Effectiveness of multicomponent treatment compared with other therapeutic interventions in patients with fibromyalgia: A systematic review with meta-analysis

Abstract

Background

Fibromyalgia (FM) is a chronic pain disease characterized by widespread musculoskeletal pain. The multicomponent treatment has showed improves symptom management in patients with FM. However, inconsistent results have been demonstrated in previous studies. Additionally, none of these studies have analyzed the effect on psychological outcomes.

Objective

To determine the effectiveness of multicomponent treatment compared with other therapeutic interventions for pain intensity and functional status, quality of life, depression and pain anxiety in patients with FM.

Methods

An electronic search was performed using MEDLINE, CENTRAL EMBASE, Web of Science, PEDro, CINAHL, SPORTDiscus, Scopus, and LILACS databases. The eligibility criteria included randomized clinical trials (RCTs) investigating the effects of multicomponent treatment compared with other therapeutic interventions (active and passive) in patients older than 18 years with FM. Effect sizes were calculated as a standard mean difference (SMD) with 95% CI using random-effects Hartung-Knapp-Sidik–Jonkman or the Mantel-Haenszel fixed method. The quality of intervention reporting was assessed with the Risk of Bias (RoB) 2, and certainty of evidence was assessed using GRADE approach. Two authors independently performed the search, study selection, data extraction, and risk-of-bias assessment.

Results

Twenty-five RCTs met the eligibility criteria, including 3476 patients. At 10–16 weeks, for multicomponent treatment versus all other interventions, the standardized mean difference in pain intensity was −0.51 (95% CI: −0.92 to −0.10, P = 0.021). For functional status, quality of life, depression, and anxiety, statistically significant differences were found in favor of multicomponent treatment (all P values <0.05). Additionally, there were no differences in the effects of multicomponent treatment and passive interventions on any clinical outcomes. Finally, our study has some limitations such as lack methodology of some clinical trials included and high heterogeneity could be over-or-under estimation the effects of the intervention's studied.

Conclusion

In the medium term, multicomponent treatment, in comparison with all other interventions (active and passive), showed statistically and clinically significant differences with moderate effect size in pain intensity in patients with FM. The quality of evidence was low to high according to the GRADE approach. Additionally, there were no differences between multicomponent treatment and passive interventions in patients with FM.

PROSPERO registration number

CRD42020142082.