Non-pharmacological treatment of chronic widespread musculoskeletal pain

Non-pharmacological treatment for patients with chronic widespread pain (CWP) and fibromyalgia (FM) aims to enhance overall health. This chapter reviews studies of exercise, education, movement therapies and sensory stimulation. Based on a systematic review of randomized controlled trials (RCTs), we suggest that aerobic exercise of low to moderate intensity, such as walking and pool exercise, can improve symptoms and distress in patients with CWP and FM, and it may improve physical capacity in sedentary patients. Aerobic exercise of moderate to high intensity has been shown to improve aerobic capacity and tender-point status. Educational programmes have been shown to enhance self-efficacy and health perception. There is no conclusive evidence about the type of educational programme that works best, but a small-group format and interactive discussions appear to be important components. Exercise combined with education appears to produce synergies. Studies of movement therapies (such as qigong) and sensory treatments (such as acupuncture and massage) are few in number. There is today no conclusive evidence about the effects of these treatments in CWR although positive effects have been reported in a few studies.