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Evid Based Complement Alternat Med. 2015;2015:610615. doi: 10.1155/2015/610615. Epub 2015 Jul 13.
A Systematic Overview of Reviews for Complementary and Alternative Therapies in the Treatment of the Fibromyalgia Syndrome.
Lauche R1, Cramer H1, Häuser W2, Dobos G1, Langhorst J1.
Author information
Objectives. This systematic overview of reviews aimed to summarize evidence and methodological quality from systematic reviews of complementary and alternative medicine (CAM) for the fibromyalgia syndrome (FMS). Methods. The PubMed/MEDLINE, Cochrane Library, and Scopus databases were screened from their inception to Sept 2013 to identify systematic reviews and meta-analyses of CAM interventions for FMS. Methodological quality of reviews was rated using the AMSTAR instrument. Results. Altogether 25 systematic reviews were found; they investigated the evidence of CAM in general, exercised-based CAM therapies, manipulative therapies, Mind/Body therapies, acupuncture, hydrotherapy, phytotherapy, and homeopathy. Methodological quality of reviews ranged from lowest to highest possible quality. Consistently positive results were found for tai chi, yoga, meditation and mindfulness-based interventions, hypnosis or guided imagery, electromyogram (EMG) biofeedback, and balneotherapy/hydrotherapy. Inconsistent results concerned qigong, acupuncture, chiropractic interventions, electroencephalogram (EEG) biofeedback, and nutritional supplements. Inconclusive results were found for homeopathy and phytotherapy. Major methodological flaws included missing details on data extraction process, included or excluded studies, study details, and adaption of conclusions based on quality assessment. Conclusions. Despite a growing body of scientific evidence of CAM therapies for the management of FMS systematic reviews still show methodological flaws limiting definite conclusions about their efficacy and safety.
"Mary-Ann Fitzcharles, MD, MSc, who also was not part of the systematic review team, said that while the quality of reviews of CAM for fibromyalgia has improved over the years, she agreed there are still huge holes in the evidence. “The final message from this very comprehensive and meticulously done overview is that poor methodology allows for only limited conclusions regarding effect for many CAM treatments for the management of fibromyalgia,” said Dr. Fitzcharles, associate professor of medicine in the Division of Rheumatology at McGill University, in Montreal. “Strategies that promote physical activity and stress reduction, and require active patient participation, are likely to have value ... while treatments that may promote passivity regarding health care for the patient, such as massage and chiropractic, have less evidence for effect … [and also foster] sickness behavior and dependency.”
Dr. Lauche and colleagues documented positive findings for all of the forms of exercise-based CAM that they examined: qigong, tai chi and yoga. There were negative findings only for qigong, although there are only a small number of studies on tai chi. There also was a preponderance of positive findings for mind–body interventions including meditation-based interventions, mindfulness-based stress reduction, and hypnosis and guided imagery. There were more mixed or limited results for biofeedback and relaxation.
Chiropractic and massage did not come out strongly in the review. This was due to a combination of limited evidence for chiropractic interventions, and only moderate positive results for massage, as well as one review showing not enough evidence and some negative results for the latter modality.
Balneotherapy and hydrotherapy have relatively strong evidence backing them. However, the evidence for acupuncture is mixed, with some “reviews finding strong evidence for effects on pain, two finding no evidence for effects and two with inconclusive results,” wrote Dr. Lauche and her co-authors. The other modalities they examined—phytotherapy, nutritional supplements and homeopathy—also were found to be supported by only equivocal evidence." -
See more at: http://www.painmedicinenews.com/Vie...015&i_id=1244&a_id=34186#sthash.yTMkqK32.dpuf
A Systematic Overview of Reviews for Complementary and Alternative Therapies in the Treatment of the Fibromyalgia Syndrome.
Lauche R1, Cramer H1, Häuser W2, Dobos G1, Langhorst J1.
Author information
- 1Department of Internal and Integrative Medicine, Kliniken Essen-Mitte, Faculty of Medicine, University of Duisburg-Essen, 45276 Essen, Germany.
- 2Department of Internal Medicine 1, Klinikum Saarbrücken, 66119 Saarbrücken, Germany ; Department of Psychosomatic Medicine and Psychotherapy, Munich University of Technology (TUM), 81865 München, Germany.
Objectives. This systematic overview of reviews aimed to summarize evidence and methodological quality from systematic reviews of complementary and alternative medicine (CAM) for the fibromyalgia syndrome (FMS). Methods. The PubMed/MEDLINE, Cochrane Library, and Scopus databases were screened from their inception to Sept 2013 to identify systematic reviews and meta-analyses of CAM interventions for FMS. Methodological quality of reviews was rated using the AMSTAR instrument. Results. Altogether 25 systematic reviews were found; they investigated the evidence of CAM in general, exercised-based CAM therapies, manipulative therapies, Mind/Body therapies, acupuncture, hydrotherapy, phytotherapy, and homeopathy. Methodological quality of reviews ranged from lowest to highest possible quality. Consistently positive results were found for tai chi, yoga, meditation and mindfulness-based interventions, hypnosis or guided imagery, electromyogram (EMG) biofeedback, and balneotherapy/hydrotherapy. Inconsistent results concerned qigong, acupuncture, chiropractic interventions, electroencephalogram (EEG) biofeedback, and nutritional supplements. Inconclusive results were found for homeopathy and phytotherapy. Major methodological flaws included missing details on data extraction process, included or excluded studies, study details, and adaption of conclusions based on quality assessment. Conclusions. Despite a growing body of scientific evidence of CAM therapies for the management of FMS systematic reviews still show methodological flaws limiting definite conclusions about their efficacy and safety.
"Mary-Ann Fitzcharles, MD, MSc, who also was not part of the systematic review team, said that while the quality of reviews of CAM for fibromyalgia has improved over the years, she agreed there are still huge holes in the evidence. “The final message from this very comprehensive and meticulously done overview is that poor methodology allows for only limited conclusions regarding effect for many CAM treatments for the management of fibromyalgia,” said Dr. Fitzcharles, associate professor of medicine in the Division of Rheumatology at McGill University, in Montreal. “Strategies that promote physical activity and stress reduction, and require active patient participation, are likely to have value ... while treatments that may promote passivity regarding health care for the patient, such as massage and chiropractic, have less evidence for effect … [and also foster] sickness behavior and dependency.”
Dr. Lauche and colleagues documented positive findings for all of the forms of exercise-based CAM that they examined: qigong, tai chi and yoga. There were negative findings only for qigong, although there are only a small number of studies on tai chi. There also was a preponderance of positive findings for mind–body interventions including meditation-based interventions, mindfulness-based stress reduction, and hypnosis and guided imagery. There were more mixed or limited results for biofeedback and relaxation.
Chiropractic and massage did not come out strongly in the review. This was due to a combination of limited evidence for chiropractic interventions, and only moderate positive results for massage, as well as one review showing not enough evidence and some negative results for the latter modality.
Balneotherapy and hydrotherapy have relatively strong evidence backing them. However, the evidence for acupuncture is mixed, with some “reviews finding strong evidence for effects on pain, two finding no evidence for effects and two with inconclusive results,” wrote Dr. Lauche and her co-authors. The other modalities they examined—phytotherapy, nutritional supplements and homeopathy—also were found to be supported by only equivocal evidence." -
See more at: http://www.painmedicinenews.com/Vie...015&i_id=1244&a_id=34186#sthash.yTMkqK32.dpuf
