Complementary Therapies for Fibromyalgia Syndrome – A Rational Approach

  • Marcelo SaadEmail author
  • Roberta de Medeiros
Fibromyalgia (M Peres, Section Editor)
Part of the following topical collections:
  1. Topical Collection on Fibromyalgia


Fibromyalgia syndrome (FMS) is a complex chronic condition, the treatment of which still poses many challenges. Complementary therapies (CT) have gained increasing popularity among FMS patients. Past reviews evaluating effectiveness of CT for treatment of FMS revealed some potential benefits arising from certain modalities. However, with the data available, it becomes difficult to formulate a unique opinion about this matter. In the present paper, the authors propose some guidelines to conciliate the expectations of patients with the lack of solid evidence, in a practicable yet responsible way. Many items should be considered before prescribing, proscribing, or tolerating a CT, besides results from randomized controlled trials, such as efficacy (mechanisms of action); effectiveness (effect in practice); efficiency (cost-benefit ratio); safety; risk-benefit ratio; legislation; healthcare service involvement; practitioner characteristics; objective (purpose); and the potential of combination with conventional treatment.


Fibromyalgia Chronic pain Complementary therapies Integrative medicine Alternative medicine Alternative therapies Complementary medicine Therapeutics 


Compliance with Ethics Guidelines

Conflict of Interest

Marcelo Saad declares that he has no potential conflicts.

Roberta de Medeiros declares that she has no potential conflicts.

Human and Animal Rights and Informed Consent

This article does not contain any studies with human or animal subjects performed by any of the authors.


Papers of particular interest, published recently, have been highlighted as: • Of importance •• Of major importance

