Patients with Fibromyalgia Benefit from Aerobic Endurance Exercise Strength training induced adaptations in neuromuscular function of premenopausal women with fibromyalgia: comparison with healthy women An exercise program in the treatment of fibromyalgia. Management of patients with fibromyalgia using biofeedback: a randomized control trial. Multidisciplinary treatment of fibromyalgia: does cognitive behavior therapy increase the response to treatment? Osteopathic manipulative treatment in conjunction with medication relieves pain associated with fibromyalgia syndrome: results of a randomized clinical pilot project. Written pain neuroscience education in fibromyalgia: a multicenter randomized controlled trial. Muscle stretching exercises and resistance training in fibromyalgia: which is better? A three-arm randomized controlled trial. Low-frequency Pulsed Electromagnetic Field Therapy in Fibromyalgia: A Randomized, Double-blind, Sham-controlled Clinical Study High or low intensity aerobic fitness training in fibromyalgia: does it matter? Utilizing exercise to affect the symptomology of fibromyalgia: a pilot study. The efficacy of the Rességuier method in the treatment of fibromyalgia syndrome: a randomized controlled trial. Efficacy of the "body movement and perception" method in the treatment of fibromyalgia syndrome: an open pilot study. Resistance exercise improves muscle strength, health status and pain intensity in fibromyalgia—a randomized controlled trial Internet-enhanced management of fibromyalgia: A randomized controlled trial Reduction of fibromyalgia symptoms through intravenous nutrient therapy: results of a pilot clinical trial. Integrating Virtual Reality With Activity Management for the Treatment of Fibromyalgia: Acceptability and Preliminary Efficacy
Abstract : Fibromyalgia ( FM ) is a disorder characterised by diffuse widespread musculoskeletal aching and stiffness and multiple tender points [ 1 ] . Its pathophysiology is poorly understood . The influence of aerobic endurance exercise on pain in patients with FM was investigated . Twenty-seven patients ( 25 female , 2 male ) participated in a controlled clinical study and performed 12 weeks of jogging , walking , cycling or swimming following a given schedule .  Twelve sedentary FM patients ( 11 female , 1 male ) served as controls . Before and after training both the study and the control groups were evaluated spiroergometrically .  Tender point pain was quantified by dolorimetry . The painful body surface was estimated by a pain body diagram , and its intensity by a visual analogue scale and a ranking scale . Patients trained for an average of 25 min two to three times a week , with an average intensity of 50 % of maximal oxygen uptake ( VO2max ) . Unlike the control group , the training group exhibited a decrease in heart rate and VO2 and an increase in respiratory quotient during submaximal workload . Maximal performance capacity and VO2max remained unchanged , whereas the wattpulse ( watt/heart rate ) improved at maximal workload . Pain parameters remained unchanged in the control group , but in the training group the mean number of positive tender points ( 15.4/12.7 ) , the mean pain threshold of the gluteal tender point ( 2.89 kp/3.50 kp ) and the painful body surface ( 18%/15 % body surface ) decreased significantly . Subjective general pain condition deteriorated in two patients but improved in 17 . Our results suggest a positive effect of aerobic endurance exercise on fitness and well-being in patients with FM OBJECTIVE To investigate the effects of 21 weeks ' progressive strength training on neuromuscular function and subjectively perceived symptoms in premenopausal women with fibromyalgia ( FM ) . METHODS Twenty one women with FM were r and omly assigned to experimental ( FMT ) or control ( FMC ) groups . Twelve healthy women served as training controls ( HT ) . The FMT and HT groups carried out progressive strength training twice a week for 21 weeks . The major outcome measures were muscle strength and electromyographic ( EMG ) recordings . Secondary outcome measures were pain , sleep , fatigue , physical function capacity ( Stanford Health Assessment Question naire ) , and mood ( short version of Beck 's depression index ) . RESULTS Female FMT subjects increased their maximal and explosive strength and EMG activity to the same extent as the HT group . Moreover , the progressive strength training showed immediate benefits on subjectively perceived fatigue , depression , and neck pain of training patients with FM . CONCLUSIONS The strength training data indicate comparable trainability of the neuromuscular system of women with FM and healthy women .  