Nonpharmacologial Treatment for Fibromyalgia

Fibromyalgia (FM) is a complex syndrome characterized by chronic widespread pain, sleep disturbances, fatigue, and cognitive impairment, associated in some cases with anxiety and depression. FM affects quality of life in many aspects and remains a therapeutic challenge. Comprehensive treatment of this condition aims not only to alleviate pain but rather needs a holistic approach to address both physical and psychological symptoms: to treat pain and functional consequences of pain. In this regard, nonpharmacological interventions have been shown to be effective, most of them with low cost and high tolerability. Education is the first required step to ensure adherence to and compliance with treatment program. Low-intensity aerobic exercise training has been shown to improve health-related quality of life (HRQOL), decrease pain intensity, and improve physical function. Meditative movement therapies (MMT)—involving core elements of specific movements, meditative instruction, and breath regulation—are considered as a complex intervention integrating concepts of mind and body with physical, emotional, and spiritual aspects. Balneotherapy (BT) and hydrotherapy (HT) are additional alternative interventions usually recommended in the management of FM. Cognitive behavioral therapy (CBT) aims to reinforce self-efficacy in managing symptoms of FM. Other complementary and alternatives therapies include hypnosis/guided imagery, biofeedback, and acupuncture. Brain neuromodulation constitutes promising therapeutic options for FM patients. Optimal management of FM patients requires an integrated multidisciplinary approach beyond pharmacologic therapy that must be tailored according to symptoms, patient’s preferences, and financial resources in order to ensure adherence to the treatment program as well as for improving outcomes.