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Systematic review and network meta-analysis of interventions for fibromyalgia: a protocol

Jason W Busse12*, Shanil Ebrahim2, Gaelan Connell3, Eric A Coomes4, Paul Bruno5, Keshena Malik6, David Torrance3, Trung Ngo3, Karin Kirmayr7, Daniel Avrahami3, John J Riva28, Peter Struijs9, David Brunarski10, Stephen J Burnie3, Frances LeBlanc3, Ivan A Steenstra1112, Quenby Mahood11, Kristian Thorlund132, Victor M Montori14, Vishalini Sivarajah15, Paul Alexander2, Milosz Jankowski16, Wiktoria Lesniak1617, Markus Faulhaber28, Małgorzata M Bała1617, Stefan Schandelmaier18 and Gordon H Guyatt2

Author Affiliations

1 Department of Anesthesia, McMaster University, 1200 Main Street West, Hamilton, Ontario, L8S 4K1, Canada

2 Department of Clinical Epidemiology and Biostatistics, McMaster University, 1200 Main Street West, Hamilton, Ontario, L8S 4K1, Canada

3 Canadian Memorial Chiropractic College, 6100 Leslie Street, Toronto, Ontario, M2H 3J1, Canada

4 Faculty of Medicine, University of Toronto, 1 Kings College Circle, Toronto, Ontario, M5S 1A8, Canada

5 Faculty of Kinesiology and Health Studies, University of Regina, 3737 Wascana Parkway, Regina, Saskatchewan, S4S 0A2, Canada

6 School of Rehabilitation Sciences, McMaster University, 1400 Main Street West, Hamilton, Ontario, L8S 1C7, Canada

7 German Hospital, Av. Pueyrredón 1640 (C1118 AAT), Buenos Aires, Argentina

8 Department of Family Medicine, McMaster University, McMaster Innovation Park, 175 Longwood Road South, Hamilton, Ontario, L8P 0A1, Canada

9 Department of Orthopaedic Surgery, Academic Medical Center, Meibergdreef 9, 1105, Amsterdam-Zuidoost, the Netherlands

10 Ontario Chiropractic Association, 20 Victoria Street, Suite 200, Toronto, Ontario, M5C 2N8, Canada

11 The Institute for Work & Health, 481 University Avenue, Toronto, Ontario, M5G 2E9, Canada

12 Dalla Lana School of Public Health, University of Toronto, 6th floor, 155 College Street, Toronto, Ontario, M5T 3M7, Canada

13 Stanford Prevention Research Center, Stanford University School of Medicine, 1265 Welch Road, Stanford, CA, 94305-5411, USA

14 Knowledge and Evaluation Research Unit, Divisions of Endocrinology and Diabetes and Health Care and Policy Research, Mayo Clinic, 200 First Street SW, Rochester, MN, 55905, USA

15 Faculty of Health Sciences, McMaster University, 1280 Main Street West, Hamilton, Ontario, L8S 4K1, Canada

16 2nd Department of Internal Medicine, Jagiellonian University Medical College, ul Skawinska 8, 31-066, Kraków, Poland

17 Polish Institute of Evidence Based Medicine, ul. Krakowska 41, 31-066, Kraków, Poland

18 Academy of Swiss Insurance Medicine, University Hospital Basel, Schanzenstrasse 55, 4031, Basel, Switzerland

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Systematic Reviews 2013, 2:18  doi:10.1186/2046-4053-2-18

Published: 13 March 2013



Fibromyalgia is associated with substantial socioeconomic loss and, despite considerable research including numerous randomized controlled trials (RCTs) and systematic reviews, there exists uncertainty regarding what treatments are effective. No review has evaluated all interventional studies for fibromyalgia, which limits attempts to make inferences regarding the relative effectiveness of treatments.


We will conduct a network meta-analysis of all RCTs evaluating therapies for fibromyalgia to determine which therapies show evidence of effectiveness, and the relative effectiveness of these treatments. We will acquire eligible studies through a systematic search of CINAHL, EMBASE, MEDLINE, AMED, HealthSTAR, PsychINFO, PapersFirst, ProceedingsFirst, and the Cochrane Central Registry of Controlled Trials. Eligible studies will randomly allocate patients presenting with fibromyalgia or a related condition to an intervention or a control. Teams of reviewers will, independently and in duplicate, screen titles and abstracts and complete full text reviews to determine eligibility, and subsequently perform data abstraction and assess risk of bias of eligible trials. We will conduct meta-analyses to establish the effect of all reported therapies on patient-important outcomes when possible. To assess relative effects of treatments, we will construct a random effects model within the Bayesian framework using Markov chain Monte Carlo methods.


Our review will be the first to evaluate all treatments for fibromyalgia, provide relative effectiveness of treatments, and prioritize patient-important outcomes with a focus on functional gains. Our review will facilitate evidence-based management of patients with fibromyalgia, identify key areas for future research, and provide a framework for conducting large systematic reviews involving indirect comparisons.

Fibromyalgia; Systematic review; Network meta-analysis; Multiple treatment comparison; Randomized controlled trials