Progressive strength training can safely be used in the treatment of FM to decrease the impact of the syndrome on the neuromuscular system , perceived symptoms , and functional capacity . These results confirm the opinion that FM syndrome has a central rather than a peripheral or muscular basis OBJECTIVE To assess the utility of an exercise program , which included aerobic , flexibility and strengthening elements , in the treatment of fibromyalgia ( FM ) . FM is a chronic musculoskeletal condition characterized by diffuse musculoskeletal pain and aching . It has been suggested that aerobic exercise is helpful in its treatment . METHODS We studied 60 patients who met American College of Rheumatology criteria for FM and had no significant comorbidities . Measurements performed on each patient at the pre and post study assessment included the number of tender points ( TP ) , total myalgic scores ( TM ) , aerobic fitness ( AF ) , flexibility and isokinetic strength . After initial evaluation patients were r and omly assigned to either an exercise or a relaxation group . Each group met 3 times per week for 6 weeks for 1 h of supervised exercise or relaxation . All patients data were stored in a computerized data base and statistical analysis was performed on all pre and post study assessment s. RESULTS Thirty-eight patients ( 18 exercise and 20 relaxation ) completed the study . Analysis of our data showed no significant difference between the groups in their pre study assessment . Post study assessment s , however , showed a significant improvement between the exercise and relaxation groups in TP ( p < 0.05 ) , TM ( p < 0.05 ) , and AF ( p < 0.05 ) . Similar improvements were also found when the pre and post study assessment of the exercise group were compared . CONCLUSION Exercise is helpful in the management of FM in the short term . It also shows that FM patients can undertake an exercise program which includes aerobic , flexibility , and strength training exercises without adverse effects . The long term utility of this type of exercise requires further evaluation OBJECTIVE Fibromyalgia syndrome ( FMS ) is a chronic rheumatological condition which could be characterized by generalized pain and fatigue . Cognitive and behavioral therapy has been found to be a suitable technique in the management of FMS . This study intends to evaluate the efficacy of electromyography ( EMG ) biofeedback to reduce pain in patients with FMS . MATERIAL S AND METHODS A r and omized controlled trial involving two groups of FMS patients , one receiving EMG biofeedback and the other a sham biofeedback  , was carried out . The assessment tools included in the study were fibromyalgia impact question naire ( FIQ ) , visual analogue scale ( VAS ) , six-minute walk test ( SMWT ) and number of tender points ; and tenderness of each tender point was done for both the groups . STATISTICS A Student 's ' t ' test was used to study the test for significance . RESULTS After using biofeedback , the mean VAS scores and the mean number of tender points were found to be 3 out of 10 and 6 out of 18 respectively . Subjective analysis from both groups showed improvement in physical and psychological realms . Statistical significance . CONCLUSION Biofeedback as a treatment modality reduces pain in patients with FMS , along with improvements in FIQ , SMWT and the number of tender points OBJECTIVE Multidisciplinary treatments ( MTs ) are usually recommended for reducing fibromyalgia ( FM ) symptoms and include physical exercise , drug management , education , and cognitive behavior therapy ( CBT ) . However , there is no evidence that CBT adds efficacy to the other therapeutic components . This r and omized controlled trial analyzed the response of FM patients to two MTs , with and without CBT , according to the presence of concurrent symptoms . METHODS Eighty-three women with FM were r and omly assigned to MT or combined MT and CBT . The MT included medical intervention , physical training , education , and discussion of the syndrome . The CBT focused on coping with stress , modifying lifestyles , and changing pain behaviors . Demographic and clinical data , information regarding tender points , and question naire responses about functional capability [ Fibromyalgia Impact Question naire ( FIQ ) ] , health status [ 36-item Short Form Health Survey ( SF-36 ) ] , and mental health [ Symptom Checklist-90-Revised ( SCL-90-R ) ] were obtained at the beginning , at the end of the 15-week treatment , and at 6-month follow-up . Subgroups are identified in relation to treatment response . RESULTS Sixty-six women ( 80 % ) completed treatment . Although the variance of the total sample had changed at posttreatment ( F=2.67 , P=.031 ) , there was no significant effect for the TimexTreatment interaction ( F=1.65 , P=.16 ) . Univariate tests detected a significant fall in the FIQ score . The subgroup of patients with fatigue showed a better response with MT+CBT than with MT . At 6-month follow-up , the statistical differences had been maintained . Intention-to-treat analysis ratified these results . CONCLUSIONS MT improves functional capability and reduces symptom impact . CBT increases mildly the effect of MT in patients with fatigue Osteopathic physicians caring for patients with fibromyalgia syndrome ( FM ) often use osteopathic manipulative treatment ( OMT ) in conjunction with other forms of st and ard medical care . Despite a growing body of evidence on the efficacy of manual therapy for the treatment of selected acute musculoskeletal conditions , the role of OMT in treating patients with chronic conditions such as FM remains largely unknown . Twenty-four female patients meeting American College of Rheumatology criteria for FM were r and omly assigned to one of four treatment groups : ( 1 ) manipulation group , ( 2 ) manipulation and teaching group , ( 3 ) moist heat group , and ( 4 ) control group , which received no additional treatment other than current medication . Participants ' pain perceptions were assessed by use of pain thresholds measured at each of 10 bilateral tender points using a 9-kg dolorimeter , the Chronic Pain Experience Inventory , and the Present Pain Intensity Rating Scale . Patients ' affective response to treatment was assessed using the Self-Evaluation Question naire . Activities of daily living were assessed using the Stanford Arthritis Center Disability and Discomfort Scales : Health Assessment Question naire . Depression was assessed using the Center for Epidemiological Studies Depression Scale . Significant findings between the four treatment groups on measures of pain threshold , perceived pain , attitude toward treatment , activities of daily living , and perceived functional ability were found . All of these findings favored use of OMT . This study found OMT combined with st and ard medical care was more efficacious in treating FM than st and ard care alone . These findings need to be replicated to determine if cost savings are incurred when treatments for FM incorporate nonpharmacologic approaches such as OMT Mounting evidence supports the use of face-to-face pain neuroscience education for the treatment of chronic pain patients . This study aim ed at examining whether written education about pain neuroscience improves illness perceptions , catastrophizing , and health status in patients with fibromyalgia . A double-blind , multicenter r and omized controlled clinical trial with 6-month follow-up was conducted . Patients with FM ( n = 114 ) that consented to participate were r and omly allocated to receive either written pain neuroscience education or written relaxation training . Written pain neuroscience education comprised of a booklet with pain neuroscience education plus a telephone call to clarify any difficulties ; the relaxation group received a booklet with relaxation education and a telephone call . The revised illness perception question naire , Pain Catastrophizing Scale , and fibromyalgia impact question naire were used as outcome measures . Both patients and assessors were blinded . Repeated- measures analyses with last observation carried forward principle were performed . Cohen 's d effect sizes ( ES ) were calculated for all within-group changes and between-group differences . The results reveal that written pain neuroscience education does not change the impact of FM on daily life , catastrophizing , or perceived symptoms of patients with FM . Compared with written relaxation training , written pain neuroscience education  improved beliefs in a chronic timeline of FM ( P = 0.03 ; ES = 0.50 ) , but it does not impact upon other domains of illness perceptions . Compared with written relaxation training , written pain neuroscience education slightly improved illness perceptions of patients with FM , but it did not impart clinical ly meaningful effects on pain , catastrophizing , or the impact of FM on daily life . Face-to-face sessions of pain neuroscience education are required to change inappropriate cognitions and perceived health in patients with FM BACKGROUND Exercise therapy is an effective component of fibromyalgia ( FM ) treatment . However , it is important to know the effects and specificities of the different types of exercise : muscle stretching and resistance training . AIM To verify and compare the effectiveness of muscle stretching exercise and resistance training for symptoms and quality of life in FM patients . DESIGN R and omized controlled trial . SETTING Physical therapy service , FM outpatient clinic . POPULATION Forty-four women with FM ( 79 screened ) . METHODS Patients were r and omly allocated into a stretching group ( N.