PAIN+ CPN

BACKGROUND: The effectiveness of mindfulness meditation (MM) for the treatment of fibromyalgia syndrome (FMS) is unknown and needs to be updated.

OBJECTIVE: This study aimed at investigating the effectiveness of MM for the treatment of FMS.

STUDY DESIGN: A systematic review and meta-analysis.

METHODS: A comprehensive search of relevant studies published from the databases' inception through April 12, 2023 was conducted within the following databases: Cochrane Library, Embase, MEDLINE, PubMed, Clinicaltrials.gov, and PsycINFO. We included randomized controlled trials that reported at least one of the following outcome indicators: the Fibromyalgia Impact Questionnaire (FIQ), the Pittsburg Sleep Quality Index (PSQI), the Beck Depression Inventory (BDI), and the Perceived Stress Scale (PSS). Results are presented in terms of mean difference (MD), supplemented by 95% CIs The I2 statistic assessed heterogeneity across 3 distinct observational time frames. We used the Grading of Recommendations Assessment, Development, and Evaluation (GRADE) framework to appraise the robustness of the evidence.

RESULTS: Ten randomized controlled trials were selected from 1,377 citations (n = 818). Various MM regimens were reported (type of mindfulness, duration, schemes, and ingredients). Among 818 patients, very low to moderate evidence indicated that MM could reduce FIQ in the short-term (MD = -6.20; 95% CI,-8.51 to -3.89; P < 0.05; GRADE: moderate); a lower PSQI score (MD = -1.84; 95% CI, -3.35 to -0.33; P < 0.05; GRADE: very low); a reduce BDI score (MD = -3.26; 95% CI, -5.77 to -0.76; P < 0.05; GRADE: moderate); and a decreased PSS score (MD = -4.85; 95% CI, -8.22 to -1.49; P < 0.05; GRADE: very low). At medium-term follow-up, MM consistently reduced the BDI score (MD = -2.88; 95% CI, -4.98 to -0.79; P < 0.05; GRADE: moderate) and decreased the PSS score (MD = -2.76; 95% CI, -4.82 to -0.70; P < 0.05; GRADE: moderate) but there was no significant difference in FIQ scores (MD = -2.78; 95% CI, -6.32 to 0.76; P > 0.05; GRADE: low) and PSQI scores (MD = -1.28; 95% CI, -3.35 to -0.80; P > 0.05; GRADE: very low). However, at long-term follow-up, MM still reduced FIQ scores (MD = -6.09; 95% CI, -9.01 to -3.16; P < 0.05; GRADE: moderate).

LIMITATIONS: The relatively small sample size and the average quality of the included studies may have introduced biases. The time and method of meditation in the included studies were not completely unified, and there were confounding factors. Additionally, the limited amount of available literature is a challenge. Despite focusing on randomized controlled trials, there is heterogeneity among these studies. Future research should aim for larger, higher-quality studies to address these limitations and provide a more comprehensive understanding of MM's effectiveness in fibromyalgia management.

CONCLUSIONS: Very low to moderate evidence shows that MM improves quality of life, relieves stress, and relieves insomnia and depression in patients with FMS in the short-term. Notably, the improvement in depression and stress levels continued into the medium-term period. Furthermore, quality of life improvement was discernible at long-term follow-up. This suggests that MM can be used as an adjunct therapy for FMS.International Prospective Register of Systematic Reviews (PROSPERO) Registration Number: CRD42023442356.

Physician rater

Psychological therapies such as cognitive behavioral therapies as well as meditative movement therapies such as Yoga and Tai Chi have been recommended by some guidelines for managing FMS. Mindfulness-based stress reduction and meditation have not been recommended in guidelines until now. In some of the studies analysed in this review, other psychological methods were added to mindfulness meditation. The authors did not do a subgroup analysis with studies that used only mindfulness-based stress reduction. In most studies, the control group received less treatment. Thus, we are left with uncertainties about the potential role of mindfulness meditation / stress reduction in managing FMS.

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