  1. 1.
    • Smith HS, Harris R, Clauw D. Fibromyalgia: an afferent processing disorder leading to a complex pain generalized syndrome. Pain Phys. 2011;14:E217–45. This is a competent article about the current fibromyalgia accumulated knowledge, available free on internet.Google Scholar
  2. 2.
    Saxena A, Solitar BM. Fibromyalgia: Knowns, Unknowns, and Current Treatment. Bull NYU Hosp Jt Dis. 2010;68:157–61.Google Scholar
  3. 3.
    Hassett AL, Gevirtz RN. Nonpharmacologic treatment for fibromyalgia: patient education, cognitive-behavioral therapy, relaxation techniques, and complementary and alternative medicine. Rheum Dis Clin North Am. 2009;35:393–407. doi: 10.1016/j.rdc.2009.05.003.PubMedCrossRefGoogle Scholar
  4. 4.
    Van Houdenhove B, Luyten P. Customizing treatment of chronic fatigue syndrome and fibromyalgia: the role of perpetuating factors. Psychosomatics. 2008;49:470–7. doi: 10.1176/appi.psy.49.6.470.PubMedCrossRefGoogle Scholar
  5. 5.
    Braz Ade S, de Paula AP, Diniz Mde F, de Almeida RN. Non-pharmacologic therapy and complementary and alternative medicine in fibromyalgia. Rev Bras Reumatol. 2011;51:269–82.PubMedGoogle Scholar
  6. 6.
    NCCAM (National Center for Complementary and Alternative Medicine). Exploring the science of complementary and alternative medicine - Third Strategic Plan; 2011–2015. NIH Publication No. 11–7643. USA, February 2011.Google Scholar
  7. 7.
    Ernst E. Musculoskeletal conditions and complementary/alternative medicine. Best Pract Res Clin Rheumatol. 2004;18:539–56.PubMedCrossRefGoogle Scholar
  8. 8.
    Wahner-Roedler DL, Elkin PL, Vincent A, Thompson JM, Oh TH, Loehrer LL, et al. Use of complementary and alternative medical therapies by patients referred to a fibromyalgia treatment program at a tertiary care center. Mayo Clin Proc. 2005;80:55–60.PubMedGoogle Scholar
  9. 9.
    Shaver JL, Wilbur J, Lee H, Robinson FP, Wang E. Self-reported medication and herb/supplement use by women with and without fibromyalgia. J Womens Health. 2009;18:709–16. doi: 10.1089/jwh.2008.1194.CrossRefGoogle Scholar
  10. 10.
    Terry R, Perry R, Ernst E. An overview of systematic reviews of complementary and alternative medicine for fibromyalgia. Clin Rheumatol. 2012;31:55–66. doi: 10.1007/s10067-011-1783-5 [Epub May 26, 2011].PubMedCrossRefGoogle Scholar
  11. 11.
    Terhorst L, Schneider MJ, Kim KH, Goozdich LM, Stilley CS. Complementary and alternative medicine in the treatment of pain in fibromyalgia: a systematic review of randomized controlled trials. J Manipulative Physiol Ther. 2011;34:483–96. doi: 10.1016/j.jmpt.2011.05.006. Epub 2011 Jun 24.PubMedCrossRefGoogle Scholar
  12. 12.
    Baranowsky J, Klose P, Musial F, Haeuser W, Dobos G, Langhorst J. Qualitative systemic review of randomized controlled trials on complementary and alternative medicine treatments in fibromyalgia. Rheumatol Int. 2009;30:1–21.PubMedCrossRefGoogle Scholar
  13. 13.
    Sarac AJ, Gur A. Complementary and alternative medical therapies in fibromyalgia. Curr Pharm Des. 2006;12:47–57.PubMedCrossRefGoogle Scholar
  14. 14.
    Schneider M, Vernon H, Ko G, Lawson G, Perera J. Chiropractic management of fibromyalgia syndrome: a systematic review of the literature. J Manipulative Physiol Ther. 2009;32:25–40. doi: 10.1016/j.jmpt.2008.08.012.PubMedCrossRefGoogle Scholar
  15. 15.
    Crofford LJ, Appleton BE. Complementary and alternative therapies for fibromyalgia. Curr Rheumatol Rep. 2001;3:147–56.PubMedCrossRefGoogle Scholar
  16. 16.
    Madsen MV, Gøtzsche PC, Hróbjartsson A. Acupuncture treatment for pain: systematic review of randomized clinical trials with acupuncture, placebo acupuncture, and no acupuncture groups. BMJ. 2009;338:a3115. doi: 10.1136/bmj.a3115.PubMedCrossRefGoogle Scholar
  17. 17.
    Langhorst J, Klose P, Musial F, Irnich D, Häuser W. Efficacy of acupuncture in fibromyalgia syndrome—a systematic review with a meta-analysis of controlled clinical trials. Rheumatology (Oxford). 2010;49:778–88. doi: 10.1093/rheumatology/kep439 [Epub Jan 25, 2010].CrossRefGoogle Scholar
  18. 18.
    Mayhew E, Ernst E. Acupuncture for fibromyalgia—a systematic review of randomized clinical trials. Rheumatology (Oxford). 2007;46:801–4.CrossRefGoogle Scholar
  19. 19.
    Cao H, Liu J, Lewith GT. Traditional Chinese medicine for treatment of fibromyalgia: a systematic review of randomized controlled trials. J Altern Complement Med. 2010;16:397–409. doi: 10.1089/acm.2009.0599.PubMedCrossRefGoogle Scholar