=14 ) , resistance group ( N.=16 ) , and control group ( N.=14 ) . Pain was assessed using the visual analog scale , pain threshold using a Fischer dolorimeter , FM symptoms using the Fibromyalgia Impact Question naire ( FIQ ) , and quality of life using the Medical Outcomes Study 36-item Short-Form Health Survey ( SF-36 ) . The three intervention groups continued with usual medical treatment . In addition , the stretching and resistance groups performed two different exercise programs twice a week for 12 weeks . RESULTS After treatment , the stretching group showed the highest SF-36 physical functioning score ( P=0.01 ) and the lowest bodily pain score ( P=0.01 ) . The resistance group had the lowest FIQ depression score ( P=0.02 ) . The control group had the highest score for FIQ morning tiredness and stiffness , and the lowest score for SF-36 vitality . In clinical analyses , the stretching group had significant improvement in quality of life for all SF-36 domains , and the resistance group had significant improvement in FM symptoms and in quality of life for SF-36 domains of physical functioning , vitality , social function , emotional role , and mental health . CONCLUSIONS Muscle stretching exercise was the most effective modality in improving quality of life , especially with regard to physical functioning and pain , and resistance training was the most effective modality in reducing depression . CLINICAL REHABILITATION IMPACT The trial included a control group and two intervention groups , both of which received exercise programs created specifically for patients with FM . In clinical practice , we suggest including both modalities in an exercise therapy program for FM Objective To evaluate the clinical effectiveness of low-frequency pulsed electromagnetic field ( PEMF ) therapy for women with fibromyalgia ( FM ) . Methods Fifty-six women with FM , aged 18 to 60 years , were r and omly assigned to either PEMF or sham therapy . Both the PEMF group ( n=28 ) and the sham group ( n=28 ) participated in therapy , 30 minutes per session , twice a day for 3 weeks . Treatment outcomes were assessed by the fibromyalgia Impact question naire ( FIQ ) , visual analog scale ( VAS ) , patient global assessment of response to therapy , Beck Depression Inventory ( BDI ) , and Short-Form 36 health survey ( SF-36 ) , after treatment ( at 4 wk ) and follow-up ( at 12 wk ) . Results The PEMF group showed significant improvements in FIQ , VAS pain , BDI score , and SF-36 scale in all domains at the end of therapy . These improvements in FIQ , VAS pain , and SF-36 pain score during follow-up . The sham group also showed improvement were maintained on all outcome measures except total FIQ scores after treatment . At 12 weeks follow-up , only improvements in the BDI and SF-36 scores were present in the sham group . Conclusion Low-frequency PEMF therapy might improve function , pain , fatigue , and global status in FM patients OBJECTIVE To determine the efficacy of training in fibromyalgia ( FM ) , we compared the effects of high intensity fitness training ( HIF ) and low intensity fitness training ( LIF ) . METHODS Thirty-seven female patients with FM were r and omly allocated to either a HIF group ( n = 19 ) or a LIF group ( n = 18 ) . Four patients ( 1 HIF group , 3 LIF group ) refused to participate after r and omization but before the start of the intervention . They were excluded from the analysis . Assessment s were performed at baseline and after 20 weeks of HIF or LIF . The primary outcome was patient 's global assessment [ on 100 mm visual analog scale ( VAS ) ] . Secondary endpoints were pain , number of tender points , total myalgic score , physical fitness , health status , and psychological distress . RESULTS One patient in the HIF group ( n = 18 ) and 2 in the LIF group ( n = 15 ) stopped training sessions during the course of the study . Nine of 18 patients in the HIF group compared to 8 of 15 patients in the LIF group achieved a participation rate of 67 % or more . Most important reasons for nonadherence were postexercise pain and fatigue , time consumption , and stress . The VAS for global well being improved slightly from 64 to 56 mm in the HIF group , and did not change in the LIF group ( 58 to 61 mm ) ( p = 0.07 ) . The Wmax ( physical fitness ) changed modestly from 110 to 123 watt in the HIF group , and from 97 to 103 watt in the LIF group ( p = 0.3 ) . VAS for pain increased from 53 to 64 mm in the