An Army Sergeant With Mysterious Pain: Crack the Case

Christopher L. Tracy, MD

Disclosures

November 10, 2014

The Use of Alternative Therapies as Adjuncts

Alternative therapies may be useful as treatment adjuncts in fibromyalgia. Although relatively few high-quality clinical trials exist to support their use, trigger-point injections, chiropractic manipulation, tai chi, yoga, acupuncture, and myofascial release therapy all have some lower-quality evidence to support their use in the correct clinical setting, as long as choice of therapy does not cause harm.[14]

Higher-quality evidence supports the use of education, cognitive-behavioral therapy, and exercise in the sustained treatment of FMS. Response to nonpharmacologic treatment tends to be better than that to pharmacologic treatments and lacks noted adverse side effects.[1]

A recent meta-analysis evaluating the effectiveness of acupuncture as treatment for FMS reviewed 523 trials, nine of which were selected for the analysis.[15] Although not enough evidence exists to prove the efficacy of acupuncture therapy for the treatment of fibromyalgia, some lower-quality studies suggest that the therapy may be superior to drugs. Acupuncture, exercise, and drugs in combination may raise pain thresholds in the short term.

The patient informs you that she has a friend who was prescribed oxycodone for pain and is wondering whether this is an appropriate therapy for her condition.

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