  20. 20.
    Jang ZY, Li CD, Qiu L, Guo JH, He LN, Yue Y. et al [Combination of acupuncture, cupping, and medicine for treatment of fibromyalgia syndrome: a multi-central randomized controlled trial]. Zhongguo Zhen Jiu. 2010;30:265–9.PubMedGoogle Scholar
  21. 21.
    Hadianfard MJ, Hosseinzadeh PM. A randomized clinical trial of fibromyalgia treatment with acupuncture compared with fluoxetine. Iran Red Crescent Med J. 2012;14:631–40 [Epub Oct 30, 2012].PubMedGoogle Scholar
  22. 22.
    Vinjamury S, Jones J, Hsiao L, Moutappa M, Weiss J. P02.66. Efficacy of acupuncture for fibromyalgia - RCT. BMC Complement Altern Med. 2012;12 Suppl 1:122.CrossRefGoogle Scholar
  23. 23.
    White P, Bishop FL, Scott C, Little P, Lewith G. Practice, practitioner, or placebo? A multifactorial, mixed-methods randomized controlled trial of acupuncture. Pain. 2012;153:455–62.PubMedCrossRefGoogle Scholar
  24. 24.
    Lundeberg T, Lund I. Are reviews based on sham acupuncture procedures in fibromyalgia syndrome (FMS) valid? Acupunct Med. 2007;25:100–6.PubMedCrossRefGoogle Scholar
  25. 25.
    Buskila D, Abu-Shakra M, Neumann L, Odes L, Shneider E, Flusser D, et al. Balneotherapy for fibromyalgia at the Dead Sea. Rheumatol Int. 2001;20:105–8.PubMedCrossRefGoogle Scholar
  26. 26.
    Ardiç F, Özgen M, Aybek H, Rota S, Çubukçu D, Gökgöz A. Effects of balneotherapy on serum IL-1, PGE2 and LTB4 levels in fibromyalgia patients. Rheumatol Int. 2007;27:441–6.PubMedCrossRefGoogle Scholar
  27. 27.
    Dönmez A, Karagülle MZ, Tercan N, Dinler M, Işsever H, Karagülle M, et al. SPA therapy in fibromyalgia: a randomized controlled clinic study. Rheumatol Int. 2005;26:168–72 [Epub Jun 17, 2005].PubMedCrossRefGoogle Scholar
  28. 28.
    Özkurt S, Dönmez A, Karagülle MZ, Uzunoglu E, Turan M, Erdogan N. Balneotherapy in fibromyalgia: a single blind randomized controlled clinical study. Rheumatol Int. 2012;32:1949–54.PubMedCrossRefGoogle Scholar
  29. 29.
    Tsao JC. Effectiveness of massage therapy for chronic, non-malignant pain: a review. Evid Based Complement Alternat Med. 2007;4:165–79 [Epub Feb 5, 2007].PubMedCrossRefGoogle Scholar
  30. 30.
    Kalichman L. Massage therapy for fibromyalgia symptoms. Rheumatol Int. 2010;30:1151–7. doi: 10.1007/s00296-010-1409-2 [Epub Mar 20, 2010].PubMedCrossRefGoogle Scholar
  31. 31.
    Ernst E. Chiropractic treatment for fibromyalgia: a systematic review. Clin Rheumatol. 2009;28:1175–8. doi: 10.1007/s10067-009-1217-9 [Epub Jun 21, 2009].PubMedCrossRefGoogle Scholar
  32. 32.
    Ernst E. Herbal medicine in the treatment of rheumatic diseases. Rheum Dis Clin North Am. 2011;37:95–102. doi: 10.1016/j.rdc.2010.11.004 [Epub Dec 3, 2010].PubMedCrossRefGoogle Scholar
  33. 33.
    Wang C, Schmid CH, Rones R, Kalish R, Yinh J, Goldenberg DL, et al. A randomized trial of tai chi for fibromyalgia. N Engl J Med. 2010;363:743–54.PubMedCrossRefGoogle Scholar
  34. 34.
    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. Clin Rheumatol. 2012;31:1205–14. doi: 10.1007/s10067-012-1996-2 [Epub May 13, 2012].PubMedCrossRefGoogle Scholar
  35. 35.
    Carbonell-Baeza A, Romero A, Aparicio VA, Ortega FB, Tercedor P, Delgado-Fernández M, et al. Preliminary findings of a 4-month Tai Chi intervention on tenderness, functional capacity, symptomatology, and quality of life in men with fibromyalgia. Am J Mens Health. 2011;5:421–9. doi: 10.1177/1557988311400063 [Epub Mar 15, 2011].PubMedCrossRefGoogle Scholar
  36. 36.
    Romero-Zurita A, Carbonell-Baeza A, Aparicio VA, Ruiz JR, Tercedor P, Delgado-Fernández M. Effectiveness of a tai-chi training and detraining on functional capacity, symptomatology and psychological outcomes in women with fibromyalgia. Evid Based Complement Alternat Med. 2012;2012:614196. doi: 10.1155/2012/614196 [Epub May 9, 2012].PubMedCrossRefGoogle Scholar
  37. 37.
    Carson JW, Carson KM, Jones KD, Bennett RM, Wright CL, Mist SD. A pilot randomized controlled trial of the Yoga of Awareness program in the management of fibromyalgia. Pain. 2010;151:530–9. doi: 10.1016/j.pain.2010.08.020.PubMedCrossRefGoogle Scholar
  38. 38.
    Hennard J. A protocol and pilot study for managing fibromyalgia with yoga and meditation. Int J Yoga Therap. 2011;21:109–21.PubMedGoogle Scholar
  39. 39.
    Relton C, Smith C, Raw J, Walters C, Adebajo AO, Thomas KJ, et al. Healthcare provided by a homeopath as an adjunct to usual care for Fibromyalgia (FMS): results of a pilot Randomized Controlled Trial. Homeopathy. 2009;98:77–82. doi: 10.1016/j.homp.2008.12.004.PubMedCrossRefGoogle Scholar
