Division of Pain Medicine, Department of Anesthesiology, Brigham and Women's Hospital, 75 Francis Street, Boston, MA, 02115, USA.
Department of Anesthesiology, Louisiana State University Health Sciences Center, New Orleans, LA, USA.
Curr Pain Headache Rep. 2018 Apr 4;22(5):33. doi: 10.1007/s11916-018-0688-2.
Fibromyalgia (FM) is the second most common rheumatologic pain disorder after osteoarthritis with a multisystem presentation. While the treatment of FM in a clinical setting incorporates both pharmacologic and non-pharmacologic modalities, the present investigation reviews evolving literature on cognitive behavioral and complementary medical therapies. The recent medical literature on FM was reviewed between 2012 and 2017 via MEDLINE and the Cochrane Central Registry of Controlled Trials, with an emphasis on randomized controlled trials, meta-analyses, and evidence-based treatment guidelines.
Cognitive behavioral therapy continues to play a significant role in the non-medical therapy of FM. It is especially helpful in high catastrophizing patients as evidenced by recent studies that note changes in the brain on functional magnetic resonance imaging. Mindfulness meditation can be helpful in improving pain symptoms and pain perception. No particular diet is found to have a meaningful impact in FM; however, various diets including low fermentable oligo- di -monosaccharides and polyols diet, gluten free, and hypocaloric may be helpful in ameliorating gastrointestinal distress in select patient populations. Current literature does not support the routine use of acupuncture for improving pain or quality of life in FM; however, given its benign side effect profile, it should not be discouraged. Goals for symptom management and pain control should be set early, and patient engagement remains critical in the management of this complex pain presentation. While low quality evidence exists for most non-pharmacologic treatment modalities for FM, CBT and mindfulness meditation show promise for future investigation.
纤维肌痛（FM）是继骨关节炎之后第二常见的风湿性疼痛疾病，具有多系统表现。虽然 FM 的临床治疗包括药物和非药物治疗，但本研究综述了认知行为和补充医学治疗方法的最新文献。通过 MEDLINE 和 Cochrane 对照试验中心注册库，对 2012 年至 2017 年期间的 FM 近期医学文献进行了回顾，重点是随机对照试验、荟萃分析和循证治疗指南。
认知行为疗法在 FM 的非药物治疗中继续发挥重要作用。最近的研究表明，认知行为疗法对高灾难化患者尤其有帮助，因为它可以改变大脑的功能磁共振成像。正念冥想有助于改善疼痛症状和疼痛感知。目前没有发现任何特定的饮食对 FM 有显著影响；然而，各种饮食，包括低可发酵寡糖、双糖和多元醇饮食、无麸质和低热量饮食，可能有助于改善特定患者群体的胃肠道不适。目前的文献不支持常规使用针灸来改善 FM 的疼痛或生活质量；然而，鉴于其良性的副作用谱，不应劝阻使用。应尽早设定症状管理和疼痛控制的目标，患者的参与仍然是管理这种复杂疼痛表现的关键。虽然 FM 的大多数非药物治疗方法的证据质量较低，但认知行为疗法和正念冥想显示出未来研究的前景。
