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Best Pract Res Clin Rheumatol. 2011 Apr;25(2):299-309. doi: 10.1016/j.berh.2011.01.005.

Non-pharmacological treatment of chronic widespread musculoskeletal pain.

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Department of Anesthesiology, University of Michigan Medical School, Chronic Pain & Fatigue Research Center, Domino's Farms, 24 Frank Lloyd Wright Drive, Ann Arbor, MI 48106, USA.


Individuals with chronic widespread pain, including those with fibromyalgia, pose a particular challenge to treatment, given the modest effectiveness of pharmacological agents for this condition. The growing consensus indicates that the best approach to treatment involves the combination of pharmacological and non-pharmacological interventions. Several non-pharmacological interventions, particularly exercise and cognitive-behavioural therapy (CBT), have garnered good evidence of effectiveness as stand-alone, adjunctive treatments for patients with chronic pain. In this article, evidenced-based, non-pharmacological management techniques for chronic widespread pain are described by using two broad categories, exercise and CBT. The evidence for decreasing pain, improving functioning and changing secondary symptoms is highlighted. Lastly, the methods by which exercise and CBT can be combined for a multi-component approach, which is consistent with the current evidence-based guidelines of several American and European medical societies, are addressed.

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