HIF group and from 52 to 54 mm in the LIF group . The large st and ard deviations around mean change in global assessment s , number of tender points , total myalgic score , and psychological distress ( by SCL-90 ) severely influenced the power to detect within- and between-group differences . Analysis limited to those patients who accomplished a high attendance rate ( > 67 % ) showed similar results . CONCLUSION High intensity physical fitness training compared to low intensity physical fitness training leads to only modest improvements in physical fitness and general well being in patients with FM , and does not positively affect psychological status and general health UNLABELLED Fibromyalgia ( FM ) , a rheumatological disorder of unknown origin , is characterized by both physical and psychological symptoms . Although inconclusive results have been reported for most treatment modalities , exercise appears to have universal support for decreasing the myriad of symptoms associated with FM . Weaknesses in the literature , however , prevent conclusive statements regarding exercise prescription and concomitant impact on FM symptomology . PURPOSE The current pilot study attempted to examine the effect of a 24-wk walking program at predetermined intensities on FM . METHODS Initial design was a r and omized control trial with  high- and low-intensity exercise groups  , and a control group . Subsequent nonr and omized control trials were based on actual exercise behavior . RESULTS No differences between initial groups were identified . By collapsing groups , heart rate ( HR ) decreased ( P < 0.05 ) weeks 0 - 12 . Functional impairments were reduced 54 % weeks 0 - 24 , with exercise having a large impact ( omega2 = 0.30 ) on this decrease . By reassigning groups , impact of FM on current health status decreased in the low-intensity group ( P < 0.05 ) and increased in the high-intensity group ( P < 0.02 ) weeks 0 - 24 . Omega squared indicated strong influence of exercise on pain ( omega2 = 0.51 ) , with greater pain in the high-intensity group . CONCLUSIONS A larger number of subjects and direct supervision of the training program to increase compliance is necessary to clarify the effects of a walking program on the manifestations of FM . Results indicate that intensity of the walking program is an important consideration . Individuals with FM can adhere to low-intensity walking programs two to three times per week , possibly reducing FM impact on daily activities OBJECTIVES In fibromyalgia syndrome ( FMS ) defined rehabilitation guidelines are yet to be vali date d. Our aim is to evaluate the efficacy of the Rességuier method ( RM ) in FMS . METHODS Forty-one patients were r and omly assigned to Interventional ( 22 pts ) and Observational ( 19 pts ) Group ( IG and OG ) . The study lasted 8 months . Patients were assessed at baseline ( T0 ) after a 2-month rehabilitation ( T1 ) and at a 6-month follow-up ( T2 ) ( only IG ) with SF-36 Physical ( PSI ) and Mental Synthetic Index ( MSI ) , Regional Pain Scale ( RPS ) , Fibromyalgia Impact Question naire ( FIQ ) , Number Rating Scales 0 - 10 to measure pain , movement quality , sleep , relax ability , analgesics number/per week . OG patients maintained their lifestyle for the duration of the study . RM aims to obtain patient awareness and control of bodily perceptions , thus reaching a modulation of responses to pain . Therapist controls patient attention and perception by verbal and manual contacts and leads them to perform bodily and respiratory active and conscious movements . RESULTS In IG , at T1 all items were improved : PSI and MSI ( p<0.001 and = 0.001 ) , FIQ ( p<0.0001 ) , RPS ( p<0.001 ) , pain ( p<0.0001 ) , movement quality ( p=0.001 ) , relax ability ( p<0.0001 ) , sleep ( p<0.001 ) ; analgesics number/per week was reduced ( p<0.001 ) . All results obtained at T1 , except FIQ , were maintained at T2 . In OG at T1 versus T0 , no difference in any of the assessed parameters was observed . CONCLUSION In FMS patients , the rehabilitation with RM  improves HRQoL , FMS-related disability and perceived pain , thus reducing the assumption of analgesics OBJECTIVES Group exercises may be useful in fibromyalgia syndrome ( FMS ) .  