1. Introduction

Fibromyalgia (FM) has been defined as a chronic and common pain disorder and is associated with comorbid symptoms such as fatigue, nonrestorative sleep, poor balance, cognition and memory problems, psychological distress, and physical function impairment [1]. The life quality is also reduced in FM [2]. It is affecting approximately 2% of the general population [3]. FM is also an expensive and controversial condition. It has been associated with significantly higher costs for the individual and society [4]. However, current data do not enable identification of distinct factors in the etiology and pathophysiology of fibromyalgia syndrome [5]. Also, an important problem in FM patients is the low compliance rate which, in the case of most patients, depends on an inadequate clinical response and on the difficulty in making a correct clinical characterization of patients [6]. Among the treatment options for FM management, there are pharmacological as well as nonpharmacologic therapies (supplementary and alternative medical treatments included) [7]. Numerous studies were reported about different nonpharmacologic treatment options [8–10].

© 2018 The Author(s). Licensee InTech. This chapter is distributed under the terms of the Creative Commons Attribution License (http://creativecommons.org/licenses/by/3.0), which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited.

© The Author(s). Licensee InTech. This chapter is distributed under the terms of the Creative Commons Attribution License (http://creativecommons.org/licenses/by/3.0), which permits unrestricted use, distribution, and eproduction in any medium, provided the original work is properly cited.

In this chapter, nonpharmacological treatment options will be explained in light of the last published guidelines.

can provide patient education, and for detailed nonpharmacologic treatments, a specialist may

Nonpharmacologic Treatment for Fibromyalgia http://dx.doi.org/10.5772/intechopen.70515 37

McLoughlin et al. [20] reported that many female patients with FM are active at a less level when compared with healthy women whose ages match [20]. They have low perceived functional ability. They also demonstrate impaired physical performance [21]. There are many reports that described positive effects of various types or combined exercises on patients with FM [22]. Pain in FM patients may be associated with the central nervous system (CNS) painprocessing abnormalities including central sensitization and insufficient pain inhibition, peripheral tissues, as well as muscles, which might contribute to chronic pain via initiating and/or maintaining central sensitization [23]. In this way, exercise is expected to contribute to pain via muscle microtrauma process, repair and adaptation, which are associated with normal-acute exercise and exercise training. It has been reported in previous studies that there are metabolic outcomes in muscle tissues, which is consistent with deconditioning [24]. Some of these findings might be normalized by aerobic and strength training-induced metabolic adaptations, which contribute to improvements in pain [25]. In addressing conditions experi-

enced by FM patients, exercise training was reported to be used successfully [8].

Although there are studies mentioning the efficiency of short-term aerobic exercises, the level of evidence for these studies is low. Effects on pain and tender points were determined to be at an insignificant level in statistical terms. In terms of the secondary outcomes such as depression, fatigue and sleep, the evidence is not clear on the effects of aerobic exercise on depression (in this respect, two studies reported medium/large effects [26]). There is no evidence that aerobic exercise prescribed at American College of Sports Medicine levels had effects on fatigue in FM patients [27]. Despite the fact that a meta-analysis shows that aerobic exercise has a positive effect on well-being and physical function, several factors moderated our appraisal. It has been demonstrated that aerobic and strength training improves depression in individuals that have depression at clinical level [28]. Moderate exercise can be beneficial for sleep in people with sleep complaints. It is also visible in training-related improvements in cardiorespiratory fitness. This situation suggests that fatigue may also be improved because as the maximal aerobic capacity of a person improves, that person will perform daily life activities at lower absolute percentages of maximal capacity [22]. Kurt et al. conducted a randomized study and reported that the FIQ score, sleep quality, total myalgic score, and depression scores of the group that received only aerobic exercise treatment improved after 15 sessions; however, in the third month follow-up, it was observed that the measurements regressed to the values that were present before the treatment. In recent studies, it has been reported that especially combined exercises or the combinations of exercise and other treatment options are

According to a Cochrane compilation conducted on the efficiency of resistance exercises in FM patients, it has been reported that moderate- and moderate- to high-intensity resistance training improves pain, tenderness, muscle strength, and multidimensional function in FM patients, and

also be consulted [18, 19].

3. Exercises

more efficient [29].