  40. 40.
    Assefi N, Bogart A, Goldberg J, Buchwald D. Reiki for the treatment of fibromyalgia: a randomized controlled trial. J Altern Complement Med. 2008;14:1115–22. doi: 10.1089/acm.2008.0068.PubMedCrossRefGoogle Scholar
  41. 41.
    Thieme K, Gracely RH. Are psychological treatments effective for fibromyalgia pain? Curr Rheumatol Rep. 2009;11:443–50.PubMedCrossRefGoogle Scholar
  42. 42.
    Lush E, Salmon P, Floyd A, Studts JL, Weissbecker I, Sephton SE. Mindfulness meditation for symptom reduction in fibromyalgia: psychophysiological correlates. J Clin Psychol Med Settings. 2009;16:200–7. doi: 10.1007/s10880-009-9153-z [Epub Mar 10, 2009].PubMedCrossRefGoogle Scholar
  43. 43.
    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. 2011;152:361–9. doi: 10.1016/j.pain.2010.10.043 [Epub Dec 13, 2010].PubMedCrossRefGoogle Scholar
  44. 44.
    Astin JA, Berman BM, Bausell B. The efficacy of mindfulness meditation plus Qigong movement therapy in the treatment of fibromyalgia: a randomized control trial. J Rheumatol. 2003;30:2257–62.PubMedGoogle Scholar
  45. 45.
    Derbyshire SW, Whalley MG, Oakley DA. Fibromyalgia pain and its modulation by hypnotic and nonhypnotic suggestion: an fMRI analysis. Eur J Pain. 2009;13:542–50. doi: 10.1016/j.ejpain.2008.06.010 [Epub Jul 23, 2008].PubMedCrossRefGoogle Scholar
  46. 46.
    Bernardy K, Füber N, Klose P, Häuser W. Efficacy of hypnosis/guided imagery in fibromyalgia syndrome—a systematic review and meta-analysis of controlled trials. BMC Musculoskelet Disord. 2011;12:133. doi: 10.1186/1471-2474-12-133.PubMedCrossRefGoogle Scholar
  47. 47.
    Castel A, Cascón R, Padrol A, Sala J, Rull M. Multicomponent cognitive-behavioral group therapy with hypnosis for the treatment of fibromyalgia: long-term outcome. J Pain. 2012;13:255–65. doi: 10.1016/j.jpain.2011.11.005 [Epub Jan 29, 2012].PubMedGoogle Scholar
  48. 48.
    Kayiran S, Dursun E, Dursun N, Ermutlu N, Karamürsel S. Neurofeedback intervention in fibromyalgia syndrome; a randomized, controlled, rater blind clinical trial. Appl Psychophysiol Biofeedback. 2010;35:293–302. doi: 10.1007/s10484-010-9135-9.PubMedCrossRefGoogle Scholar
  49. 49.
    Zautra AJ, Fasman R, Davis MC, Craig AD. The effects of slow breathing on affective responses to pain stimuli: an experimental study. Pain. 2010;149:12–8. doi: 10.1016/j.pain.2009.10.001 [Epub Jan 15, 2010].PubMedCrossRefGoogle Scholar
  50. 50.
    Menzies V, Taylor AG, Bourguignon C. Effects of guided imagery on outcomes of pain, functional status, and self-efficacy in persons diagnosed with fibromyalgia. J Altern Complement Med. 2006;12:23–30.PubMedCrossRefGoogle Scholar
  51. 51.
    Chan CL, Wang CW, Ho RT, Ng SM, Ziea ET, Wong VT. Qigong exercise for the treatment of fibromyalgia: a systematic review of randomized controlled trials. J Altern Complement Med. 2012;18:641–6. doi: 10.1089/acm.2011.0347 [Epub Jul 3, 2012].PubMedCrossRefGoogle Scholar
  52. 52.
    Lee MS, Pittler MH, Ernst E. Internal qigong for pain conditions: a systematic review. J Pain. 2009;10:1121–7:e14. doi:  10.1016/j.jpain.2009.03.009. [Epub Jun 25, 2009]Google Scholar
  53. 53.
    Lynch M, Sawynok J, Hiew C, Marcon D. A randomized controlled trial of qigong for fibromyalgia. Arthritis Res Ther. 2012;14:R178.PubMedCrossRefGoogle Scholar
  54. 54.
    • Dossey L. The Next Decade: How It Might Unfold. EXPLORE. 2012;8:73–80. This is a courageous article about future paradigms related to the concept of health care.PubMedCrossRefGoogle Scholar
  55. 55.
    Shi GX, Yang XM, Liu CZ, Wang LP. Factors contributing to therapeutic effects evaluated in acupuncture clinical trials. Trials. 2012;13:42. doi: 10.1186/1745-6215-13-42.PubMedCrossRefGoogle Scholar
  56. 56.
    •• de Medeiros R, Saad M. Complementary therapies – considerations before recommend, tolerate or proscribe them. in complementary therapies for the contemporary healthcare. Ed: Saad M, de Medeiros R. InTech Publisher, Rijeka, Croatia. 2012. ISBN: 978-953-51-0801-6, doi: 10.5772/50446. This is a book chapter, as described at

Copyright information

© Springer Science+Business Media New York 2013

Authors and Affiliations

  1. 1.S. Paulo Medical College of AcupunctureS. PauloBrazil
  2. 2.Centro Universitario S. CamiloS. PauloBrazil

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