Complementary and Integrative Medicine Use Extremely Common in Fibromyalgia, Mayo Clinic Study Says

Complementary and Integrative Medicine Use Extremely Common in Fibromyalgia, Mayo Clinic Study Says

The use of complementary and integrative medicine (CIM) continues to be extremely common among people with fibromyalgia (FM), with many patients using spiritual healing, massage therapy, and spine manipulation (chiropractic treatments), a study from the Mayo Clinic reports.

Incorporating these options may improve fibromyalgia management, so it is imperative for health care professionals to be aware of these various therapies, and know their efficacy, indications, and risks, the researchers said.

The investigators urge clinicians to screen for use of CIMs during their patient appointments and provide counseling accordingly.

The study, “Use of Complementary and Integrative Therapies by Fibromyalgia Patients: A 14-Year Follow-up Study,” was published in the journal Mayo Clinic Proceedings Innovations, Quality & Outcomes.

With no cure available for fibromyalgia, treatments focus on improving overall functioning and reducing symptoms.

Patients are known to respond better to a combination of approaches, for instance by complementing medical therapies with non-medication treatments.

Despite several recent advances, many people with fibromyalgia still experience long-term pain, and look for new or alternative ways to help relieve it. Many times, they turn to complementary and integrative medicine.

In fact, several research studies have indicated promising results of various CIM approaches for FM.

According to a report by the U.S. Department of Health and Human Services (HHS), the Centers for Disease Control and Prevention (CDC), and the National Center for Health Statistics, issued in 2018, the use of CIM therapies “remains high” and is increasing, including among people with pain disorders.

To investigate the trends of CIM use among people with fibromyalgia, physician-researchers at the Mayo Clinic surveyed patients about their frequency and patterns of use of such therapies. The investigators compared the results, from 2017, with those from a previous study done in 2003, which reported high adherence to these approaches (98%).

A total of 310 people with fibromyalgia — 87% women, mean age 44 years — were surveyed about their use of CIM in the preceding six months. Participants were referred to the Mayo Clinic fibromyalgia treatment program from January to July 2017.

The survey asked about three primary CIM approaches: treatments and techniques, vitamins and minerals, and herbs and other dietary supplements.

Nearly all participants — 304 of the 310, or 98.1% — reported using some form of CIM, similar to what was reported back in 2003.

The top preferred practices were spiritual healing (54.0%), massage therapy (50.0%), chiropractic treatments (39.3%), aromatherapy (39.0%), and exercise for a specific medical problem (38.6%). Chiropractic treatments are a system of techniques focused on the manipulation of the spine, while aromatherapy is the therapeutic use of essential oils extracted from plants.

Other treatments included taking supplements of melatonin (37.9%), magnesium (36.3%), green tea (36.1%), and fish oil (34.5%). Less frequently, patients were doing chelation therapy, dance therapy, and hypnosis. According to the National Center for Complimentary and Integrative Health, chelation therapy is a procedure in which a substance is used to bind with molecules, such as metals or minerals, so that they can be removed from the body.

Compared with 2003, more people now were using CIM treatment or techniques (86.9% versus 94.2%) and herbs or dietary supplements (50.9% vs. 57.1%). In contrast, fewer people reported consuming vitamins and minerals (83% vs. 73.5%).

Techniques with the greatest increase in use were aromatherapy (14.9% to 39.0%), homeopathic medicine (10.0% to 24.2%), and art therapy (4.8% to 17.1%).

As to herbs and other dietary supplements, in 2017 patients were consuming more flaxseed (13.2% to 28.5%), fish oil (11.1% to 34.5%), garlic (9.0%  to 23.7%), ginger (4.8% to 30.3%), and melatonin (4.8% to 37.9%) as compared with the 2003 reports.

Intake of cayenne, senna, and methylsulfonylmethane also rose above 5%, compared with less than that threshold in 2003. Other less frequently used supplements included lutein, creatine, kava, ashwagandha, cat’s claw, goldenseal, and stinging nettle.

Regarding the use of vitamins and minerals, the intake of vitamin E decreased significantly — from 31.1% to 13.4% — while vitamin B complex use increased from 24.9% to 39.3%.

The use of various CIM-based treatments differed significantly by age and generations. In 2017, massage and spiritual healing were among the most used practices for all generations but melatonin was more popular among millennials, or young adults, ages 18-34.

Across generations, the use of massage, spiritual healing, chiropractic treatments, exercise for a specific medical problem, vitamin B complex, and magnesium remained relatively stable.

“We believe that CIM use is firmly rooted in our patients with FM and is here to stay,” the researchers said. “What originally began as ‘alternative’ treatment options has slowly, with the aid of ongoing research, assimilated into conventional medical practice and is now considered ‘complementary’ and ‘integrative.’”

The investigators said clinicians should be discussing these therapies with their patients.

“It is imperative for health care professionals to be aware of these various treatment options and to be familiar with their associated basic efficacies, indications, and risks,” they said.

“Clinicians need to develop an effective strategy to screen patients for CIM use, assess CIMs for possible drug interactions, continually monitor for treatment efficacy (as would be done with all conventional treatments), and provide appropriate counsel,” the team concluded.

Online resources that can provide support to clinicians include the National Center for Complementary and Integrative Health website and the Natural Medicines Comprehensive Database.