Mind-body therapies for the treatment of fibromyalgia. A systematic review.
OBJECTIVE
To assess the effectiveness of mind-body therapy (MBT) for fibromyalgia syndrome (FM) by systematically reviewing randomized/quasirandomized controlled trials using methods recommended by the Cochrane Collaboration.


METHODS
Nine electronic databases, 69 conference proceedings, and several citation lists were searched for relevant trials in any language. Eligible trials were scored for methodological quality using a validated instrument. Information on major outcomes was extracted. Insufficient data reporting prevented statistical pooling, therefore a best-evidence synthesis was performed.


RESULTS
Thirteen trials involving 802 subjects were included. Seven trials received a high methodological score. Compared to waiting list/treatment as usual, there is strong evidence that MBT is more effective for self-efficacy, limited evidence for quality of life, inconclusive evidence for all other outcomes. There is limited evidence that MBT is more effective than placebo (for pain and global improvement); inconclusive evidence that MBT is more effective than physiotherapy, psychotherapy, or education/attention control for all outcomes; strong evidence that moderate/high intensity exercise is more effective than MBT (for pain and function). There is moderate evidence that MBT plus exercise (MBT+E) is more effective than waiting list/treatment as usual (for self-efficacy and quality of life); limited evidence that MBT+E is more effective than education/attention control; inconclusive for other outcomes. There is inconclusive evidence for MBT+E vs other active treatments for all outcomes. Longterm within-groups results show greatest benefit for MBT+E.


CONCLUSIONS
MBT is more effective for some clinical outcomes compared to waiting list/treatment as usual or placebo. Compared to active treatments, results are largely inconclusive, except for moderate/high intensity exercise, where results favor the latter. Further research needs to focus on the synergistic effects of MBT plus exercise and/or plus antidepressants.
Hadhazy
V A
VA
Complementary Medicine Program, University of Maryland School of Medicine, Baltimore, USA.
Ezzo
J
J
Creamer
P
P
Berman
B M
BM
D001676:Biofeedback, Psychology; D015928:Cognitive Behavioral Therapy; D016208:Databases, Factual; D005081:Exercise Therapy; D005356:Fibromyalgia / Q000628:therapy*; D006801:Humans; D019222:Mind-Body Relations, Metaphysical; D012064:Relaxation Therapy; D020377:Self Efficacy; D016896:Treatment Outcome