Fibromyalgia

Sandra Utz et al. (2025) · Biomedicines

This prospective observational study followed 101 adults with long-standing fibromyalgia syndrome (FMS) through a two-week integrative inpatient stay in Bamberg, Germany, with no control group. FMS is a chronic condition marked by widespread pain, fatigue, sleep problems, anxiety and depression, and the authors describe it as the third most common rheumatic disease. The program was built on classical European naturopathy: water-based therapies and heat, exercise, plant-based nutrition or medical fasting, herbal remedies and mind-body practices such as relaxation. The question was whether such a combined approach would ease symptoms at discharge and six months later. Of 134 patients who joined (127 women, ages 22 to 80), 101 returned questionnaires on admission, at discharge and after six months. During the stay they took part in meditative movement, physical therapy, hydrotherapy, lectures and cooking classes, and some had whole-body heat sessions or a 5-day fast on under 300 kcal a day. Pain, fatigue, anxiety, depression, stress and quality of life were measured with standard questionnaires (such as the HADS for anxiety and depression and the MFI-20 for fatigue) and compared over time with repeated-measures statistics. Overall pain intensity dropped from 71.5 to 63.0 on a 0-100 scale at discharge (a moderate effect, dz = 0.62) and was still lower at six months (64.4). Current pain fell sharply during the stay (6.56 to 4.37 out of 10) but crept back to 5.96 at six months. Fatigue improved from 71.1 to 63.3 and then partly returned (68.0). Anxiety and depression scores each fell by roughly 2.5 points at discharge and were still lower than baseline at six months. Stress and feelings of helplessness improved mainly after discharge, and mental quality of life rose between discharge and follow-up. Patients who fasted kept their pain gains at six months (p = 0.006), whereas non-fasters did not (p = 0.062), although this difference was borderline (interaction p = 0.050) and not randomised. The results come from an uncontrolled, single-centre sample in which a quarter of the participants did not complete the six-month questionnaire, so the changes cannot be attributed to the program alone. More than half the patients reported obstacles to continuing the methods at home, such as lack of time and exhaustion. The authors call for randomised trials with long-term follow-up and propose a follow-up day-clinic programme to help consolidate the learned self-management skills and everyday routines.

Suhas Balakrishna et al. (2026) · Journal of lifestyle medicine

This systematic review and meta-analysis pooled 33 controlled studies with 2,651 adults to ask whether pelotherapy, the application of mineral-rich mud, peat or clay as packs, wraps or full baths, eases musculoskeletal disorders. These include osteoarthritis (joint cartilage wear), rheumatoid arthritis (an autoimmune joint disease), fibromyalgia (widespread pain) and chronic low back pain. Pelotherapy is a traditional naturopathic practice used in spas, balneological centres and clinics in at least 40 countries, and the authors set out to test it against modern standards: pre-registration, risk-of-bias rating and GRADE certainty scoring. The team searched eight databases and trial registers up to April 2026. Included trials enrolled adults with a confirmed musculoskeletal diagnosis, applied mud as the main treatment for 10 to 21 sessions over two to three weeks, and compared it with sham treatment, usual care, waiting lists or nothing. Pain was mostly rated on a 0-100 mm visual analogue scale or a 0-10 numeric scale, and function on questionnaires such as the WOMAC. Two reviewers worked independently and combined results with random-effects statistics. Pain dropped clearly after mud treatment (standardised mean difference -0.74, a moderate-to-large effect, roughly 18.5 mm on the 100 mm scale and above the 15 mm threshold for a meaningful change). The effect was still present at 3 months (-0.61) and at 6 months (-0.49, low certainty). Physical function (-0.69) and quality of life (+0.58 on SF-36) improved as well, with osteoarthritis trials using the WOMAC at -0.82 and rheumatoid arthritis trials using the HAQ at -0.58. Morning stiffness (-0.52) and C-reactive protein, a blood marker of inflammation (-0.44), fell modestly, while the erythrocyte sedimentation rate did not change significantly. Knee osteoarthritis showed the biggest benefit (-0.86), and Dead Sea mud the strongest peloid effect (-0.84). Serious adverse events were no more common than in controls (relative risk 0.98); about 6.5% of mud recipients had mild, short-lived skin redness, largely from heat. The authors note several limits: participants cannot be blinded to mud, peloid type, temperature and protocol varied widely, results differed between trials (I2 = 62% for pain), a correction for possible publication bias lowered the pain estimate to -0.66, most trials came from European spa settings, and safety beyond 12 months is unknown. They call for larger blinded trials with standardised peloids and longer follow-up, and frame pelotherapy as an adjunct to, not a replacement for, drug and physiotherapy care.

