THERAPIES

Non-Pharmacological/Complementary Therapies

It is important to consider what non drug therapies one can try to manage the fatigue and pain symptoms.

Most of the drugs that are used can have side effects so often finding the right drug can take some time and trial and error  so it is important in the meantime to trial any of the complementary therapies listed below.

These don’t have the strength of good quality evidence and therefore need to be discussed with your healthcare professional or doctor before you trial that. They are often not offered on the NHS and therefore if you are going to pay for them then you need to be very clear on what you want to achieve.

Often a good way to ask the relevant healthcare professional about any treatment is the BRAN approach – ask for Benefits (B), Risks (R), Alternatives (A), and what if we do Nothing (N).

The evidence for this set of therapies mentioned below has been from the most recent scientific evidence from McFarlane’s Study in 2016. 

Acupuncture:

There are different versions of this practiced in many places and both electric and other versions such as Tui-na and Electro-acupuncture have been trialled for Fibromyalgia. “One high-quality review included nine trials, with 395 patients, and demonstrated that acupuncture, added to standard therapy, resulted in a 30% improvement in pain. Electro-acupuncture was also associated with improvements in pain and fatigue.

Biofeedback:

This technique was introduced and then trialled in a variety of medical conditions. In pain due to fibromyalgia, the main way it is supposed to work is by helping a person gain more control over normally involuntary(ie things you cant usually control) functions like heart rate, breathing, muscle tension and temperature. Other things that can be controlled include sweat glands and brain waves. In the studies that have been done upto now, it can reduce pain intensity but hasn’t made much benefit on fatigue or function. The idea behind biofeedback is that, by harnessing the power of your mind and becoming aware of what's going on inside your body, you can gain more control over your health.One commercially available measure of biofeedback as an example is the heart rate variability testing.

Chiropractic therapy:

Both this and osteopathic therapy are often the first choice for many patients. It may be beneficial to some as first line therapy but the studies that have been done are very low quality and hence this kind of care is often not available on the NHS. The McFarlane paper chose not to recommend chiropractic therapy citing safety concerns.

Cognitive behavioral therapy:

This is often provided very well locally in West Berkshire. In academic studies and systematic reviews by McFarlane et al, more than 2000 patients have been enrolled into various studies. Although the quality of individual trials was reported as generally poor, Cognitive behavioral therapies (CBTs) were effective in reducing pain and disability at the end of treatment compared with a variety of controls, and results were sustained long term.

Exercise:

This is one of the few techniques on which there is unanimous agreement to work to improve it locally in our population. The largest, a Cochrane review, considered 47 different exercise interventions and concluded that Aerobic exercise was associated with improvements in pain and physical function.

Hydrotherapy: Very few studies have been done  and only Four reviews were done which included up to 21 trials and 1306 participants. There was a significant improvement in pain at the end of therapy, maintained in the longer term (There was consistency with regard to the evidence for hydrotherapy and balneotherapy, although little evidence to suggest superiority of one over the other.

Hypnotherapy: hypnotherapy was compared with a variety of control therapies such as cognitive intervention, active control (physical therapy/massage/relaxation/autogenic training) and treatment as usual. Two of the four hypnotherapy trials report some significant benefit in terms of pain, the other two demonstrate null, non-significant results.

Massage: Comparator treatments included transcutaneous electrical nerve stimulation (TENS), standard care, guided relaxation and acupuncture. Overall, massage was not associated with a significant improvement in pain (and of the two ITT analyses, one favoured massage and one favoured control (both significant). No studies have been done to distinguish between the various forms of massage offered by various healthcare professionals.

Meditation: This has become very popular now in managing the symptoms of pain especially coupled with anxiety. The study by McFarlane mentions that a total of more than 500 patients in various studies that were done on therapies such as yoga, Taichi or qigong showed improvements in sleep and fatigue. These were also maintained long term.

Mindfulness/mind–body therapy:  Mindfulness is now part of many CBT style treatments and is often titled mindfulness based cognitive therapies(MBCT). It can also be used for stress reduction and goes by the name of Mindfulness Based Stress Reduction (MBSR)  Although the studies done were not very robust, they are very safe and often can be helpful especially when included as part of other lifestyle modifications.

Apart from this, there are a number of more alternative /complementary therapies that have been used in literature and studied and often offered to patients locally.

These don’t have the strength of good quality evidence and therefore need to be discussed with your healthcare professional or doctor before you trial these.

They are not offered on the NHS so go by the BRAN approach – ask for Benefits (B), Risks (R), Alternatives (A), and what if we do Nothing (N).

 

Such techniques include: Guided Imagery,  Homoeopathy, Electrothermal and phototherapeutic therapy/phytothermotherapy, music therapy and journaling/storytelling.

References: Macfarlane GJ, et al. Ann Rheum Dis 2017;76:318–328. doi:10.1136/annrheumdis-2016-209724 323. on 16 October 2018 by guest.

© 2019 WBFM group and RBH

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