NON-PHARMACOLOGICAL INTERVENTIONS FOR MANAGING FIBROMYALGIA IN PRIMARY CARE: A COMPREHENSIVE REVIEW

Abstract

Fibromyalgia is a chronic, multifaceted disorder characterized by widespread musculoskeletal pain, fatigue, cognitive dysfunction, and sleep disturbances. It represents one of the most common chronic pain syndromes encountered in primary care, disproportionately affecting women and often coexisting with other chronic conditions such as irritable bowel syndrome, chronic fatigue syndrome, depression, and anxiety. Due to its complex pathophysiology, involving central sensitization, neuroendocrine dysregulation, and psychosocial influences, pharmacological therapies alone are insufficient for long-term management and often lead to partial or unsatisfactory relief. Consequently, current international guidelines recommend prioritizing non-pharmacological interventions as first-line strategies for managing fibromyalgia. This review aims to synthesize the evidence on non-pharmacological interventions that can be effectively implemented in primary care, including structured exercise programs, cognitive and behavioral therapies, patient education and self-management strategies, dietary and lifestyle modifications, complementary and alternative therapies, and emerging digital health approaches. We highlight how these interventions address not only symptom reduction but also the functional, emotional, and psychosocial needs of patients, thereby promoting long-term well-being. In addition, the paper emphasizes the critical role of primary care practitioners in coordinating multidisciplinary care, personalizing treatment plans, and empowering patients toward active participation in their health journey. By integrating evidence-based non-pharmacological interventions into routine primary care practice, healthcare systems can move away from a narrow biomedical approach toward a comprehensive, patient-centered model. This paradigm shift offers the potential to improve patient outcomes, enhance quality of life, and reduce the reliance on pharmacological treatments with limited efficacy and potential side effects.