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Effects of Physical-Agent Pain Relief Modalities for Fibromyalgia Patients: A Systematic Review and M 时间:2018-10-01 16:38   来源:未知   作者:admin   点击: 次 Abstract:Purpose. We conducted a systematic review and meta-analysis to investigate the effects of the following physical-agent modalities for pain relief in fibromyalgia (FM) patients. Methods. We identified randomized controlled studies of adults with FM in the MEDLINE, CINAHL, and PEDro databases. The primary outcome measure was pain relief measured by a visual analogue scale (VAS), and the secondary outcome measures of interest were subjective improvements in the number of tender points, Fibromyalgia Impact Questionnaire (FIQ), and quality of life (QOL) scores. Results. Eleven studies were included in our review. The studies’ physical-agent modalities were low-level laser therapy (LLLT), thermal therapy, electromagnetic field therapy, and transcutaneous electrical nerve stimulation (TENS). LLLT did not reduce VAS scores, but it significantly reduced both the number of tender points and FIQ score. Thermal therapy was associated with significantly reduced VAS scores, tender points, and FIQ scores. Electromagnetic field therapy was associated with significantly reduced VAS score and FIQ score. TENS significantly reduced VAS scores. Conclusion. Our analyses revealed that thermal therapy and LLLT had a partial effect on pain relief in FM patients, and this beneficial effect may have a positive influence on FM patients’ health status.
1. Introduction
  Fibromyalgia (FM) is an idiopathic, common, and complex syndrome, defined as long-lasting, widespread, and symmetrical nonarticular musculoskeletal pain with generalized tender points at specific anatomical sites [1, 2]. The pain that individuals with FM experience interferes with their performance of activities of daily life (ADLs) and results in a decreased quality of life (QOL) [2–5].
  There are many possible treatments for FM that can be classified as pharmacological and nonpharmacological therapies [6–8]. The authors of a 2014 meta-analysis reported that very few drugs in well-designed clinical trials have demonstrated significant relief for multiple FM symptom domains, whereas nonpharmacologic treatments with weaker study designs have demonstrated multidimensional effects [8]. Nonpharmacological therapies such as physical exercise including strength training, aerobic training, and yoga [9, 10] and multicomponent therapy interventions [11, 12] have been used for FM. Physical-agent modalities are defined as passive treatments such as thermotherapy, cryotherapy, massage, electrotherapy, laser treatment, and others are nonpharmacological interventions used for FM patients [10]. Even though several placebo-controlled trials assessing the effects of physical-agent modalities on pain, ADLs, and QOL in patients with FM have been published in recent years, some studies had small sample sizes and have presented controversial results. A further elucidation of the effects of each physical-agent modality for FM is needed. We conducted the present study to systematically review the effects of physical-agent modalities for the treatment of FM, especially for the improvement of pain, ADLs, and QOL.
2. Methods
2.1. Search Strategy
  We performed electronic searches of three databases—MEDLINE (the US National Library of Medicine bibliographic database), CINAHL (the Cumulative Index to Nursing and Allied Health Literature), and PEDro (the Physiotherapy Evidence Database)—up to February 28, 2017. A primary search with the term “fibromyalgia” was combined with the following terms: “cryotherapy,” “icing,” “low-level laser,” “laser therapy,” “electronical stimulation,” “TENS,” “electrotherapy,” “magnetic therapy,” “ultrasound,” “ultrasonic,” “thermotherapy,” “heat therapy,” “thermal therapy,” “shortwave,” “microwave,” “hot pack,” “wrapping,” and “traction,” and secondly, with “randomized controlled trial.” Reference lists of included articles were scanned for additional citations. The full search strategy is available upon request.