Fibromyalgia

Lifestyle modifications

NUTRITION

  • A low FODMAP diet may reduce symptoms, particularly fibromyalgia patients with irritable bowel syndrome (7)
  • Vitamin D: Limited evidence suggests that supplementation or adequate levels may reduce symptoms (5)
  • There is some evidence that a plant based diet may reduce symptoms of fibromyalgia (6)

PHYSICAL ACTIVITY

  • Regular physical activity / exercise is the only therapy with a strong recommendation (2)
  • Activities that combine exercise with relaxation training is effective (1)
  • Both aerobic exercise and resistance training are associated with improved pain and physical function (2)
  • Both land based and water based exercise are effective (3)
  • Pain may increase in the beginning of an exercise program. Thus, it is important to motivate the patient to continue the program, preferably light to moderate intensity 2-3 times per week (3)
  • Regular aerobic exercise may possibly also reduce fatigue and stiffness (4)

STRESS

  • Stress may increase fibromyalgia symptoms. Thus learning stress management is useful (8)

SLEEP

  • Most people with fibromyalgia have non restorative sleep (9)
  • Maintain good sleep hygiene (8)
  • Low quality evidence shows that among people with fibromyalgia cognitive behavior therapy for insomnia (CBT-I) improves sleep quality, pain, anxiety, depression, but not sleep efficiency compared to other non-pharmacological treatments (10)

References

1) https://bestpractice.bmj.com/topics/en-gb/187/treatment-algorithm

2) Macfarlane, Gary J., et al. “EULAR revised recommendations for the management of fibromyalgia.” Annals of the rheumatic diseases 76.2 (2017): 318-328. (Link)

3) Häuser, Winfried, et al. “Efficacy of different types of aerobic  exercise in fibromyalgia syndrome: a systematic review and meta-analysis  of randomised controlled trials.” Arthritis research & therapy 12.3 (2010): 1-14. (Link)

4) Bidonde, Julia, et al. “Aerobic exercise training for adults with fibromyalgia.” Cochrane Database of Systematic Reviews 6 (2017). (Link)

5) https://www.ingentaconnect.com/content/ben/crr/2022/00000018/00000004/art00006

6) https://www.mdpi.com/1660-4601/18/9/4955

7) https://www.tandfonline.com/doi/full/10.1080/07853890.2018.1564360

8) https://www.uptodate.com/contents/initial-treatment-of-fibromyalgia-in-adults

9) https://www.uptodate.com/contents/clinical-manifestations-and-diagnosis-of-fibromyalgia-in-adults

10) https://www.tandfonline.com/doi/abs/10.1080/09638288.2021.1954706


Resources

EXPLANATION TO EVIDENCE PRESENTATION

Figure: Evidence pyramid

Evidence based on guidelines and evidence based Clinical Decision Systems is written in BOLD font

Evidence based on meta analysis or systematic reviews is written in BOLD and CURSIVE font

​Evidence based on randomized controlled trials is written in PLAIN font

Evidence based on observational / cohort studies is written in CURSIVE font