The ' Body movement and perception ' ( BMP ) method is based on low impact exercises , awareness of body perception and relaxation , aim ed at treating small groups of patients following the Resseguier method ( RM ) and integrating RM with exercises derived from soft gymnastics . We assessed the effects of BMP method on FMS . METHODS 40 women with FMS ( age and disease duration : 51.7±7.2 and 4.9±3.8 years ) participated in an open pilot study . BMP sessions were performer twice a week ( 50 minutes each ) for 8 weeks . Patients were assessed at enrolment ( T0 ) and at the end of the study ( T1 ) by a self-administered question naire ( temporal characteristics of pain , pain interference in working and recreational activities and in night-time rest , awareness of pain , fatigue , irritability , well-being , quality of movement , ability to focus on perception and to perceive whole body , postural selfcontrol , ability to relax ) and a clinical evaluation ( tender points , assumption of analgesics/NSAIDs , distribution of pain , pain in sitting and st and ing position , pain during postural passages and gait , postural body alignment , muscular contractures ) . RESULTS At T1 , FMS patients significantly improved with respect to T0 in pain , fatigue , irritability , well-being , quality of movement , postural self-control , ability to relax mind and body , movement perception , tender point scores , assumption of analgesic/NSAIDs , body alignment and muscle contractures ( p<0.05 for all the comparisons T1 versus T0 ) . CONCLUSIONS In FMS patients , rehabilitation with BMP  improves pain and well being , reduces the number of tender points and muscle contractures , thus it is useful in FMS management Introduction Fibromyalgia ( FM ) is characterized by persistent widespread pain , increased pain sensitivity and tenderness . Muscle strength in women with FM is reduced compared to healthy women . The aim of this study was to examine the effects of a progressive resistance exercise program on muscle strength , health status , and current pain intensity in women with FM . Methods A total of 130 women with FM ( age 22–64 years , symptom duration 0–35 years ) were included in this assessor-blinded r and omized controlled multi-center trial examining the effects of progressive resistance group exercise compared with an active control group . A person-centred model of exercise was used to support the participants ’ self-confidence for management of exercise because of known risks of activity-induced pain in FM . The intervention was performed twice a week for 15 weeks and was supervised by experienced physiotherapists . Primary outcome measure was isometric knee-extension force ( Steve Strong ® ) , secondary outcome measures were health status ( FIQ total score ) , current pain intensity ( VAS ) , 6MWT , isometric elbow-flexion force , h and -grip force , health related quality of life , pain disability , pain acceptance , fear avoidance beliefs , and patient global impression of change ( PGIC ) . Outcomes were assessed at baseline and immediately after the intervention . Long-term follow up comprised the self-reported question naires only and was conducted after 13–18 months . Between-group and within-group differences were calculated using non-parametric statistics . Results Significant improvements were found for isometric knee-extension force ( p = 0.010 ) , health status ( p = 0.038 ) , current pain intensity ( p = 0.033 ) , 6MWT ( p = 0.003 ) , isometric elbow flexion force ( p = 0.02 ) , pain disability ( p = 0.005 ) , and pain acceptance ( p = 0.043 ) in the resistance exercise group ( n = 56 ) when compared to the control group ( n = 49 ) . PGIC differed significantly ( p = 0.001 ) in favor of the resistance exercise group at post-treatment examinations . No significant differences between the resistance exercise group and the active control group were found regarding change in self-reported question naires from baseline to 13–18 months . Conclusions Person-centered progressive resistance exercise was found to be a feasible mode of exercise for women with FM , improving muscle strength , health status , and current pain intensity when assessed immediately after the intervention . Trial registration Clinical Trials.gov identification number : NCT01226784 , Oct 21 , 2010 & NA ; Both pharmacological and non‐pharmacological interventions have demonstrated efficacy in the management of fibromyalgia ( FM ) .  Non‐pharmacological interventions however are far less likely to be used in clinical setting s , in part due to limited access . This manuscript presents the findings of a r and omized controlled trail of an Internet‐based exercise and behavioral self‐management program for FM design ed for use in the context of a routine clinical care . 