity analyses intervention type, Outcome 1 Functioning as assessed post‐intervention.
11.1
11.1. Analysis
Comparison 11 Movement therapies versus usual care ‐ sensitivity analyses quality, Outcome 1 Functioning as assessed post‐intervention.
12.1
12.1. Analysis
Comparison 12 Movement therapies versus attention control, Outcome 1 Functioning as assessed post‐intervention.
12.2
12.2. Analysis
Comparison 12 Movement therapies versus attention control, Outcome 2 Functioning as assessed at 3 month follow‐up.
12.3
12.3. Analysis
Comparison 12 Movement therapies versus attention control, Outcome 3 Pain as assessed by a 10‐point VAS scale post‐intervention.
12.4
12.4. Analysis
Comparison 12 Movement therapies versus attention control, Outcome 4 Pain as assessed by a 10‐point VAS scale at 3 month follow‐up.
12.5
12.5. Analysis
Comparison 12 Movement therapies versus attention control, Outcome 5 Mood as assessed post‐intervention.
12.6
12.6. Analysis
Comparison 12 Movement therapies versus attention control, Outcome 6 Mood as assessed at 3 month follow‐up.
12.7
12.7. Analysis
Comparison 12 Movement therapies versus attention control, Outcome 7 All cause attrition post‐intervention.
12.8
12.8. Analysis
Comparison 12 Movement therapies versus attention control, Outcome 8 Adverse events post‐intervention.
12.9
12.9. Analysis
Comparison 12 Movement therapies versus attention control, Outcome 9 Self‐efficacy as assessed post‐intervention.
12.10
12.10. Analysis
Comparison 12 Movement therapies versus attention control, Outcome 10 Self‐efficacy as assessed at 3 month follow‐up.
12.11
12.11. Analysis
Comparison 12 Movement therapies versus attention control, Outcome 11 Tender points as assessed post‐intervention.
12.12
12.12. Analysis
Comparison 12 Movement therapies versus attention control, Outcome 12 Tender points as assessed at 3 month follow‐up.
12.13
12.13. Analysis
Comparison 12 Movement therapies versus attention control, Outcome 13 Quality of life as assessed post‐intervention.
12.14
12.14. Analysis
Comparison 12 Movement therapies versus attention control, Outcome 14 Quality of life as assessed at 3 month follow‐up.
12.15
12.15. Analysis
Comparison 12 Movement therapies versus attention control, Outcome 15 Sleep quality as assessed by the Pittsburgh Sleep Quality Index post‐intervention.
12.16
12.16. Analysis
Comparison 12 Movement therapies versus attention control, Outcome 16 Sleep quality as assessed by the Pittsburgh Sleep Quality Index at 3 month follow‐up.
13.1
13.1. Analysis
Comparison 13 Movement therapies versus attention control ‐ sensitivity analyses, Outcome 1 Functioning as assessed post‐intervention.
13.2
13.2. Analysis
Comparison 13 Movement therapies versus attention control ‐ sensitivity analyses, Outcome 2 Functioning as assessed at 3 month follow‐up.
13.3
13.3. Analysis
Comparison 13 Movement therapies versus attention control ‐ sensitivity analyses, Outcome 3 Pain as assessed by a 10‐point VAS scale post‐intervention.
13.4
13.4. Analysis
Comparison 13 Movement therapies versus attention control ‐ sensitivity analyses, Outcome 4 Pain as assessed by a 10‐point VAS scale at 3 month follow‐up.
13.5
13.5. Analysis
Comparison 13 Movement therapies versus attention control ‐ sensitivity analyses, Outcome 5 Mood as assessed post‐intervention.
13.6
13.6. Analysis
Comparison 13 Movement therapies versus attention control ‐ sensitivity analyses, Outcome 6 Mood as assessed at 3 month follow‐up.
14.1
14.1. Analysis
Comparison 14 Relaxation versus usual care, Outcome 1 Functioning as assessed post‐intervention.
14.2
14.2. Analysis
Comparison 14 Relaxation versus usual care, Outcome 2 Pain as assessed post‐intervention.
