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National Institutes of Health • National Center for Complementary and Alternative Medicine

NCCAM Clinical Digest

Mind and Body Practices for Fibromyalgia :
What the Science Says

June 2014

In general, research on complementary health approaches for fibromyalgia must be regarded as preliminary. However, recent systematic reviews and randomized clinical trials provide encouraging evidence that practices such as tai chi, qi gong, yoga, massage therapy, acupuncture, and balneotherapy may help relieve some fibromyalgia symptoms.

Meditative Movement Therapies—Tai Chi, Qi Gong, Yoga

The Evidence Base

  • The best evidence on the efficacy of meditative movement therapies comes from small randomized controlled trials. The evidence is summarized in a recent systematic review and meta-analysis.

Efficacy

  • In the 2013 systematic review and meta-analysis, the investigators considered data from seven separate trials involving 362 participants. They found evidence that meditative movement therapies such as tai chi, qi gong, and yoga resulted in modest improvements in sleep disturbances, fatigue, depressed mood, and health-related quality of life at the conclusion of the study treatment period. The investigators also found evidence of continued improvement in sleep disturbances and health-related quality of life 3 to 6 months later. The investigators concluded that high-quality studies with larger sample sizes are needed to confirm these results.
  • A 2010 NCCAM-funded study (included in the 2013 systematic review) compared the effects of a tai chi program with a wellness education and stretching program for managing fibromyalgia over a 12-week period. The investigators found evidence that the participants in the tai chi group had significant improvements in symptoms such as pain, sleep quality, depression, as well as quality of life. Participants in the tai chi group maintained these benefits for up to 24 weeks. A larger follow-up study of tai chi for fibromyalgia, also supported by NCCAM, is under way.

Safety

  • Tai chi and qi gong are generally regarded as safe practices. However, people who are pregnant, or who have a hernia, joint problems, back pain, fractures, or severe osteoporosis should use caution and consult their health care provider.
  • Yoga is generally considered to be safe in healthy people when practiced appropriately. However, people with certain conditions such as high blood pressure, glaucoma, or sciatica, and women who are pregnant should modify or avoid some yoga poses.

Massage

The Evidence Base

  • The best evidence regarding massage for fibromyalgia consists of data from small randomized controlled trials, summarized in a 2010 systematic review.

Efficacy

  • The 2010 systematic review included data from six small randomized controlled trials and two single-arm studies of a variety of different forms of massage. The investigators reported evidence of modest, short-term benefits of massage on fibromyalgia symptoms. However, the investigators noted that all reviewed studies had methodological problems, and they concluded that additional rigorous research is needed to establish whether massage therapy is a safe and effective intervention for fibromyalgia.

Safety

  • Massage therapy appears to have few risks when performed by a trained practitioner. However, massage therapists should take precautions with certain health conditions.

Acupuncture

The Evidence Base

  • The best evidence on the efficacy of acupuncture for fibromyalgia is summarized in two systematic reviews of several randomized controlled trials.

Efficacy

  • A 2013 Cochrane review summarized data from nine trials involving a total of 395 participants evaluating any type of invasive acupuncture for fibromyalgia. The investigators found low-to-moderate evidence that acupuncture, compared with no treatment or standard therapy, improves pain and stiffness in people with fibromyalgia. Consistent with findings in other pain conditions, they found moderate-level evidence that the effect of acupuncture does not differ from that of sham acupuncture in reducing pain or fatigue, or improving sleep or well-being. However, the authors noted that small sample sizes and heterogeneity of treatment and control interventions weaken the level of evidence and its clinical implications. They concluded that larger studies are warranted.
  • A 2010 systematic review included data from seven randomized controlled trials evaluating acupuncture for fibromyalgia, involving a total of 385 participants. The investigators reported evidence of a small analgesic effect of acupuncture. However, the effect was not clearly distinguishable from bias, and they concluded that acupuncture cannot be recommended for the management of fibromyalgia symptoms.

Safety

  • Acupuncture is generally considered safe when performed by an experienced practitioner using sterile needles. Relatively few complications from acupuncture have been reported.
  • Serious adverse events related to acupuncture are rare but include infections and punctured organs.
  • There are fewer adverse effects associated with acupuncture than with many standard drug treatments (such as anti-inflammatory medication and steroid injections) used to manage painful musculoskeletal conditions like fibromyalgia, myofascial pain, and osteoarthritis.

Balneotherapy (Hydrotherapy)

The Evidence Base

  • Studies have examined the use of balneotherapy—bath therapy for health purposes—for fibromyalgia. The best evidence concerning the effects of balneotherapy for fibromyalgia is summarized in a 2009 systematic review of data from several randomized controlled trials.

Efficacy

  • A 2009 qualitative systematic review found moderate evidence that balneotherapy may provide short-term improvement in pain and health-related quality of life for patients with fibromyalgia. However, because of variations in the individual study designs and small sample sizes, the investigators determined that definite conclusions about the value of balneotherapy cannot be reached based on the current evidence.

Safety

  • Balneotherapy is generally considered safe. A few mild side effects (i.e., slight flushing) have been reported.

NCCAM Clinical Digest is a service of the National Center for Complementary and Alternative Medicine, NIH, DHHS. NCCAM Clinical Digest, a monthly e-newsletter, offers evidence-based information on CAM, including scientific literature searches, summaries of NCCAM-funded research, fact sheets for patients, and more.

The National Center for Complementary and Alternative Medicine is dedicated to exploring complementary and alternative healing practices in the context of rigorous science, training CAM researchers, and disseminating authoritative information to the public and professionals. For additional information, call NCCAM's Clearinghouse toll-free at 1-888-644-6226, or visit the NCCAM Web site at nccam.nih.gov. NCCAM is 1 of 27 institutes and centers at the National Institutes of Health, the Federal focal point for medical research in the United States.

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