title: Evidence for the efficacy of complementary and alternative medicines in the management of fibromyalgia: a systematic review.
abstract: OBJECTIVE
  To critically evaluate the evidence regarding complementary and alternative medicines (CAMs) taken orally or applied topically for the treatment of FM.
  
  
  METHODS
  Randomized controlled trials of FM using CAMs, in comparison with other treatments or placebo, published in English up to March 2009, were eligible for inclusion. They were identified using systematic searches of bibliographic databases and manual searching of reference lists. Information was extracted on outcomes, and statistical significance, in comparison with alternative treatment or placebo, and side effects were reported. The methodological quality of the primary studies was determined.
  
  
  RESULTS
  Single studies on four CAMs, and three on different approaches to homeopathic care were identified. Their methodological quality was moderate. The homeopathy studies were small, but each reported an improvement in pain. The effects of anthocyanidins, capsaicin and S-adenosylmethionine each showed at least one statistically significant improved outcome compared with placebo. However, the studies of anthocyanidins and capsaicin only demonstrated an improvement in a single outcome, sleep disturbance and tenderness, respectively, of several outcomes considered. No evidence of efficacy was found regarding Soy in a single study. Most of these CAMs were free of major adverse effects and usually associated with only minor adverse effects such as dizziness, nausea and stomach upsets.
  
  
  CONCLUSIONS
  There is insufficient evidence on any CAM, taken orally or applied topically, for FM. The small number of positive studies lack replication. Further high-quality trials are necessary to determine whether these initial findings can be supported by a larger evidence base.
authors.affiliation: Aberdeen Pain Research Collaboration (Epidemiology Group), School of Medicine and Dentistry, University of Aberdeen, Foresterhill, Aberdeen AB25 2ZD, Scotland, UK.
authors.forename: Vijitha
authors.initials: V
authors.lastname: De Silva
authors.forename: Ashraf
authors.initials: A
authors.lastname: El-Metwally
authors.forename: Edzard
authors.initials: E
authors.lastname: Ernst
authors.forename: George
authors.initials: G
authors.lastname: Lewith
authors.forename: Gary J
authors.initials: GJ
authors.lastname: Macfarlane
mesh_terms: D000872:Anthocyanins / Q000627:therapeutic use*; D002211:Capsaicin / Q000627:therapeutic use*; D000529:Complementary Therapies / Q000379:methods*; D003362:Cost-Benefit Analysis; D005356:Fibromyalgia / Q000628:therapy*; D006801:Humans; D016032:Randomized Controlled Trials as Topic; D012436:S-Adenosylmethionine / Q000627:therapeutic use*; D013025:Glycine max; D016896:Treatment Outcome
chemical_list: D000872:Anthocyanins; D012436:S-Adenosylmethionine; D002211:Capsaicin