14.3
14.3. Analysis
Comparison 14 Relaxation versus usual care, Outcome 3 Mood as assessed post‐intervention.
14.4
14.4. Analysis
Comparison 14 Relaxation versus usual care, Outcome 4 All cause attrition post‐intervention.
14.5
14.5. Analysis
Comparison 14 Relaxation versus usual care, Outcome 5 Self‐efficacy as assessed post‐intervention.
14.6
14.6. Analysis
Comparison 14 Relaxation versus usual care, Outcome 6 Fatigue as assessed post‐intervention.
14.7
14.7. Analysis
Comparison 14 Relaxation versus usual care, Outcome 7 Sleep as assessed post‐intervention.
15.1
15.1. Analysis
Comparison 15 Relaxation versus attention control, Outcome 1 Pain as assessed post‐intervention.
15.2
15.2. Analysis
Comparison 15 Relaxation versus attention control, Outcome 2 Mood as assessed post‐intervention.
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Update of

  • doi: 10.1002/14651858.CD001980.pub2

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Fors 2000 {published data only}
    1. Fors EA, Gotestam KG. Patient education, guided imagery and pain related talk in fibromyalgia coping. European Journal of Psychiatry 2000;14(4):233‐40.
Garcia 2006 {published data only}
    1. Garcia J, Simon MA, Duran M, Canceller J, Aneiros FJ. Differential efficacy of a cognitive‐behavioral intervention versus pharmacological treatment in the management of fibromyalgic syndrome. Psychology, Health and Medicine 2006;11(4):498‐506. - PubMed
Gillis 2006 {published and unpublished data}
    1. Gillis ME, Lumley MA, Mosley‐Williams A, Leisen JCC, Roehrs T. The health effects of at‐home written emotional disclosure in fibromyalgia: a randomized trial. Annals of Behavioral Medicine 2006;32(2):135‐46. - PMC - PubMed
Hammond 2006 {published data only}
    1. Hammond A, Freeman K. Community patient education and exercise for people with fibromyalgia: a parallel group randomized controlled trial. Clinical Rehabilitation 2006;20:835‐46. - PubMed
Hamnes 2012 {published data only}
    1. Hamnes B, Mowinckel P, Kjeken I, Hagen KB. Effects of a one week multidisciplinary inpatient self‐management programme for patients with fibromyalgia: a randomised controlled trial. BMC Musculoskeletal Disorders 2012;13:189. - PMC - PubMed
Holmer 2004 {published and unpublished data}
    1. Holmer ML, Gevirtz R, Spira JL, Greenberg MA. The effects of yoga on symptoms and psychosocial adjustment in fibromyalgia syndrome patients. Conference abstracts from papers presented at the 35th annual meeting. 2004; Vol. 29:302.
Hsu 2010 {published and unpublished data}
    1. Hsu MC, Schubiner H, Lumley MA, Stracks JS, Clauw DJ, Williams DA. Sustained pain reduction through affective self awareness in fibromyalgia: a randomized controlled trial. Journal of General Internal Medicine 2010;25(10):1064‐70. - PMC - PubMed
Jensen 2012 {published data only}
    1. Jensen KB, Kosek E, Wicksell R, Kemani M, Olsson G, Merle JV, et al. Cognitive behavioral therapy increases pain‐evoked activation of the prefrontal cortex in patients with fibromyalgia. Pain 2012;153:1495‐503. - PubMed
Jones 2012 {published and unpublished data}
    1. Jones KD, Sherman CA, Mist SD, Carson JW, Bennett RM, Li F. A randomized controlled trial of 8‐form tai chi improves symptoms and functional mobility in fibromyalgia patients. Clinical Rheumatology 2012;31:1205‐14. - PMC - PubMed
Kayiran 2010 {published and unpublished data}
    1. Kayiran S, Dursun E, Dursun N, Ermutlu N, Karamursel S. Neurofeedback intervention in fibromyalgia syndrome; a randomized, controlled, rater blind clinical trial. Applied Psychophysiology Biofeedback 2010;35:293‐302. - PubMed
Langford 2009 {published and unpublished data}
    1. Langford MM. The efficacy of a combined cognitive‐behavioural and interpersonal therapy approach to the treatment of fibromyalgia syndrome: a randomized controlled trial. Dissertation.
