Low-frequency Pulsed Electromagnetic Field Therapy in Fibromyalgia: A Randomized, Double-blind, Sham-controlled Clinical Study Neurotherapy of fibromyalgia? Management of patients with fibromyalgia using biofeedback: a randomized control trial. Internet-enhanced management of fibromyalgia: A randomized controlled trial Written pain neuroscience education in fibromyalgia: a multicenter randomized controlled trial. Integrating Virtual Reality With Activity Management for the Treatment of Fibromyalgia: Acceptability and Preliminary Efficacy The contribution of pain, reported sleep quality, and depressive symptoms to fatigue in fibromyalgia Efficacy and Safety of Medicinal Plants or Related Natural Products for Fibromyalgia: A Systematic Review Inaccuracy in the diagnosis of fibromyalgia syndrome: analysis of referrals. Six weeks of whole-body vibration exercise improves pain and fatigue in women with fibromyalgia. Values-Based Action in Fibromyalgia: Results From a Randomized Pilot of Acceptance and Commitment Therapy Patients with fibromyalgia display less functional connectivity in the brain’s pain inhibitory network Multidisciplinary treatment of fibromyalgia: does cognitive behavior therapy increase the response to treatment? [Shared decision making (SDM) with chronic pain patients. The patient as a partner in the medical decision making process]. Effectiveness of group acceptance and commitment therapy for fibromyalgia: A 6-month randomized controlled trial (EFFIGACT study) Characterization and consequences of pain variability in individuals with fibromyalgia. A randomized placebo-controlled study of noninvasive cortical electrostimulation in the treatment of fibromyalgia patients.
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 evaluate the efficacy of a novel variant of electroencephalograph biofeedback , the Low Energy Neurofeedback System ( LENS ) , that utilizes minute pulses of electromagnetic stimulation to change brainwave activity for the amelioration of fibromyalgia ( FM ) symptoms . DESIGN R and omized , double-blind , placebo-controlled clinical trial . SETTING Tertiary referral academic medical center , outpatient . PATIENTS Thirty-four patients diagnosed with FM according to 1990 American College of Rheumatology classification criteria . INTERVENTIONS Active or sham LENS , depending on r and omization , for 22 treatment sessions . OUTCOME MEASURES Primary outcome measure was the Fibromyalgia Impact Question naire total score . Secondary outcome measures included number of tender points ( TPs ) and pressure required to elicit TPs on physical examination , quantitative sensory testing heat pain threshold , and self-reported cognitive dysfunction , fatigue , sleep problems , global psychological distress , and depression obtained at baseline , immediate post-treatment , and 3- and 6-month follow-up . RESULTS Participants who received the active or sham interventions improved ( Ps < 0.05 ) on the primary and a variety of secondary outcome measures , without statistically significant between group differences in evidence at post-treatment or 3- or 6-month follow-up . Individual session self-reported ratings of specific symptoms ( cognitive dysfunction , fatigue , pain , and sleep , and overall activity level ) over the course of the 22 intervention sessions indicated significant linear trends for improvement for the active intervention condition only ( Ps < 0.05 ) . CONCLUSION LENS can not be recommended as a single modality treatment for FM . However , further study is warranted to investigate the potential of LENS to interact synergistically with other pharmacologic and nonpharmacologic therapies for improving symptoms in FM 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 & 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 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 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 & NA ; The major objective of this research was to evaluate the predictors of fatigue in patients with fibromyalgia ( FM ) , using cross‐sectional and daily assessment method ologies . In the cross‐sectional phase of the research involving a sample of 105 FM patients , greater depression and lower sleep quality were concurrently associated with higher fatigue . While pain was correlated with fatigue , it did not independently contribute to fatigue in the regression equation . For a subset of patients from the cross‐sectional sample ( n=63 ) who participated in a week of prospect i ve daily assessment of their pain , sleep quality , and fatigue , multiple regression analysis of aggregated ( averaged ) daily scores revealed that previous day 's pain and sleep quality predicted next day 's fatigue . Depression from the cross‐sectional phase was not related to aggregated daily fatigue scores . A path analytic framework was tested with disaggregated ( removing between subjects variability ) data in which pain was predicted to contribute to lower sleep quality which , in turn , was predicted to lead to greater fatigue . The results revealed that poor sleep quality fully accounted for the positive relationship between pain and fatigue , thus substantiating the mediational role of sleep quality . The findings are indicative