Spinal manipulation for fibromyalgia: a narrative review

Area of Science:

• Rheumatology
• Complementary and Alternative Medicine
• Evidence-Based Practice

Background:

• Fibromyalgia is a chronic condition characterized by widespread pain and fatigue.
• Management of fibromyalgia often involves a multimodal approach.
• Spinal manipulative therapy (SMT) is a manual therapy technique that has been explored for various musculoskeletal conditions.

Purpose of the Study:

• To review and summarize the existing literature on the efficacy of spinal manipulative therapy for fibromyalgia management.
• To assess the quality of evidence supporting SMT in fibromyalgia treatment.

Main Methods:

• A comprehensive narrative literature review was conducted up to February 29, 2024.
• Searches utilized keywords like "manipulation AND fibromyalgia" across multiple databases (MEDLINE, ICL, PEDro, Cochrane Library, Google Scholar) and clinical trials registries.
• Inclusion criteria focused on publications concerning SMT for fibromyalgia, excluding non-peer-reviewed articles.

Main Results:

• A total of 38 publications met the inclusion criteria, including case reports, pilot studies, randomized controlled trials, systematic reviews, and clinical practice guidelines.
• Higher-quality controlled studies yielded mixed results regarding SMT efficacy for fibromyalgia.
• Lower-quality studies more frequently reported positive outcomes following SMT.

Conclusions:

• The evidence for the efficacy of spinal manipulative therapy in managing fibromyalgia is limited and inconclusive.
• Systematic reviews indicate a lack of established efficacy or inconclusive findings.
• Clinical practice guidelines present varied recommendations, ranging from strong opposition to consideration as part of multimodal treatment.