Lera 2009 {published and unpublished data}
    1. Lera S, Gelman SM, Lopez M, Abenoza M, Zorrilla JG, Castro‐Fornieles J, et al. Multi‐disciplinary treatment of fibromyalgia: does cognitive behavior therapy increase the response to treatment?. Journal of Psychosomatic Research 2009;67:433‐41. - PubMed
Liu 2012 {published and unpublished data}
    1. Liu W, Zahner L, Cornell M, Le T, Ratner J, Wang Y, et al. Benefit of Qigong exercise in patients with fibromyalgia: a pilot study. International Journal of Neuroscience 2012;122:657‐64. - PubMed
Luciano 2011 {published data only}
    1. Luciano JV, Martinez N, Penarrubia‐Maria MT, Fernandez‐Vergel R, Garcia‐Campayo J, Verduras C, Blanco, et al and the FibroQoL Study Group. Effectiveness of a psychoeducational treatment program implemented in a general practice for fibromyalgia patients. Clinical Journal of Pain 2011;27(5):383‐90. - PubMed
Lynch 2012 {published and unpublished data}
    1. Lynch M, Sawynok J, Hiew C, Marcon D. A randomized controlled trial of qigong for fibromyalgia. Arthritis Research and Therapy 2012;14:R178. - PMC - PubMed
Maddali‐Bongh 2010 {published and unpublished data}
    1. Maddali‐Bongi S, Felice C, Rosso A, Galluccio F, Landi G, Tai G, et al. The efficacy of the Resseguier method in the treatment of fibromyalgia syndrome: a randomised controlled trial. Clinical and Experimental Rheumatology 2010;28:S46‐S50. - PubMed
Mannerkorpi 2004 {published and unpublished data}
    1. Mannerkorpi K, Arndorw M. Efficacy and feasibility of a combination of body awareness therapy and qigong in patients with fibromyalgia: a pilot study. Journal of Rehabilitation Medicine 2004;36(6):279‐81. - PubMed
Martinez‐Valero 2008 {published and unpublished data}
    1. Martinez‐Valero C, Castel A, Capafons A, Sala J, Espejo B, Cardena E. Hypnotic treatment synergizes the psychological treatement of fibromyalgia: a pilot study. American Journal of Clinical Hypnosis 2008;50(4):311‐21. - PubMed
Menzies 2006 {published and unpublished data}
    1. Menzies V, Taylor AG, Bourguignon C. Effects of guided imagery on outcomes of pain, functional status, and self efficacy in persons diagnosed with fibromyalgia. The Journal of Alternative and Complementary Medicine 2006;12(1):23‐30. - PMC - PubMed
Miro 2011 {published and unpublished data}
    1. Miro E, Lupianez J, Martinez MP, Snachez AI, Diaz‐Piedra C, Guzman MA, et al. Cognitive‐behavioral therapy for insomnia improves attention function in fibromyalgia syndrome: a pilot randomized controlled trial. Journal of Health Psychology 2011;16(5):770‐82. - PubMed
Oliver 2001 {published and unpublished data}
    1. Oliver K, Cronan TA, Walen HR, Tomita M. Effects of social support and education on health care costs for patients with fibromyalgia. The Journal of Rheumatology 2001;28(12):2711‐9. - PubMed
Oneva‐Zafra 2010 {published and unpublished data}
    1. Oneva‐Zaffra MD, Castro‐Sanchez AM, Mataran‐Penarrocha GA, Moreno‐Lorenzo C. Effect of music as nursing intervention for people diagnosed with fibromyalgia. Pain Management 2010;14(2):e39‐46. - PubMed
Parra‐Delgado 2013 {published and unpublished data}
    1. Parra‐Delgado M, Latorre‐Postigo JM. Effectiveness of mindfulness‐based cognitive therapy in the treatment of fibromyalgia: a randomised trial. Cognitive Therapy Research 2013;37:1015‐26.
