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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 3 RCTs (n = 128) of women with FM [101103] 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) [129131], 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 2 double-blind, placebo-controlled RCT (n = 78) [144, 145] VAS fatigue No clinically meaningful improvement
  1. BFI, Brief Fatigue Inventory; CBT, cognitive behavioral therapy; CFS, chronic fatigue syndrome; FIQ, Fibromyalgia Impact Questionnaire; FM, fibromyalgia; MAF, Multidimensional Assessment of Fatigue; MCID, minimal clinically important difference; RCT, randomized controlled trial; SF-36, Medical Outcomes Study Short Form-36; TENS, transcutaneous electrical nerve stimulation; VAS, Visual Analogue Scale.