What non-pharmacological management strategies are recommended for patients with fibromyalgia?

Non-pharmacological management strategies for patients with fibromyalgia primarily focus on self-management, physical activity, psychological therapies, and certain adjunctive treatments. A supervised group exercise programme tailored to the individual's needs, preferences, and abilities is recommended to help manage chronic primary pain, including fibromyalgia, and to encourage long-term physical activity for general health benefits ³. Psychological therapies such as cognitive behavioural therapy (CBT) or acceptance and commitment therapy (ACT) delivered by trained healthcare professionals are advised to support coping with chronic pain ³.

Acupuncture or dry needling may be considered as a single course delivered by appropriately trained healthcare professionals in community settings, provided the treatment is within defined time limits ³. Transcutaneous electrical nerve stimulation (TENS) is not routinely recommended due to lack of evidence of benefit, although some guidelines like SIGN suggest it could be considered for chronic pain relief, including fibromyalgia, with low or high frequency showing similar analgesic outcomes ¹.

Self-management strategies are emphasized from early to long-term management stages, empowering patients to manage symptoms and improve function ¹. Psychological approaches also include exploring maladaptive coping strategies and relaxation techniques, although evidence for their effectiveness is limited and inconsistent ².

Recent clinical reviews and expert consensus highlight the importance of a multidisciplinary approach combining physical, psychological, and educational interventions to improve quality of life and reduce symptom burden in fibromyalgia (Macfarlane et al., 2017; Clauw, 2014). Exercise, particularly aerobic and strengthening activities, is a cornerstone of management, improving pain and function (Flynn, 2020). Psychological therapies such as CBT have demonstrated benefits in symptom management and coping skills (Macfarlane et al., 2017). Overall, non-pharmacological management should be individualized, flexible, and supportive of patient self-efficacy.