Researchers report that non-pharmacological treatment strategies, such as cognitive behavioral therapy and mindfulness meditation, can be useful for treating patients with fibromyalgia.
The review study, titled “Evidence-Based Non-Pharmacological Therapies for Fibromyalgia,” was published in the journal Current Pain and Headache Reports.
When physicians conduct a functional assessment of patients with fibromyalgia, they should look at the psychological, neurocognitive, and physical impairment domains.
Acceptable types of treatment for fibromyalgia patients include an array of therapies ranging from pharmacological medications to mindfulness meditation, cognitive behavioral therapy, acupuncture and others.
Fibromyalgia is also associated with comorbidities such as mood disorders, gastrointestinal diseases, and obesity, all of which need to be addressed by the physician as part of treatment.
Researchers suggest that an ideal treatment approach should start with the education of the patient regarding the disease and treatment options, followed by a combination of pharmacologic and non-pharmacologic treatments.
To determine the prevailing opinions on this topic, researchers from Brigham and Women’s Hospital in Boston and Louisiana State University Health Sciences Center in New Orleans conducted a literature review.
Their focus was on the usefulness of cognitive behavioral and various complementary medical therapies in the treatment of fibromyalgia.
Through their literature search, researchers determined a multimodal treatment approach.
On the first visit, the patient should be educated about the complex disease process using a simplified approach. The patient should then be informed about the impact of fibromyalgia symptoms on the body by using an analogy called the circle of pain-anxiety-sleep.
Next, researchers suggest that the treatment of pain — outside of pharmacologic treatment — should focus on cognitive behavioral therapy and mindfulness meditation. These two types of treatments can help reduce pain and improve sleep.
Studies have shown that there is no specific nutritional diet that is useful in treatment of fibromyalgia. However, some diets have been shown to help patients with fibromyalgia who experience gastrointestinal symptoms.
Specifically, studies have shown that a low FODMAP (fermentable oligosaccharides, disaccharides, monosaccharides and polyols) diet, and gluten-free and hypocaloric diets can aid in improving gastrointestinal distress in some patients.
Exercise, while important for general well-being, is not always practical for patients with fibromyalgia because most patients experience significant chronic pain. But researchers emphasize that the idea of exercise should be introduced on initial counseling and long-term goals should be set for patients.
Existing literature also indicates that acupuncture provides no proven benefit in the treatment of fibromyalgia. However, acupuncture has no adverse effects, so it should not be discouraged.
“Goals for symptom management and pain control should be set early, and patient engagement remains critical in the management of this complex pain presentation,” the authors state. “While low quality evidence exists for most non-pharmacologic treatment modalities for [fibromyalgia], CBT [cognitive behavioral therapy] and mindfulness meditation show promise for future investigation.”
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