J Manipulative Physiol Ther. 2009 Jan;32(1):25-40.

Schneider M, Vernon H, Ko G, Lawson G, Perera J.

School of Health and Rehabilitation Sciences, University of 

Pittsburgh, Pittsburgh, Pa, USA. <drmike@city-net.com>

PMID: 19121462

OBJECTIVE: Fibromyalgia syndrome (FMS) is one of the most commonly 

diagnosed nonarticular soft tissue conditions in all fields of 

musculoskeletal medicine, including chiropractic. The purpose of this 

study was to perform a comprehensive review of the literature for the 

most commonly used treatment procedures in chiropractic for FMS and 

to provide evidence ratings for these procedures. The emphasis of 

this literature review was on conservative and nonpharmaceutical therapies.

METHODS: The Scientific Commission of the Council on Chiropractic 

Guidelines and Practice Parameters (CCGPP) was charged with 

developing literature syntheses, organized by anatomical region, to 

evaluate and report on the evidence base for chiropractic care. This 

article is the outcome of this charge. As part of the CCGPP process, 

preliminary drafts of these articles were posted on the CCGPP Web 

site www.ccgpp.org (2006-8) to allow for an open process and the 

broadest possible mechanism for stakeholder input. Online 

comprehensive literature searches were performed of the following 

databases: Cochrane Database of Systematic Reviews; National 

Guidelines Clearinghouse; Cochrane Central Register of Controlled 

Trials; Manual, Alternative, and Natural Therapy Index System; Index 

to Chiropractic Literature, Cumulative Index to Nursing and Allied 

Health Literature; Allied and Complementary Medicine; and PubMed up 

to June 2006.

RESULTS: Our search yielded the following results: 8 systematic 

reviews, 3 meta-analyses, 5 published guidelines, and 1 consensus 

document. Our direct search of the databases for additional 

randomized trials did not find any chiropractic randomized clinical 

trials that were not already included in one or more of the 

systematic reviews/guidelines. The review of the Manual, Alternative, 

and Natural Therapy Index System and Index to Chiropractic Literature 

databases yielded an additional 38 articles regarding various 

nonpharmacologic therapies such as chiropractic, acupuncture, 

nutritional/herbal supplements, massage, etc. Review of these 

articles resulted in the following recommendations regarding 

nonpharmaceutical treatments of FMS. Strong evidence supports aerobic 

exercise and cognitive behavioral therapy. Moderate evidence supports 

massage, muscle strength training, acupuncture, and spa therapy 

(balneotherapy). Limited evidence supports spinal manipulation, 

movement/body awareness, vitamins, herbs, and dietary modification.

CONCLUSIONS: Several nonpharmacologic treatments and manual-type 

therapies have acceptable evidentiary support in the treatment of FMS.