118 individuals with FM were r and omly assigned to either ( a ) st and ard care or ( b ) st and ard care plus access to a Web‐Enhanced Behavioral Self‐Management program ( WEB‐SM ) grounded in cognitive and behavioral pain management principles . Individuals were assessed at baseline and again at 6 months for primary endpoints : reduction of pain and an improvement in physical functioning . Secondary outcomes included fatigue , sleep , anxiety and depressive symptoms , and a patient global impression of improvement . Individuals assigned to the WEB‐SM condition reported significantly greater improvement in pain , physical functioning , and overall global improvement . Exercise and relaxation techniques were the most commonly used skills throughout the 6 month period . A no‐contact , Internet‐based , self‐management intervention demonstrated efficacy on key outcomes for FM . While not everyone is expected to benefit from this approach , this study demonstrated that non‐pharmacological interventions can be efficiently integrated into routine clinical practice with positive outcomes OBJECTIVE To evaluate the effectiveness of a modified Myers ' formula of intravenous nutrient therapy ( IVNT ) on the symptoms of fibromyalgia ( FM ) in therapy-resistant FM patients . METHODS In this pilot clinical trial , 7 participants with therapy resistant FM were given IVNT once per week for 8 weeks . Patient 's pain levels , fatigue , and activities of daily living were evaluated weekly . RESULTS All participants reported decreased pain levels , decreased fatigue , and increased activities of daily living . Participants noted increased energy levels within 24 - 48 hours of the initial infusion . At the end of the study , all participants reported increased energy and activities of daily living as well as a 60 % reduction in pain ( P=.005 ) and an 80 % decrease in fatigue ( P=-.005 ) . No participants , however , reported complete or lasting resolution of pain or fatigue . No side effects were reported . DISCUSSION Anecdotal reports have indicated benefit for IVNT for patients with chronic pain , including FM . However , except for 2 reports , the medical literature is devoid of any studies of IVNT for the treatment of FM . In this pilot study , 7 participants received  IVNT  once a week for 8 weeks . All participants had long-st and ing FM ( at least 8 years ) and had tried conventional therapies , such as antidepressants , nonsteroidal anti-inflammatory drugs , and exercise , without significant or lasting relief . All had improvement in symptoms and increases in their activities of daily living , although no participant reported complete resolution of symptoms .  IVNT appears to be safe to reduce FM symptoms Objectives : Cognitive-behavioral therapies ( CBT ) for fibromyalgia syndrome ( FMS ) are important interventions in the management of this condition . Empirical evidence reports that although the results are promising , further research is needed to respond more appropriately to these patients . This study focuses on exploring the use of Virtual Reality ( VR ) as an adjunct to the activity management component . The aim of this study is to present the results of a small-sized r and omized controlled trial to test the preliminary efficacy and acceptability of this component . Material s and Methods : The final sample was composed of 61 women diagnosed with FMS according to the American College of Rheumatology . The sample was r and omly allocated to 2 conditions : VR treatment and treatment as usual . Results : Participants in the VR condition achieved significant improvements in the primary outcome : disability measured with the FIQ . The improvement was also significant in secondary outcomes , such as perceived quality of life and some of the coping strategies included in the Chronic Pain Coping Inventory : task persistence and exercise . There were no differences in other secondary outcome measures like pain intensity and interference and depression . Participants reported high satisfaction with the VR component . Discussion : The effects were related to the psychological aspects targeted in the treatment . The component was well accepted by FMS patients referred from a public hospital . These findings show that the VR component could be useful in the CBT treatment of FMS and encourage us to continue exploring the use of integrating VR with CBT interventions for the treatment of FMS
Conclusion The main results included reduction in pain , fatigue , number of tender points , depression , and anxiety , with increased functional capacity and quality of life .
Background Fibromyalgia ( FM ) is characterized by chronic and generalized musculoskeletal pain .
There is currently no cure for FM , but palliative treatments are available .
One type of treatment is strength training ( ST ) .
However , there is a need for more information on optimal training protocol s , intensity , and volume needed to improve symptoms .
The aim of this study was to analyze the effects of ST in the treatment of FM through a systematic review of experimental research .