PAIN
April 4, 2018

An Alternative Path to Treating Fibromyalgia

The chronic pain of fibromyalgia can be hard to bear. Tai chi may offer some relief.

Fibromyalgia is a condition characterized by chronic pain, fatigue and depression. The muscle and joint pain it produces are usually managed with a combination of medication and exercise.

However, pain medication offers patients, at best, modest relief, and patients with fibromyalgia who take short- or long-acting opioids not only run the risk of addiction, they tend to have poorer health outcomes compared to those taking non-opioids.

A study compares the effectiveness of tai chi to aerobic exercise as a way to manage the pain of fibromyalgia.

Moderate aerobic exercise is generally recommended for those with fibromyalgia, but because of fluctuations in their symptoms, many people with fibromyalgia find it difficult to stick to an exercise program. So finding alternative approaches to managing the pain of fibromyalgia is needed.

“We are in the middle of an opioid crisis. And the problem is often lack of sufficient treatment options for managing pain,” Chenchen Wang, lead author of a new study looking at the use of tai chi for chronic pain management, told TheDoctor.

Tai chi, an ancient discipline with origins in Chinese medicine, can improve the physical and mental health of those with fibromyalgia, Wang said. Identifying other options for managing pain using complementary and alternative medicine (CAM) rather than drugs is an urgent priority in this country. Tai chi combines physical, psychosocial, spiritual and behavioral elements to improve health and fitness.

Over 225 people with fibromyalgia were enrolled in the study, which compared the effectiveness of tai chi to aerobic exercise as a way to manage the pain of fibromyalgia. On average, people in the study had endured nine years of chronic pain. None of them had practiced tai chi or used any other alternative therapies within the past six months.

At the start of the study, participants filled out the fibromyalgia impact questionnaire (FIQR), in which they rated their physical and psychological symptoms, including pain intensity, physical functioning, depression, anxiety, fatigue and overall well being. Then they were randomly assigned to either supervised aerobic exercise twice weekly for 24 weeks, or one of four supervised tai chi groups that met either once weekly or twice weekly for either 12 or 24 weeks. All participants noted any changes in their symptoms at 12, 24 and 52 weeks.

Patients' scores on the FIQR improved in all five groups at 12, 24 and 52 weeks, but the four tai chi groups improved significantly more than the aerobic exercise group at 24 weeks. Those who did tai chi for 24 weeks improved more than those who did tai chi for 12 weeks, although there was no increase in benefit for those who did tai chi twice weekly compared to those who did tai chi once weekly.

In an accompanying patient review of the use of tai chi for managing fibromyalgia pain, participant Amy Price wrote, “Would I recommend tai chi for other patients with a fibromyalgia diagnosis? My answer is a qualified yes.”

Price, the patient editor for research and evaluation at The British Medical Journal which published the study, advises patients considering tai chi to talk to their doctors. Patients who try tai chi and experience pain should ask the instructor if they can modify the exercise.

The benefits of tai chi were consistent across a diverse group of patients, regardless of the instructor. This consistency suggests the results may be applicable to patients in a variety of settings, the authors write. They hope to do a multi-center trial, in different cities and perhaps even different countries, said Wang, who is the director of the Center for Complementary and Integrative Medicine at Tufts Medical Center.

In addition to the study, an opinion piece and Price's patient review are also published in BMJ.

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