of a dysfunctional , cyclical pattern of heightened pain and non‐restful sleep underlying the experience of fatigue in FM To assess the effects of medicinal plants ( MPs ) or related natural products ( RNPs ) on fibromyalgia ( FM ) patients , we evaluate the possible benefits and advantages of MP or RNP for the treatment of FM based on eight r and omized placebo-controlled trials ( RCTs ) involving 475 patients . The method ological quality of all studies included was determined according to JADAD and “ Risk of Bias ” with the criteria in the Cochrane H and book for Systematic Review s of Interventions 5.1.0 . Evidence suggests significant benefits of MP or RNP in sleep disruption , pain , depression , joint stiffness , anxiety , physical function , and quality of life . Our results demonstrated that MP or RNP had significant effects on improving the symptoms of FM compared to conventional drug or placebo ; longer tests are required to determine the duration of the treatment and characterize the long-term safety of using MP , thus suggesting effective alternative therapies in the treatment of pain with minimized side effects OBJECTIVE To examine prospect ively the accuracy of an initial diagnosis for fibromyalgia ( FM ) . METHODS All patients newly referred for rheumatology consultation in a 6-month period were evaluated prospect ively for either a preceding , current or subsequent diagnosis of FM . Clinical characteristics , previous and subsequent management and health care utilization were assessed . The final diagnosis at 6 months was verified and accuracy regarding the diagnosis of FM was assessed . RESULTS Seventy six ( 12 % ) of all new patients were either referred with a question of FM or finally diagnosed with FM . At the final evaluation the accuracy of the diagnosis regarding FM by either the referring physician or by the rheumatologist at the time of the initial visit was correct in 34 % of patients . The FM group in comparison with those with some other rheumatological diagnosis had more tender points ( 12.5 vs 4 ) and were more fatigued . In contrast , prolonged early morning stiffness and limitation of lumbar spinal mobility in more than one plane was more common in the non-FM group . CONCLUSION There is a disturbing inaccuracy , mostly observed to be overdiagnosis , in the diagnosis of FM by referring physicians . This finding may help explain the current high reported rates of FM and caution physicians to consider other diagnostic possibilities when addressing diffuse musculoskeletal pain OBJECTIVE The aim of this study was to investigate the effectiveness of a 6-week traditional exercise program with supplementary whole-body vibration ( WBV ) in improving health status , physical functioning , and main symptoms of fibromyalgia ( FM ) in women with FM . METHODS Thirty-six ( 36 ) women with FM ( mean + /- st and ard error of the mean age 55.97 + /- 1.55 ) were r and omized into 3 treatment groups : exercise and vibration ( EVG ) , exercise ( EG ) , and control ( CG ) . Exercise therapy , consisting of aerobic activities , stretching , and relaxation techniques , was performed twice a week ( 90 min/day ) . Following each exercise session , the EVG underwent a protocol with WBV , whereas the EG performed the same protocol without vibratory stimulus . The Fibromyalgia Impact Question naire ( FIQ ) was administered at baseline and 6 weeks following the initiation of the treatments . Estimates of pain , fatigue , stiffness , and depression were also reported using the visual analogue scale . RESULTS A significant 3 x 2 ( group x time)-repeated measures analysis of variance interaction was found for pain ( p = 0.018 ) and fatigue ( p = 0.002 ) but not for FIQ ( p = 0.069 ) , stiffness ( p = 0.142 ) , or depression ( p = 0.654 ) . Pain and fatigue scores were significantly reduced from baseline in the EVG , but not in the EG or CG . In addition , the EVG showed significantly lower pain and fatigue scores at week 6 compared to the CG , whereas no significant differences were found between the EG and CG ( p > 0.05 ) . CONCLUSION Results suggest that a 6-week traditional exercise program with supplementary WBV safely reduces pain and fatigue , whereas exercise alone fails to induce improvements Fibromyalgia Syndrome ( FMS ) is a chronic pain condition characterized by pain , fatigue , and nonrestorative sleep . The disruptive symptoms of FMS are associated with reductions in quality of life related to family , intimate relationships , and work . The present study was part of a r and omized pilot study of an 8-week Acceptance and Commitment Therapy ( ACT ) intervention compared to education in a sample of 28 women with FMS . The Chronic Pain Values Inventory was administered at baseline , postintervention , and 12 week follow-up . Both groups showed significant improvements in family success , which were maintained at follow-up . Groups showed a differential pattern of success in work . The ACT group demonstrated significant , maintained improvements in success in intimate relationships , while the education group reported no changes over time . Findings suggest that both interventions may lead to improvements in valued living ; however different interventions may