Table 6 Supplementary table of non-pharmacological, pharmacological, and dietary supplements and botanicals
From: Beyond pain in fibromyalgia: insights into the symptom of fatigue
Intervention | Design and sample | Scales used | Effect on fatigue |
|---|---|---|---|
Non-pharmacological | |||
Balneotherapy | VAS fatigue | Clinically meaningful improvement | |
Cognitive behavioral therapy | 1 RCT comparing multidisciplinary treatment to treatment augmented with CBT (n = 83) of women with FM [71] | FIQ fatigue | Cannot draw conclusion |
Electroconvulsive therapy | 1 pilot study (n = 13) of patients with FM and concomitant depression [104] | FIQ fatigue | Clinically meaningful improvement |
Low-energy laser therapy | 1 single-blind, placebo-controlled trial (n = 40) of women with FM [105] | Likert scale rating fatigue as mild, moderate, severe or extreme | Cannot draw conclusion in 1 RCT, clinically meaningful improvement in 1 RCT |
1 RCT (n = 75) of patients with FM [106] | FIQ fatigue | ||
Mindfulness | 1 open pilot study (n = 40) of women with FM [107] | Not identified | Cannot draw conclusion |
Noninvasive cortical electrostimulation | 1 placebo-controlled RCT (n = 77) of patients with FM [108] | FIQ fatigue | Clinically meaningful improvement |
Pulsed ultrasound and interferential current | 1 double-blind, placebo-controlled RCT (n = 17) of patients with FM [109] | VAS fatigue | Clinically meaningful improvement |
Qigong | 1 single-arm pilot study (n = 10) in women with FM [110] | Not identified | Cannot draw conclusion |
Sensory motor rhythm treatment | 1 RCT (n = 36) patients with FM [111] | VAS fatigue | Clinically meaningful improvement |
TENS | 1 RCT (n = 28) women with FM where TENS was used as an adjuvant to aerobic and stretching exercise [112] | FIQ fatigue | Clinically meaningful improvement |
Transcranial magnetic stimulation | 2 double-blind, placebo-controlled RCTs (n = 70) of patients with FM [113, 114] | FIQ fatigue | Clinically meaningful improvement |
Vegetarian diet | 1 observational study (n = 30) of patients with FM [115] and 1 open RCT (n = 78) of patients with FM [116] | FIQ fatigue | Clinically meaningful improvement in 1 RCT, cannot draw conclusion in open RCT |
VAS fatigue | |||
Whole-body vibration exercise | 1 pilot study (n = 36) of women with FM [117] | FIQ fatigue | Clinically meaningful improvement |
Written emotional expression | 1 RCT (n = 92) of patients with FM [118] | Vitality subscale of SF-36 | Cannot draw conclusion |
Yoga | 1 pilot RCT (n = 53) of women with FM [119] | FIQ fatigue | Clinically meaningful improvement |
Pharmacological | |||
Amitriptyline | 2 placebo-controlled RCTs of patients with FM (n = 127) [106, 120] | FIQ fatigue | 1 RCT found clinically meaningful improvement, 1 RCT found no clinically meaningful improvement, cannot draw conclusion in 1 open-label RCT |
1 open RCT (n = 78) of patients with FM [116] | VAS fatigue | 2 meta-analyses found improvement, but MCID cannot be determined | |
2 meta-analyses of 10 RCTs (n = 615) [121] and 13 RCTs [122] in patients with FM | |||
Armodafinil | 1 single-blind, placebo-controlled, RCT of patients with FM and fatigue (n = 60) [123] | BFI | Cannot draw conclusion |
Cyclobenzaprine | 1 meta-analysis of 5 RCTs (n = 312) in patients with FM [124] | No improvement | |
Esreboxetine | 2 double-blind, placebo-controlled, multicenter RCTs (n = 1,389) [125, 126] | MAF | No clinically meaningful improvement |
Fluoxetine | 1 double-blind, placebo-controlled RCT of patients with FM (n = 60) [127] | FIQ fatigue | Clinically meaningful improvement |
Gamma-hydroxybutyrate/sodium oxybate | 1 open-label pilot study (n = 11) of patient with FM [128] | VAS fatigue | Clinically meaningful improvement in 2 RCTs, cannot draw conclusion in 1 RCT and retrospective review |
FIQ fatigue | |||
3 double-blind, placebo-controlled RCTs of patients with FM (n = 876) [129–131], 1 retrospective review of patients with CFS and FM treated in a neurology practice (n = 118) [132] | Retrospective review | ||
Mirtazapine | 1 single-arm, open-label trial of patients with FM (n = 29) [133] | VAS fatigue | Cannot draw conclusion |
Pramipexole | 1 double-blind, placebo-controlled RCT (n = 60) [134] | VAS fatigue | Clinically meaningful improvement |
Pyridostigmine | 1 double-blind, placebo-controlled RCT of patients with FM (n = 165) [135] | FIQ fatigue | Clinically meaningful improvement |
Quetiapine | 1 open-label study (n = 35) of patients with FM who had not responded to previous FM treatments [136] | FIQ fatigue | Clinically meaningful improvement |
Raloxifene | 1 double-blind, placebo-controlled RCT (n = 100) of post-menopausal women with FM [137] | VAS fatigue | Clinically meaningful improvement |
Tropisetron | 1 pilot study of intravenous tropisteron in patients with FM (n = 42) [138] | 4 point rating of fatigue (0 = absent, 1 = hardly, 2 = moderate, 3 = considerable) | Cannot draw conclusion |
Dietary supplements and botanicals | |||
Acetyl l-carnitine | 1 double-blind, placebo-controlled RCT (n = 102) of patients with FM [139] | VAS fatigue | Clinically meaningful improvement |
Coenzyme Q | 1 double-blind, placebo-controlled RCT (n = 20) [140] | FIQ fatigue | Cannot draw conclusion |
Dehydroepiandosterone | 1 double-blind, crossover RCT in post-menopausal women with FM (n = 52) [141] | VAS fatigue | No clinically meaningful improvement |
Ginseng | 1 double-blind, placebo-controlled RCT (n = 52) [120] | VAS fatigue | No clinically meaningful improvement |
IV nutrient therapy | 1 pilot study (n = 7) of patients with FM [142] | 5 point numeric scale (5 = high energy, 0 = low energy) | Cannot draw conclusion |
Melatonin | 1 open-label, pilot study (n = 21) of patients with FM [143] | VAS fatigue | Clinically meaningful improvement |
S-Adenosylmethionine | VAS fatigue | No clinically meaningful improvement |