Table 3.

A comparison of non‐pharmacological therapies for FM 4, 6

Treatment	Regimen	Reported outcomes	Advantages	Disadvantages
Patient education	Provide core information about diagnosis, treatment and prognosis; manage expectations	Can improve symptoms and functionality; might reduce disability levels	Can be carried out as part of normal consultations	Might need to be repeated during each consultation or require separate educational sessions Might be time‐consuming Might require additional support staff to help provide education
Exercise	Start low, go slow: build up to moderate activity over time	Can improve physical function, quality of life and reduce symptoms of pain and depression	Easily incorporated into daily routine Even small increases in activity have been shown to be of value	Might cause worsening of symptoms if exercise programme is begun too rapidly Access to exercise facilities might be limited Might require consultation with other HCPs (e.g. physical therapists)
CBT	Face‐to‐face counselling, online self‐help courses, books, CDs, FM Web sites	Provides knowledge about FM and coping strategies. Can provide sustained improvements in FM symptoms, and reduce impact on daily life	Effective in one‐on‐one settings, small groups and via the Internet Internet‐based programmes provide convenience for patients	Most effective when combined with other treatments Access to mental health providers might be limited and might be costly
Sleep hygiene	Optimise sleep environment and prioritise relaxing sleep routine	Can improve pain scores and mental well‐being	Easily incorporated into daily routine	Patient might be resistant to changes in routine (e.g. avoiding coffee at night, not watching television in bed)
CAM therapies	Various: examples include tai chi, yoga, massage, diet, balneotherapy and acupuncture	Can increase patient self‐sufficiency and improve pain/functioning	Limited evidence for efficacy	Most CAM therapies have not been rigorously studied Limited access to some of these treatments in some communities Might be costly

CAM, complementary and alternative medicine; CBT, cognitive behavioural therapy; FM, fibromyalgia; HCP, healthcare professional.