Evidence-based approaches for the management of fibromyalgia syndrome: a scoping review

Background: Fibromyalgia syndrome (FMS) is a chronic widespread pain syndrome characterized primarily by widespread pain, fatigue, sleep dysfunction and low exercise tolerance. The pathophysiology is complex and its understanding evolving, and clinical management is difficult, with heterogeneous interventions employed. Objectives: This scoping review provides an overview of fibromyalgia syndrome, and the evidence for the principal rehabilitation approaches. CINAHL, Cochrane, Medline and PubMed databases were searched from 1996 to 2021. Rehabilitation approaches included exercise, psychologically-based approaches, multicomponent approaches, and complementary and alternative therapies. Major findings: Due to factors such as methodological shortcomings of existing studies, and the lack of evidence on individual modalities, it is difficult to draw definitive conclusions as to which is the most appropriate rehabilitation approach in FMS. However, there is evidence from meta-analyses and several international guidelines for the use of approaches incorporating exercise. There is also some evidence for the use of psychologically-informed interventions such as cognitive-behavioural therapy (CBT) approaches. Evidence for other interventions is more equivocal. Conclusions: It appears that a combination of interventions (e.g. exercises combined with education and psychological approaches), is the most promising means of managing patients with FMS. Issues such as high numbers of drop-outs from exercise programmes, lack of long-term follow-up in many studies, and patients’ preferences warrant further investigation. An individualized approach based upon extent of psychological involvement, severity of symptoms and level of disability is also recommended.