be best suited for certain valued domains . The results of this study indicate that FMS patients are able to improve their success in family and intimate relationships and losses in these areas are not necessarily permanent Background There is evidence for augmented processing of pain and impaired endogenous pain inhibition in Fibromyalgia syndrome ( FM ) . In order to fully underst and the mechanisms involved in FM pathology , there is a need for closer investigation of endogenous pain modulation . In the present study , we compared the functional connectivity of the descending pain inhibitory network in age-matched FM patients and healthy controls (HC).We performed functional magnetic resonance imaging ( fMRI ) in 42 subjects ; 14 healthy and 28 age-matched FM patients ( 2 patients per HC ) , during r and omly presented , subjectively calibrated pressure pain stimuli . A seed-based functional connectivity analysis of brain activity was performed . The seed coordinates were based on the findings from our previous study , comparing the fMRI signal during calibrated pressure pain in FM and HC : the rostral anterior cingulate cortex ( rACC ) and thalamus . Results FM patients required significantly less pressure ( kPa ) to reach calibrated pain at 50 mm on a 0–100 visual analogue scale ( p < .001 , two-tailed ) . During fMRI scanning , the rACC displayed significantly higher connectivity to the amygdala , hippocampus , and brainstem in healthy controls , compared to FM patients . There were no regions where FM patients showed higher rACC connectivity . Thalamus showed significantly higher connectivity to the orbitofrontal cortex in healthy controls but no regions showed higher thalamic connectivity in FM patients . Conclusion Patients with FM displayed less connectivity within the brain ’s pain inhibitory network during calibrated pressure pain , compared to healthy controls . The present study provides brain-imaging evidence on how brain regions involved in homeostatic control of pain are less connected in FM patients . It is possible that the dysfunction of the descending pain modulatory network plays an important role in maintenance of FM pain and our results may translate into clinical implication s by using the functional connectivity of the pain modulatory network as an objective measure of pain dysregulation 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 Fibromyalgia syndrome ( FMS ) is an exemplary condition of chronic widespread pain that is difficult to control and often leads to frustration and resignation on the part of both the patient and the doctor . Shared decision making  ( SDM ) could be a means to facilitate doctor-patient interaction and might therefore influence therapeutic decisions taken . We conducted a prospect i ve study to evaluate the effects of SDM with FMS patients . We developed a communication train-ing program for physicians and a computer-based information tool on FMS for patients . The study included 133 FMS patients . Intervention group I ( IG I ) was treated by communication-trained doctors and had access to a computer-based information tool on FMS , intervention group II ( IG II ) was treated by st and ard doctors and received the information tool , and the control group ( CG ) was treated by st and ard doctors and got no additional information . All three groups we-re offered the same evidence -based treatment options for FMS . Patients of the IGs were more willing to become involved in exercise , to enroll in  integrated group therapy  for FMS patients ( IGTF ) , and to take  analgesics .  Patients of the CG preferred anti-depressants . More patients from IG II and CG opted for relaxation techniques .  Patients in IG I and IG II choose significantly more therapeutic options than patients in the CG . SDM is one means to increase  FMS patients ' readiness for treatment . Especially the element of providing sufficient medical information seems to account for this effect . The readiness to enroll in physical activities , to take analgesics , and to participate in psychotherapeutic elements was most likely to be raised through SDM Summary Acceptance and commitment therapy is effective for improving several clinical outcomes in fibromyalgia patients ABSTRACT In the last decade , there has been burgeoning interest in the effectiveness of third‐generation psychological therapies for managing fibromyalgia ( FM ) symptoms . The present study examined the effectiveness of acceptance and commitment therapy ( ACT ) on functional status as well as the role of pain acceptance as a mediator of treatment outcomes in FM patients . A total of 156 patients with FM were enrolled at primary health care centers in Zaragoza , Spain . The patients were r and omly assigned to a group‐based form of ACT ( GACT ) , recommended pharmacological treatment ( RPT ; pregabalin + duloxetine ) , or wait list ( WL ) . The primary end point was functional status ( measured with the Fibromyalgia Impact Question naire , FIQ ) . Secondary end points included pain catastrophizing , pain acceptance , pain , anxiety , depression , and health‐related quality of life . The differences between groups were calculated by linear mixed‐effects ( intention‐to‐treat approach ) and mediational models through path analyses . Overall , GACT was statistically superior to both RPT and WL immediately after treatment , and improvements were maintained at 6 months with medium effect sizes in most cases . Immediately after treatment , the number needed to treat for 20 % improvement compared to RPT was 2 ( 95 % confidence interval 1.2–2.0 ) , for 50 % improvement 46 , and for achieving a status of no worse than mild impaired function ( FIQ total score < 39 ) also 46 . Unexpectedly , 4 of the 5 tested path analyses did not show a mediation effect . Changes in pain acceptance only mediated the relationship between study condition and health‐related quality of life . These findings are discussed in relation to previous psychological research on FM treatment OBJECTIVE A growing body of evidence suggests that real-time electronic assessment s of pain are preferable to traditional paper- and -pencil measures . We used electronic assessment data derived from a study of patients with fibromyalgia ( FM ) to examine variability of pain over time and to investigate the implication s of pain fluctuation in the context of a clinical trial . METHODS The study group comprised 125 patients with FM who were enrolled in a r and omized , placebo-controlled trial of milnacipran .  Pain intensity levels  were captured in real time by participants using electronic diaries .  Variability in pain was assessed as the st and ard deviation of pain entries over time ( pain variability index [ PVI ] ) . RESULTS Substantial between-subject differences in pain variability were observed ( mean + /- SD PVI 1.61 + /- 0.656 [ range 0.27 - 4.05 ] ) . The fluctuation in pain report was constant over time within individuals ( r = 0.664 , P < 0.001 ) . Individuals with greater variability were more likely to be classified as responders in a drug trial ( odds ratio 6.14 , P = 0.006 ) ; however , this association was primarily attributable to a greater change in pain scores in individuals receiving placebo ( r = 0.460 , P = 0.02 ) rather than active drug ( r = 0.09 , P > 0.10 ) . CONCLUSION Among individuals with FM , there were large between-subject differences in real-time pain reports . Pain variability was relatively constant over time within individuals . Perhaps the most important finding is that individuals with larger pain fluctuations were more likely to respond to placebo . It is not clear whether these findings are applicable only to patients with FM or whether they may also be seen in patients with other chronic pain conditions OBJECTIVE The aim of this multicenter study was to evaluate the efficacy , safety , and tolerability of noninvasive cortical electrostimulation in the management of fibromyalgia ( FM ) . DESIGN A prospect i ve , r and omized , double-blind , placebo-controlled design was used . Setting . Subjects received therapy at two different outpatient clinical locations . PATIENTS There were 77 subjects meeting the American College of Rheumatology 1990 classification criteria for FM . Intervention . Thirty-nine ( 39 ) active treatment ( AT ) FM patients and 38 placebo controls received 22 applications of either noninvasive cortical electrostimulation or a sham therapy over an 11-week period . OUTCOME MEASURES The primary outcome measures were the number of tender points ( TePs ) and pressure pain threshold ( PPT ) . Secondary outcome measures were responses to the Fibromyalgia Impact Question naire ( FIQ ) , Symptom Checklist-90 ( SCL-90 ) , Beck Depression Inventory-II , and a novel sleep question naire , all evaluated at baseline and at the end of treatment . RESULTS Intervention provided significant improvements in TeP measures : compared with placebo , the AT patients improved in the number of positive TePs ( -7.4 vs -0.2 , P<0.001 ) and the PPT ( 19.6 vs -3.2 , P<0.001 ) . Most secondary outcomes also improved more in the AT group : total FIQ score ( -15.5 vs -5.6 , P=0.03 ) , FIQ pain ( -2.0 vs -0.6 , P=0.03 ) , FIQ fatigue ( -2.0 vs -0.4 , P=0.02 ) , and FIQ refreshing sleep ( -2.1 vs -0.7 , P=0.02 ) ; and while FIQ function improved ( -1.0 vs -0.2 ) , the between-group change had a 14 % likelihood of occurring due to chance ( P=0.14 ) . There were no significant side effects observed . CONCLUSIONS Noninvasive cortical electrostimulation in FM patients provided modest improvements in pain , TeP measures , fatigue , and sleep ; and the treatment was well tolerated . This form of therapy could potentially provide worthwhile adjunctive symptom relief for FM patients
There was low- quality evidence that acupuncture  improves pain compared to no treatment or st and ard treatment , but good evidence that it is no better than sham acupuncture .
The evidence for homoeopathy , spinal manipulation and herbal medicine was limited .
No firm conclusions were drawn for efficacy of either spinal manipulation or homoeopathy for FM .
Background Fibromyalgia ( FM ) is a chronic , debilitating pain disorder .
Dissatisfaction with conventional medicine can lead people with FM to turn to complementary and alternative medicine ( CAM ) .
Two previous overviews of systematic review s of CAM for FM have been published , but they did not assessed for risk of bias in the review process .