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New treatments for fibromyalgia syndrome

Issue 34 Synovium (Autumn 2011)

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Two studies catching the editorial eye recently in connection with fibromyalgia syndrome (FMS) were ‘hypnosis with guided imagery’1 and implantation of a vagus nerve stimulator.2

Guided imagery – if you were not aware – is ‘a dynamic, psychophysiologic process in which a person imagines and experiences an internal reality in the absence of external stimuli’. Sadly the systematic review found that most of the studies were of poor quality and concluded that this treatment could not be recommended.

With regard to vagus nerve stimulation, however, in an uncontrolled study 7 of 14 women with a 2-year history of FMS fitted with a vagus nerve stimulator were significantly improved after 11 months, and 2 patients no longer fulfilled the FMS diagnostic criteria. However, unanticipated or serious adverse events occurred in 4 patients. Interesting stuff. We suspect that it is going to be difficult to mount a double-blind, placebo-controlled trial of vagus nerve stimulation in sufficient numbers of subjects to persuade most of us that this is a treatment worth pursuing in these austere times, especially with such a high incidence of serious adverse effects.

We are reminded of a very wise old general practitioner who (among many such pronouncements) often said, ‘The more treatments there are, the less confident you can be that any of them are effective!’

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