Homeopathy in the treatment of fibromyalgia—A comprehensive literature-review and meta-analysis

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Highlights

  • Homeopathy has been recommended in the treatment of fibromyalgia.

  • Research in this area is widespread from single cases to RCTs.

  • Calculation of overall effect sizes: tender point count, pain intensity, and fatigue.

  • Results remain inconclusive.

  • Results define a sufficient basis for discussing the possible potential benefits.

Summary

Background

Coping with the complex nature of fibromyalgia symptoms (FMS) still remains a challenge for patients. Taking into account the possible adverse events of pharmacological treatments patients often seek additional treatments for the management of fibromyalgia and turn towards complementary and alternative medicine (CAM).

Objective

In this review, we aimed to investigate the current state of literature of homeopathy in the treatment of FMS.

Methods

We searched Medline, the Cochrane Register of Controlled Trials, Embase, AMED, PsycInfo and CAMbase for the terms “fibromyalgia AND homeopath$” through February 2013. In addition we searched Google Scholar, the library of the Carstens Foundation and that of the Deutsche Homöopathische Union (DHU). Standardized mean differences (SMD) with 95% confidence intervals (CI) were calculated and meta-analyzed using the generic inverse variance method.

Results

We found 10 case-reports, 3 observational studies, 1 non-randomized and 4 randomized controlled trials (RCTs) on homeopathy for fibromyalgia. Both case reports and observational studies are naturally predominated by the use of qualitative and not validated outcome measures. Meta-analyses of CCTs revealed effects of homeopathy on tender point count (SMD = −0.42; 95%CI −0.78, −0.05; P = 0.03), pain intensity (SMD = −0.54; 95%CI −0.97, −0.10; P = 0.02), and fatigue (SMD = −0.47; 95%CI −0.90, −0.05; P = 0.03) compared to placebo.

Conclusion

The results of the studies as well as the case reports define a sufficient basis for discussing the possible benefits of homeopathy for patients suffering from fibromyalgia syndrome although any conclusions based on the results of this review have to be regarded as preliminary.

Introduction

The fibromyalgia syndrome (FMS) is a condition defined by chronic widespread pain, fatigue, cognitive disturbances and sleep disorders.1, 2 Patients with FMS also experience various somatic symptoms and psychological distress.1, 2 Fibromyalgia is a frequent comorbidity alongside other rheumatologic conditions. Thus patients experience substantial disabilities and often report a negative impact of fibromyalgia on their quality of life, mood, anxiety, depression and self-esteem.3

According to a recent epidemiological study of Branco et al.4 fibromyalgia affects about 1.4–3.7% of adults in Europe depending on the country. Epidemiological studies estimated how many people in the general population meet the FM-criteria at the time and found that with a European point prevalence of 2.9% this leads to a total of about 15 million people in Europe suffering from fibromyalgia.4 With respect to the costs a recent study of Berger et al.5 reports three times higher healthcare costs over 12 months in fibromyalgia patients compared to a matched patient sample in the US. These results are comparable with finding of the same research group in German GPs: compared to other primary care patients, fibromyalgia patients counted for twice as many GP visits, referrals and sick notes.6

In conventional medical practice, fibromyalgia is treated by using a wide range of symptom specific pharmacological therapies, including antidepressants, opioids, non-steroidal anti-inflammatory drugs, sedatives, muscle relaxants, and anti-epileptics.33 Non-pharmaceutical treatments include aerobic exercises, physical therapies, massage, and cognitive behavioural therapy. Evidence-based recommendations for the management of fibromyalgia syndrome identified by a team of UK researchers in 2008 included antidepressants, analgesics, and “other pharmacological” and exercise, cognitive behavioural therapy, education, dietary interventions and “other non-pharmacological”.32 Treatment by opioids (except Tramadol) was not recommended by recent evidence-based guidelines.

However, coping with the complex nature of fibromyalgia symptoms still remains a challenge for patients. Taking into account the possible adverse events of pharmacological treatments patients often seek additional treatments for the management of fibromyalgia and turn towards complementary and alternative medicine (CAM). According to a survey by Wahner-Roedler et al.7 89% of patients referred to a fibromyalgia treatment programme at a tertiary care centre had used at least some type of CAM therapy during the previous 6 months including exercise therapy (48%), spiritual healing and prayers (45%), massage therapy (44%), chiropractic treatments (37%), or vitamins and minerals (35–25%). Nevertheless the evidence base for many of those therapeutic options for fibromyalgia is quite sparse and the methodological quality of clinical studies often is low.

A recent overview of Terry et al.,8 a meta-analysis of Langhorst et al.,9 and a qualitative review of Baranowsky et al.10 not only found positive results for hydrotherapy and spa therapy but also for homeopathy. According to Perry et al.8 existing RCTs in homeopathy suggested results in favour of homeopathy which up to now have not been summarized by means of a meta-analysis. Moreover, results from observational studies or even case reports have not been collected to complement these findings.

Thus, in the following review we aimed to comprehensively investigate the current state of literature for homeopathic interventions in the treatment of patients suffering from fibromyalgia and examine all reports from single case reports to clinical trials. We were particularly interested in the reporting of pain intensity and tender muscle points before and after treatment.

Section snippets

Search strategy

To get a first overview, the following electronical databases were used to find articles on fibromyalgia and homeopathy: Medline, PubMed, Embase, AMED, CAMbase11 and the library of the Carstens Foundation. The literature search, which was constructed around search terms for ‘homeopathy’ and ‘fibromyalgia syndrome’, was adapted and translated for each database, if necessary. For example, the following search strategy was used on the PubMed/MEDLINE database:

(Hoemopathy [MeSH Terms] OR homeopathy

Results

In total, we retrieved 10 case-reports, 3 uncontrolled observational trials, 1 non-randomized controlled trial and 4 randomized controlled trials on homeopathy for fibromyalgia from the literature search (for flow chart, see Fig. 1). They are listed chronologically by means of their research design in Table 1, Table 2, Table 3.

Discussion

The treatment of fibromyalgia is still a challenge for patients and physicians. Due to quite heterogeneous courses of the disease a variety of therapeutic options have been investigated so far, including a variety of complementary therapies. Perry et al.8 had reported on the effects of homeopathy in fibromyalgia and concluded that “homoeopathy was better than the control interventions in alleviating the symptoms of FMS” but also pointed out problems in the quality of the clinical trials.

In 2010

Conclusions

Given the low number and included trials and the low methodological quality, any conclusion based on the results of this review have to be regarded as preliminary. However, as single case studies and clinical trials indicate a positive effect, homeopathy could be considered a complementary treatment for patients with fibromyalgia.

Conflict of interest statement

The authors declare that they have no conflicts of interest.

Funding

No funding was received from any source by any of the authors specifically for this review.

Key messages

  • Available data suggest that homeopathic treatment of fibromyalgia is helpful in pain management and reduction of fatigue.

  • Further studies are merited in terms of multicenter trials to broaden the evidence base.

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