Limited evidence supports use of CAM for fibromyalgia

Clinical question Are complementary and alternative medicines (CAM) effective in treating patients with fibromyalgia?

Bottom line In this systematic review of CAM in the treatment of patients with fibromyalgia, capsaicin was effective in treating pain or tenderness, anthocyanidins were effective in treating sleep disturbance, soy was no better than placebo, and S-adenosylmethionine was better than placebo in improving several global measures. However, there have been very few studies on this topic and there is a strong potential for publication bias in favor of studies demonstrating benefit. (Level of evidence = 1a–)

Synopsis These authors looked for English language studies of CAM in patients with fibromyalgia in multiple databases. They also searched clinical trials registries for unpublished studies. Two reviewers independently assessed study eligibility and assessed study quality using the 5-point Jadad scale (5 points equals “perfect”). They resolved disagreements by consensus. Ultimately, only seven small studies (12 to 62 patients) were included. The methodologic quality was mixed: three were high quality, three were fair, and one was poor. Three of the studies assessed various homeopathic treatments, one evaluated anthocyanidins, one studied capsaicin, one assessed soy, and one studied S-adenosylmethionine. The studies ranged in duration from 4 weeks to 1 year. Soy was no better than placebo. In each of the studies evaluating anthocyanidins, capsaicin, and S-adenosylmethionine, the intervention was more effective than placebo. However, in each of the studies, a large number of outcomes were assessed. When studying a large number of outcomes, a statistically significant result will be found approximately 5% of the time. Patients treated with anthocyanidins improved only on sleep disturbance and those receiving capsaicin improved only on sleep disturbance and tenderness. Patients taking S-adenosylmethionine had improvements in tenderness, quality of life, global health, and depression. In the studies of homeopathy, patients demonstrated improvements in tender point pain, tender point count, quality of life, global health, and depression compared with patients who received placebo. In none of the reports of these studies can we determine if the improvement in outcomes was clinically important. Most of the CAM compounds were free of major adverse effects; minor effects reported included dizziness, nausea, and stomach upsets and home opathic treatment side effects only included allergic reactions. The small number of studies raises a strong concern for publication bias.

De Silva V, El-Metwally A, Ernst E, et al; Arthritis Research Campaign working group on complementary and alternative medicines. Evidence for the efficacy of complementary and alternative medicines in the management of fibromyalgia: a systematic review. Rheumatology (Oxford). 2010;49(6):1063-1068.