Tatiana Leite Müller et al. (2026) · International journal of biometeorology

This systematic review of nine studies with 465 adults looked at climatotherapy, the therapeutic use of climate and natural settings, for musculoskeletal and rheumatologic disorders such as osteoarthritis, rheumatoid arthritis, fibromyalgia and ankylosing spondylitis. The settings were the Dead Sea (very salty water, low humidity, distinctive solar radiation and air pressure about 5% above sea level) and coastal sites using thalassotherapy, which means bathing and exercising in seawater, sometimes with marine mud, sun exposure and sea air. Because these programs vary widely, the authors wanted to gather what trials say about pain, physical function, quality of life and safety. The reviewers searched three databases through September 2025 and included eight randomized trials and one non-randomized study from 1995 to 2011, mostly in Israel. Participants were aged 18 to 65 and stayed at a spa or coast for 10 days up to 12 weeks. Comparison groups used freshwater pools, usual care, pool exercise or the same program in Norway. Pain was usually rated on a 0 to 100 visual analog scale, and quality of life was measured with questionnaires such as the SF-36. Most studies reported short-term improvements in pain, stiffness, function and quality of life, mainly within groups. Only two studies could be pooled for pain, giving an inconclusive overall result (SMD -0.47, 95% CI -5.47 to 4.53; an interval too wide to show benefit or no benefit). Split by condition, osteoarthritis showed a large effect (SMD -1.01, meaning pain fell by roughly one standard deviation more than with comparison) while fibromyalgia showed a small non-significant one (SMD -0.18, p = 0.158). In fibromyalgia, single-study estimates showed fewer tender points (SMD -0.50, p = 0.0047) and better physical quality of life (SF-36 physical score 0.36, p = 0.0391), but mood scores (p = 0.5968) and overall fibromyalgia impact (p = 0.0612) did not change significantly. No serious adverse events were reported, though only one study recorded adverse events explicitly. The evidence has important limits: trials were small and published between 1995 and 2011, participants and therapists could not be blinded, safety was inconsistently recorded, and several programs combined many components, so the effect of the climate itself is hard to separate. Only one trial analyzed all participants as randomized, and the pooled estimate rests on two studies. Certainty was judged low. The authors suggest climatotherapy may be a complementary option, particularly for osteoarthritis, and call for multicenter randomized trials with standard outcome sets and systematic safety reporting.

Yolanda Nadal-Nicolás et al. (2020) · International journal of environmental research and public health

This randomized controlled trial with 24 women asked whether hands-on massage therapy can move the needle on fibromyalgia — the chronic condition that combines widespread muscle pain with fatigue, unrefreshing sleep, and mood struggles. Researchers in Alicante, Spain recruited women aged 47 to 59 with rheumatologist-confirmed fibromyalgia affecting the neck and upper back, then randomized them to real treatment or a convincing placebo. The real treatment was manual therapy with moderate finger pressure on the back of the neck and upper back — fifteen minutes, twice a week, for four weeks, growing gradually firmer as each patient tolerated. The placebo was clever: an ultrasound machine applied to the same area for the same time, but switched off and used without gel, so participants experienced an equally plausible clinical ritual. Pain, fatigue, sleep, anxiety, and mood were measured before and after the month of treatment. Pain responded decisively. The manual therapy group's pain scores dropped by 4.2 points from baseline (p<0.001 — a large within-group effect of 2.07), and after treatment they sat 2.9 points below the placebo group (p=0.044, a moderate between-group effect of 0.59). Everything else stayed flat: fatigue, sleep quality, anxiety, and mood showed no significant improvement over placebo. An interesting side note - fatigue and poor sleep moved together (R=0.411), as did pain and anger-hostility scores (R=0.436), hinting at how fibromyalgia symptoms interlock. For women with fibromyalgia, this trial offers a practical, specific prescription: gentle-to-moderate pressure massage on the neck and upper back, twice weekly, genuinely reduces pain beyond the placebo effect — but on this evidence it should be expected to help pain, not the full fibromyalgia symptom cluster. The trial was small (24 analyzed), dropout hit the placebo arm harder, and all participants were women from one region, so larger trials are needed before firmer conclusions.

YuJuan Zhang et al. (2020) · Current rheumatology reports

This review examined five years of research — 16 review articles and 11 randomized controlled trials published between 2016 and 2020 — to answer a question millions of people ask: does acupuncture actually work for chronic musculoskeletal pain? That umbrella covers osteoarthritis, rheumatoid arthritis, fibromyalgia, and chronic low back pain, which together form the leading cause of disability worldwide. About three million American adults already use acupuncture yearly, most of them for these very conditions. The reviewers, writing in Current Rheumatology Reports, held studies to clear standards: randomized trials with at least 20 adults, pain as a measured primary outcome, and a genuine control group — sham needling, waiting list, active therapy, or routine care. They excluded dry needling and moxibustion so the conclusions would apply specifically to classical acupuncture at standard points. The answer turned out to be condition-specific, and refreshingly honest. Knee osteoarthritis and chronic low back pain earned the strongest support: short-term pain relief is real, and the authors call acupuncture a safe and reasonable referral option for both — a stance Medicare has since echoed by covering acupuncture for chronic low back pain. Fibromyalgia sits in the middle: acupuncture may help, but the evidence is thinner. Hip osteoarthritis and rheumatoid arthritis land on the other side: the available evidence does not support acupuncture for either, a negative finding stated without hedging. Safety was favorable across the board. For joint or back pain, this review is essentially a map of where the evidence for acupuncture stands. It is a narrative synthesis rather than a statistical meta-analysis, so it pools no numbers of its own, and its authors close with the field''s standing caveat: the short-term benefits reported across these trials still need confirmation in larger, more rigorous studies, especially for the conditions in the middle ground.