Prolonged Medical Fasting May Benefit Pain Symptoms in Fibromyalgia

A prolonged therapeutic fasting intervention, integrated into a multimodal medical approach, has the potential to benefit patients with fibromyalgia regarding their pain and psychosomatic symptoms, according to new research.¹

Application of medically supervised fasting of a maximum of 600 kcal daily, for an average of 7 to 8 days, led to improvements in multiple disease-specific parameters, including quality of life, functionality, and pain perception, among a single-center population with fibromyalgia.

“Our data suggest feasibility, safety, and potential advantages of medically supervised fasting for patients with fibromyalgia syndrome, when embedded in a multimodal therapeutic inpatient approach,” wrote the investigative team, led by Daniela A. Koppold, department of internal medicine and nature based therapies, Immanuel Hospital Berlin.

Fibromyalgia’s complexities arise from diagnostic challenges, as no radiological or laboratory markers can confirm its presence, and clinical presentation can fluctuate between individual patients.² Typically, diagnosis is determined through pain scales and a history of persistent pain in at least four of five body regions for ≥3 months. The chronic pain disorder commonly occurs concomitantly in patients with rheumatological diseases.

Given the condition’s complexity, rheumatological organizational guidelines stress the importance of multimodal treatment approaches, with preference for non-pharmacological interventions over medications.³ Dietary interventions, while not yet incorporated into these guidelines, have shown an effect on quality of life and pain perception in preliminary trial data.

In this observational study, Koppold and colleagues assessed the feasibility and impact of prolonged therapeutic fasting embedded into a multimodal treatment setting on inpatients with fibromyalgia.¹ Participants, recruited from February 2018 to December 2020 at the investigators’ institution in Germany, completed questionnaires at hospital admission and discharge, and 3, 6, and 12 months later.

The Fibromyalgia Impact Questionnaire (FIQ), a validated questionnaire specifically used for the symptomatic presentations of fibromyalgia, was used to determine the feasibility and effectiveness of prolonged therapeutic fasting in fibromyalgia management. An improvement of 14% is acknowledged as the minimal clinically important difference (MCID) in the FIQ.

For analysis, baseline values (V0) and vital signs were compared with measurements at later visits (V1 to V4) through unadjusted t-tests. Overall, the study population comprised 168 female and 8 male patients exhibiting fibromyalgia and following a therapeutic fasting intervention during the study period. Of this population, 90% fasted, lasting between 3 and 12 days, with an average of 7.6 days.

Upon analysis, Koppold and colleagues identified a significant improvement in fibromyalgia manifestations in the FIQ. The FIQ total score dropped from 58.3 ± 11.1 to 44.6 ± 15.5 between admission and discharge, a reduction of 13.7 ± 13.9 points (P <.001). Translating to a decrease of 23.5%, investigators noted the marked reduction in the total score is larger than the MCID of 14%.

These strong improvements in the total score occurred due to large effects in the “Overall” and “Symptoms” subscores (P <.0001), as well as a slight benefit in the “Function” subscore (P = .0328) and a clinically significant effect in the pain subscore (P <.0001).

Reductions in pain (–1.1 ± 2.5; P <.001) and improvements in quality of life (WHO-5, +4.9 ± 12.3; P <.001) identified in V1 were sustained across the entire study period of one year. On the other hand, improvements in mindfulness (P <.001), anxiety (P <.0001), and depression (P <.0001) observed during inpatient treatment were not sustained over the long term.

Safety data showed no serious adverse events were reported during the inpatient stay for any participant. Given the potential for positive effects on presentations of fibromyalgia, Koppold and colleagues suggested the need to study prolonged medical fasting in outpatient settings and whether the duration of the fast could show similar effects.

“In general, if a safe and feasible intervention of 5–10 days were able to lower disease burden in FMS in the medium and long term, giving it further attention seems worthwhile,” they wrote.

References

1. _{Koppold DA, Kandil FI, Müller A, et al. Effects of Prolonged Medical Fasting during an Inpatient, Multimodal, Nature-Based Treatment on Pain, Physical Function, and Psychometric Parameters in Patients with Fibromyalgia: An Observational Study. Nutrients. 2024;16(7):1059. Published 2024 Apr 4. doi:10.3390/nu16071059}
2. _{Berwick R, Barker C, Goebel A; guideline development group. The diagnosis of fibromyalgia syndrome. Clin Med (Lond). 2022;22(6):570-574. doi:10.7861/clinmed.2022-0402}
3. _{Macfarlane GJ, Kronisch C, Dean LE, et al. EULAR revised recommendations for the management of fibromyalgia. Ann Rheum Dis. 2017;76(2):318-328. doi:10.1136/annrheumdis-2016-209724}