Picard 2013 {published data only}
    1. Picard P, Jusseaume C, Boutet M, Duale C, Mulliez A, Aublet‐Cuvellier B. Hypnosis for management of fibromyalgia. International Journal of Clinical and Experimental Hypnosis 2013;61(1):111‐23. - PubMed
Riedel 2012 {published data only}
    1. Riedel SL, Bluefield WV. Effects of guided imagery in persons with fibromyalgia. Electronic thesis 2012.
Scheidt 2013 {published and unpublished data}
    1. Scheidt CE, Waller E, Endorf K, Schmidt S, Konig R, Zeeck A, et al. Is brief psychodynamic psychotherapy in primary fibromyalgia syndrome with concurrent depression an effective treatment? A randomized controlled trial. General Hospital Psychiatry 2013;35:160‐7. - PubMed
Schmidt 2011 {published data only}
    1. Schmidt S, Grossman P, Schwarzer B, Jena S, Naumann J, Walach H. Treating fibromyalgia with mindfulness‐based stress reduction: results from a 3‐armed randomized controlled trial. Pain 2010;152(2):361‐9. - PubMed
Sephton 2007 {published and unpublished data}
    1. Sephton SE, Salmon P, Weissbecker I, Ulmer C, Floyd A, Hoover K, et al. Mindfulness meditation alleviates depressive symptoms in women with fibromyalgia: results of a randomized clinical trial. Arthritis Care and Research 2007;15:77‐85. - PubMed
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Soares 2002 {published and unpublished data}
    1. Soares JJF, Grossi G. A randomized, controlled comparison of educational and behavioural interventions for women with fibromyalgia. Scandinavian Journal of Occupational Therapy 2002;9(1):35‐45.
Stuifbergen 2010 {published and unpublished data}
    1. Stuifbergen AK, Blozis SA, Becker H, Phillips L, Timmerman G, Kullberg V, et al. A randomized controlled trial of a wellness intervention for women with fibromyalgia syndrome. Clinical Rehabilitation 2010;24:305‐18. - PMC - PubMed
Thieme 2006 {published data only}
    1. Thieme K, Flor H, Turk DC. Psychological pain treatment in fibromyalgia syndrome: efficacy of operant behavioural and cognitive behavioural treatments. Arthritis Research and Therapy 2006;8:R121. - PMC - PubMed
Van Santen 2002 {published and unpublished data}
    1. Santen M, Bolwijn P, Verstappen F, Bakker C, Hidding A, Houben H, et al. A randomized clinical trial comparing fitness and biofeedback training versus basic treatment in patients with fibromyalgia. Journal of Rheumatology 2002;29(3):575‐81. - PubMed
Vlaeyen 1996 {published data only}
    1. Vlaeyen JWS, Teeken‐Gruben NJG, Goosens MEKB, Rutten van Molken MPMH, Pelt RAGB, Eek H, et al. Cognitive ‐educational treatment of fibromyalgia: a randomized clinical trial. 1. Clinical Effects. The Journal of Rheumatology 1996;23(7):1237‐45. - PubMed
Wang 2010 {published and unpublished data}
    1. Wang C, Schmid CH, Rones R, Kalish R, Yinh J, Goldenberg DL, et al. A randomized trial of Tai Chi for fibromyalgia. The New England Journal of Medicine 2010;363:743‐54. - PMC - PubMed
Wicksell 2013 {published and unpublished data}
    1. Wicksell RK, Kemani M, Jensen K, Kosek E, Kadetoff D, Sorjonen K, et al. Acceptance and commitment therapy for fibromyalgia: a randomized controlled trial. European Journal of Pain 2012;17:599‐611. - PubMed
Wigers 1996 {published and unpublished data}
    1. Wigers SH, Stiles TC, Vogel PA. Effects of aerobic exercise versus stress management treatment in fibromyalgia. Scandinavian Journal of Rheumatology 1996;25(2):77‐86. - PubMed
Williams 2002 {published data only}
    1. Williams DA, Cary MA, Groner KH, Chaplin W, Glazier LJ, Rodriquez AM, et al. Improving physical functional status in patients with fibromyalgia: a brief cognitive behavioral intervention. The Journal of Rheumatology 2002;29(6):1280‐6. - PubMed
Williams 2010 {published and unpublished data}
