Chiropractic Management of Fibromyalgia Syndrome: A Systematic Review of the Literature
Received 29 April 2008; received in revised form 10 July 2008; accepted 11 August 2008.
Abstract
Objective
Fibromyalgia syndrome (FMS) is one of the most commonly diagnosed nonarticular soft tissue conditions in all fields of musculoskeletal medicine, including chiropractic. The purpose of this study was to perform a comprehensive review of the literature for the most commonly used treatment procedures in chiropractic for FMS and to provide evidence ratings for these procedures. The emphasis of this literature review was on conservative and nonpharmaceutical therapies.
Methods
The Scientific Commission of the Council on Chiropractic Guidelines and Practice Parameters (CCGPP) was charged with developing literature syntheses, organized by anatomical region, to evaluate and report on the evidence base for chiropractic care. This article is the outcome of this charge. As part of the CCGPP process, preliminary drafts of these articles were posted on the CCGPP Web site www.ccgpp.org (2006-8) to allow for an open process and the broadest possible mechanism for stakeholder input. Online comprehensive literature searches were performed of the following databases: Cochrane Database of Systematic Reviews; National Guidelines Clearinghouse; Cochrane Central Register of Controlled Trials; Manual, Alternative, and Natural Therapy Index System; Index to Chiropractic Literature, Cumulative Index to Nursing and Allied Health Literature; Allied and Complementary Medicine; and PubMed up to June 2006.
Results
Our search yielded the following results: 8 systematic reviews, 3 meta-analyses, 5 published guidelines, and 1 consensus document. Our direct search of the databases for additional randomized trials did not find any chiropractic randomized clinical trials that were not already included in one or more of the systematic reviews/guidelines. The review of the Manual, Alternative, and Natural Therapy Index System and Index to Chiropractic Literature databases yielded an additional 38 articles regarding various nonpharmacologic therapies such as chiropractic, acupuncture, nutritional/herbal supplements, massage, etc. Review of these articles resulted in the following recommendations regarding nonpharmaceutical treatments of FMS. Strong evidence supports aerobic exercise and cognitive behavioral therapy. Moderate evidence supports massage, muscle strength training, acupuncture, and spa therapy (balneotherapy). Limited evidence supports spinal manipulation, movement/body awareness, vitamins, herbs, and dietary modification.
Conclusions
Several nonpharmacologic treatments and manual-type therapies have acceptable evidentiary support in the treatment of FMS.
aVisiting Assistant Professor, School of Health and Rehabilitation Sciences, University of Pittsburgh, Pittsburgh, Pa, USA
bProfessor, Graduate Education and Research, Canadian Memorial Chiropractic College, Toronto, Ontario, Canada
cMedical Director, Canadian Centre for Integrative Medicine, Physiatry Intervention Clinic, Sunnybrook Health Sciences Centre, University of Toronto, Toronto, Ontario, Canada
dAssistant Professor, Canadian Memorial Chiropractic College, Toronto, Ontario, Canada
eStudent, School of Medicine, University of Toronto, Ontario, Canada
Submit requests for reprints to: Michael Schneider, DC, Assistant Professor and PhD candidate, School of Health and Rehabilitation Sciences, University of Pittsburgh, Pittsburgh, PA, USA
ABSTRACT