Fibromyalgia - comparative efficacy of pharmacological and non-pharmacological interventions

E. Nüesch and colleagues recently published a meta analysis with the title: “Comparative efficacy of pharmacological and non-pharmacological interventions in fibromyalgia syndrome: network meta-analysis”. They searched in electronic databases and included “102 trials in 14 982 patients and eight active interventions (tricyclic antidepressants, selective serotonin reuptake inhibitors, serotonin noradrenaline reuptake inhibitors (SNRIs), the gamma-amino butyric acid analogue pregabalin, aerobic exercise, balneotherapy, cognitive behavioural therapy (CBT), multicomponent therapy)”.

They concluded: “Benefits of pharmacological treatments in FMS are of questionable clinical relevance and evidence for benefits of non-pharmacological interventions is limited.” I can follow this conclusion, but they also concluded: “A combination of pregabalin or SNRIs as pharmacological interventions and multicomponent therapy, aerobic exercise and CBT as non-pharmacological interventions seems most promising for the management of FMS.” No, I don’t think so. This is wishful thinking; it isn’t a conclusion of the published results of the meta-analysis. Cognitive behavioural therapy won’t be as effective with drugged clients as it would be with client being free of drugs. The authors used “seems”, which I look at as reconciliation. Maybe the authors just didn’t dare to yell their results unmitigated into the faces of their possible sponsors for further research: “When restricted to large trials with ≥100 patients per group, heterogeneity was low and benefits for SNRIs and pregabalin compared with placebo were statistically significant, but small and not clinically relevant.”

For me this meta-analysis shows that one shouldn’t rely on pharmacotherapy in the treatment of fibromyalgia, but that multimodal approaches still have homework to do – studies!


Link to PubMed: http://www.ncbi.nlm.nih.gov/pubmed/22739992