# Stress Management as a Clinical Approach to the Complementary Treatment of Fibromyalgia
## 4 Discussion  
The purpose of this review is to assess the effectiveness of strategies for managing and reducing stress, anxiety and depression associated with fibromyalgiagia, improving coping capacity and lowering the perception of pain. The observed effectiveness may be due to the fact that the use of these techniques or treatments allows patients to obtain knowledge and skills when facing and managing pain, thus reducing the perception that the user has about it.  
The data provided are sufficiently solid to verify the effectiveness of these actions, although it is true that the results of this review should be interpreted with caution due to the heterogeneity of the studies in terms of methodological quality, sample size and follow-up periods [10; 11; 12; 13; 14].  
Several studies have shown that performing CBT while maintaining pharmacological treatment significantly reduces anxiety and depression and, therefore, confers greater control over pain. The pain suffered by the patient is the same, but after performing this type of intervention, the patient is able to manage the pain, making it more bearable, thus mitigating the impact it generates on activities of daily living [8; 9; 10; 11]. This is why those individuals who have participated in clinical trials that provided CBT online present a longer-lasting improvement over time, since they are able to continue performing the techniques taught during the research [12; 13].  
Other research has shown how the implementation of interventions based on mindfulness (Tai Chi and/or mindfulness) is able to help the user, reducing anxiety, stress, insomnia, etc. [15; 16; 17]. One of the trials compared this type of technique with aerobic exercise. Both presented improvements, with the difference that those who carried out mindfulness experienced greater benefits, in addition to greater self-efficacy [16; 17].  
With regard to multidisciplinary treatment, it is demonstrated that physical exercise, directed by a physiotherapist, in addition to adequate psychological therapy provided by a professional specialist in this field, is capable of improving the quality of life of patients who present with this type of pain. These combined treatments yield better results than if they exclusively carried out conservative or pharmacological treatment, showing that this type of intervention represents an important supplement with regard to the treatment of musculoskeletal pain [18; 19].  
Interventions that used an alternative treatment were effective when used as adjuvant treatment, being usually recommended due to the absence of adverse effects in those people who have been diagnosed with fibromyalgia, since they are capable of significantly reducing catastrophic pain (tendency to focus excessively on the painful sensation, exaggerating the damage and feeling unable to control it) and the interference it causes in the patient's daily life. This is due to learning techniques focused on the emotions of the individual, who thus gains a greater management of their person [20; 21].  
Regarding the limitations of the study, although the results obtained are conclusive in terms of the objectives of the study, larger samples could yield more conclusive results. The heterogeneity between the studies means that the results found should be considered with caution. Given the scarcity of clinical trials that address stress management in fibromyalgia, it is difficult to address and see how these therapies affect patients holistically, since each study focuses on specific somatic or psychiatric disorders. This in itself justifies the implementation of future research.