Dietary interventions in fibromyalgia

Fibromyalgia is a chronic pain condition characterised by prolonged and widespread general pain and tenderness, sleep disturbances and fatigue. The pain is felt mainly in the muscles, but also joint pain occurs. Pain sensitivity is also increased, which means that things that usually do not hurt for healthy people is perceived as painful for someone with the condition. Fibromyalgia affects approximately 2–6% of the population, of which 80 percent are women.

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SBU Enquiry Service

Consists of structured literature searches to highlight studies that can address questions received by the SBU Enquiry Service from Swedish healthcare or social service providers. We assess the risk of bias in systematic reviews and when needed also quality and transferability of results in health economic studies. Relevant references are compiled by an SBU staff member, in consultation with an external expert when needed.

Question

What is the effect of dietary interventions in fibromyalgia?

Identified literature

Table 1. Systematic reviews with low/medium risk of bias.
* One study is included in both systematic reviews.
RCT = Randomized Controlled Trial, CCT = Controlled Clinical Trial (non-randomized); UCT = Uncontrolled Clinical Trial
FODMAPs = Low Fermentable Oligo-. Di- and Monossacharides, Alcohols and Polyols
Included studies Population/intervention Outcome
Silva et al 2019 [1]
7 included studies
(3 RCT, 1 CCT, 3 UCT)		 Patients with fibromyalgia diagnosed according to American College of Rheumatology (ACR) criteria revised in 2010

Dietary intervention (dietary supplementation was not included)		 Primary patient-reported outcome (PRO):
Pain and functional repercussion

Secondary outcomes:
Fatigue, quality of sleep, quality of life, anxiety and depression, gastrointestinal symptoms, and inflammation biomarkers
Authors' conclusion:
“Pain and functional repercussion in fibromyalgia patients seem to improve with a hypocaloric diet, a raw vegetarian diet or a low FODMAPs diet. Other PROs, such as quality of life, quality of sleep, anxiety and depression and inflammatory biomarkers also showed a significant improvement with these interventions. However, due to the low quality of the included studies, these promising results should be interpreted with caution, and no quantitative and objective conclusions should be drawn.”
Joustra et al 2017* [2]
32 observational studies
(case-control)

1 RCT + observational data
(cross-sectional)
2 RCT + observational data
(case-control)

(45 studies in total for FMS and chronic fatigue syndrome)		 Patients with fibromyalgia (FMS) according to official diagnostic criteria
Vitamin and mineral supplements		 Vitamin or mineral status, clinical parameters including symptom severity and quality of life
Authors' conclusion:
“We found little evidence to support our hypothesis that vitamin and mineral deficiencies play a role in the pathophysiology of […] FMS, or that the use of nutritional supplements is effective in these patients. Poor study quality and considerable heterogeneity in most studies was found, which makes it difficult to reach a final conclusion.”
Straube et al 2015* [3]
1 study on fibromyalgia
(10 studies in total on different chronic pain conditions)		 Studies of adults with all types of chronic pain conditions (including fibromyalgia)
Vitamin D supplementation		 Primary outcome:
Patient-reported clinically significant pain relief

Secondary outcome:
Other patient-rated pain outcomes, adverse events, withdrawals, quality of life
Authors' conclusion:
“There is no evidence that vitamin D supplementation reduces pain in people with chronic pain. Treating chronic pain with vitamin D is unlikely to have any benefit, or be cost effective.”

References

  1. Silva AR, Bernardo A, Costa J, Cardoso A, Santos P, Mesquita MF, et al. Dietary interventions in Fibromyalgia: a systematic review. Ann Med 2019:1-29.
  2. Joustra ML, Minovic I, Janssens KAM, Bakker SJL, Rosmalen JGM. Vitamin and mineral status in chronic fatigue syndrome and fibromyalgia syndrome: A systematic review and meta-analysis. PLoS One 2017;12:e0176631.
  3. Straube S, Derry S, Straube C, Moore RA. Vitamin D for the treatment of chronic painful conditions in adults. Cochrane Database of Systematic Reviews 2015.
Contact SBU
Published: Report no: ut201910 Registration no: SBU 2018/519
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Literature search

Literature search.pdf

Project group

Laura Lintamo and Sara Fundell at SBU.

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