Nizard Julien, Laroche Françoise, Berna Fabrice
Nantes Université; Nantes University Hospital, Multidisciplinary Pain, Palliative and Integrative Care Department, UIC 22; UMRS INSERM-Nantes Université-Oniris 1229 RMeS Regenerative Medicine and Skeleton; Collège Universitaire des Médecines Intégrative et Complémentaires (CUMIC), Nantes, France.
Saint-Antoine (Paris) University Hospital, Multidisciplinary Pain Center, INSERM U987, Université de Paris, Paris, France.
Pain Rep. 2025 Jun 25;10(4):e1278. doi: 10.1097/PR9.0000000000001278. eCollection 2025 Aug.
Recent guidelines for managing fibromyalgia highlight the importance of a graded-care approach, tailoring treatment to predominant symptoms, and appropriately integrating nonpharmacological treatments and complementary medicine (CM). Many fibromyalgia patients turn to nonpharmacological treatment and CM for various reasons, including concerns about medication side effects and persistent symptoms despite pharmacological treatment. In addition, these approaches are sometimes mistakenly, but often, perceived as natural and, therefore, widely accepted as well-tolerated with minimal risks. However, as with many patients using CM, fibromyalgia patients frequently engage in these practices without informing their physicians, often because of fear of a negative reaction. This can occur in contexts that lack adequate safeguards, such as treatment by noncertified practitioners, undocumented practices, excessive costs, or unsafe environments. In this narrative review, we first provide updated definitions of these practices, discuss their potential benefits and associated risks, and explore the challenges in their evaluation. We then summarize key findings from the literature before proposing a structured approach for discussing these practices with fibromyalgia patients. This includes assessing their prior experiences, expectations, and motivations for long-term adherence. We also offer guidance on selecting qualified practitioners and ensuring a sufficiently safe treatment environment. Finally, we highlight essential "red flags" that pain specialists and health care providers should discuss with patients, emphasizing the need for caution or even discontinuation of certain practices when these warning signs are present.
近期纤维肌痛管理指南强调了分级护理方法的重要性，即根据主要症状调整治疗方案，并适当整合非药物治疗和补充医学（CM）。许多纤维肌痛患者出于各种原因求助于非药物治疗和补充医学，包括对药物副作用的担忧以及尽管接受了药物治疗但症状仍持续存在。此外，这些方法有时会被错误地（但通常如此）认为是天然的，因此被广泛接受且风险极小。然而，与许多使用补充医学的患者一样，纤维肌痛患者经常在未告知医生的情况下采用这些疗法，这通常是因为担心医生会有负面反应。这种情况可能发生在缺乏充分保障措施的情况下，例如由未经认证的从业者进行治疗、无记录的治疗行为、费用过高或环境不安全等。在这篇叙述性综述中，我们首先提供这些疗法的最新定义，讨论其潜在益处和相关风险，并探讨评估这些疗法时面临的挑战。然后，我们总结文献中的关键发现，之后提出一种与纤维肌痛患者讨论这些疗法的结构化方法。这包括评估他们之前的经历、期望以及长期坚持治疗方案的动机。我们还提供有关选择合格从业者和确保治疗环境足够安全的指导。最后，我们强调疼痛专家和医疗服务提供者应与患者讨论的重要“警示信号”，强调当出现这些警示迹象时需要谨慎甚至停止某些疗法。