    1. Williams DA, Kuper D, Segar M, Mohan N, Sheth M, Clauw DA. Internet‐enhanced management of fibromyalgia: a randomized controlled trial. Pain 2010;151(3):694‐702. - PMC - PubMed
Woolfolk 2012 {published and unpublished data}
    1. Woolfolk RL, Allen LA, Apter JT. Affective‐cognitive behavioral therapy for fibromyalgia: a randomized controlled trial. Pain Research and Treatment 2012;2012:937873. [DOI: 10.1155/2012/937873] - DOI - PMC - PubMed

References to studies excluded from this review

Alvarez‐Nemegyei 2006 {published data only}
    1. Alvarez‐Nemegyei J, Negreros‐Castillo A, Nuno‐Gutierrez BL, Alvarez‐Berzunza J, Alcocer‐Martinez LM. Efficacy of Eriksonian hypnosis in women with fibromyalgia syndrome [Eficacia de la hipnosis ericksoniana en el sindrome de fibromialgia en mujeres]. Revista Medica del Instituto Mexicano del Seguro Social 2006;45(4):395‐401. - PubMed
Ang 2013b {published data only}
    1. Ang DC, Kaleth AS, Bigatti S, Mazzuca SA, Jensen MP, Hilligoss J, et al. Research to encourage exercise for fibromyalgia (REEF): use of motivational interviewing, outcomes from a randomized‐controlled trial. Clinical Journal of Pain 2013;29(4):296‐304. - PMC - PubMed
Arcos‐Carmona 2011 {published data only}
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Bieber 2004 {published data only}
    1. Bieber C, Müller KG, Blumenstiel K, Schuller‐Roma B, Richter A, Hochlehnert A, et al. Shared decision making (SDM) with chronic pain patients. The patient as a partner in the medical decision making process. Bundesgesundheitsblatt, Gesundheitsforschung, Gesundheitsschutz 2004;47(10):985‐91. - PubMed
Bieber 2008 {published data only}
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Bosch‐Romero 2002 {published data only}
    1. Bosch Romero PE, Saenz Moya N, Vallis Esteve M, Vinolas Valer S. Study of quality of life of patients with fibromyalgia: impact of a health education programme. Atencion Primaria 2002;30:16‐21. - PMC - PubMed
Casanueva‐Fernandez 2012 {published data only}
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Castel 2013 {published data only}
    1. Castel A, Fontova R, Montull S, Perinan R, Poveda MJ, Miralles I, et al. Efficacy of a multi‐disciplinary fibromyalgia treatment adapted for women with low educational levels: a randomized controlled trial. Arthritis Care and Research 2013;65(3):421‐31. - PubMed
Cedraschi 2004 {published data only}
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Gowans 1999 {published data only}
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Hochlehnert 2006 {published data only}
    1. Hochlehnert A, Richter A, Bludau HB, Bieber C, Blumenstiel K, Mueller K, et al. A computer‐based information‐tool for chronic pain patients. Computerized information to support the process of shared decision‐making. Patient Education and Counseling 2006;61(1):92‐8. - PubMed
Hunt 2000 {published data only}
    1. Hunt J, Bogg J. An evaluation of the impact of a fibromyalgia self‐management programme on patient morbidity and coping. Advances in Physiotherapy 2000;2(4):168‐75.
King 2002a {published data only}
    1. King SJ, Wessel J, Bhambhani Y, Sholter D, Maksymowych W. The effects of exercise and education, individually or combined, in women with fibromyalgia. The Journal of Rheumatology 2002;29(12):2620‐7. - PubMed
King 2002b {published data only}
    1. King SJ, Wessel J, Bhambhani Y, Sholter D, Maksymowych W. Predictors of success of intervention programs for persons with fibromyalgia. The Journal of Rheumatology 2002;29(5):1034‐40. - PubMed
Kravitz 2006 {published data only}
    1. Kravitz HM, Esty ML, Katz RS, Fawcett J. Treatment of fibromyalgia syndrome using low‐intensity neurofeedback with the Flexyx Neurotherapy System: a randomized controlled clinical trial. Journal of Neurotherapy 2006;10(2‐3):41‐58.
Lemstra 2005 {published data only}
    1. Lemstra M, Olszynski WP, Lemstra M. The effectiveness of multidisciplinary rehabilitation in the treatment of fibromyalgia: a randomized controlled trial. Clinical Journal of Pain 2005;21(2):166‐74. - PubMed
Mannerkorpi 2000 {published data only}
    1. Mannerkorpi K, Nyberg B, Ahlmén M, Ekdahl C. Pool exercise combined with an education program for patients with fibromyalgia syndrome. A prospective, randomized study. Journal of Rheumatology 2000;27(10):2473‐81. - PubMed
McBeth 2012 {published data only}
    1. McBeth J, Prescott G, Scotland G, Lovell K, Keeley P, Hannaford P, et al. Cognitive behaviour therapy, exercise or both for treating chronic widespread pain. Archives of Internal Medicine 2012;172(1):48‐57. - PubMed
McVeigh 2006 {published data only}
    1. McVeigh JG, Hurley DA, Basford JR, Sim J, Baxter GD, Finch MB. Effectiveness of a combined pool‐based exercise and education programme compared to usual medical care in fibromyalgia syndrome: a randomised, controlled trial. Physical Therapy Reviews 2006;11(3):217.
Nelson 2010 {published data only}
    1. Nelson DV, Bennett RM, Barkhuizen A, Sexton GJ, Jones KD, Esty ML, et al. Neurotherapy of fibromyalgia?. Pain Medicine 2010;11(6):912‐9. - PubMed
Van Eijk‐Hustings 2013 {published data only}
    1. Eijk‐Hustings Y, Kroese M, Tan F, Boonen A, Bessems‐Beks M, Landewe R. Challenges in demonstrating the effectiveness of multidisciplinary treatment on quality of life, participation and health care utilisation in patients with fibromyalgia: a randomised controlled trial. Clinical Rheumatology 2013;32:199‐209. - PubMed
van Koulil 2010 {published data only}
    1. Koulil S, Lankveld W, Kraaimaat FW, Helmond T, Vedder A, Hoorn H, et al. Tailored cognitive‐behavioral therapy and exercise training for high‐risk patients with fibromyalgia. Arthritis Care & Research 2010;62(10):1377‐85. - PubMed
Zhang 2009 {published data only}
    1. Zhang. Influence of psychological intervention on therapeutic effects of massage therapy for fibromyalgia syndrome. Journal of Guangzhou University of Traditional Chinese Medicine 2009; Vol. 26, issue 1:20‐3.

References to studies awaiting assessment

Thorsell 2011 {published and unpublished data}
    1. Thorsell J, Finnes A, Dahl JA, Lundgren T, Gybrant M, Gordh T, et al. A comparative study of 2 manual‐based self‐help interventions, acceptance and commitment therapy and applied relaxation for persons with chronic pain. Clinical Journal of Pain 2011;27(8):716‐23. - PubMed
Toussaint 2012 {published and unpublished data}
    1. Toussaint LT, Whipple MO, Abboud LL, Vincent A, Wahner‐Roedler DL. A mind‐body technique for symptoms related to fibromyalgia and chronic fatigue. Explore 2012;8(2):92‐8. - PubMed
Wang 2012 {published and unpublished data}
    1. Wang C. Cost‐effectiveness of tai chi mind‐body exercise for the treatment of fibromyalgia. Explore Meeting. 2013.

References to ongoing studies

Garcia‐Campayo 2009 {published data only}
    1. Garcia‐Campayo J, Serrano‐Blanco A, Rodero B, Magallon R, Alda M, Andres E, et al. Effectiveness of the psychological and pharmacological treatment of catastrophization in patients with fibromyalgia: a randomized controlled trial. Trials 2009;10(24):1‐7. - PMC - PubMed
Miles 2010 {published data only}
    1. Miles. Effects of gentle yoga versus CBT on fibromyalgia symptoms. APA Convention Presentation. 2010:Topic 36.5.

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