INTRODUCTION: This network meta-analysis aimed to assess the efficacy of acupuncture, intravenous lidocaine, and diet compared with other comparators such as physiotherapy and sham/placebo in fibromyalgia patients. MATERIALS AND METHODS: We searched Embase, PubMed, Scopus, and Web of Science for relevant studies till September 2021. The included studies were randomized controlled clinical trials. For the network meta-analysis, we used the R software. RESULTS: There were 23 included RCTs. The total sample size was 1409 patients. Compared with the sham/placebo group, the network analysis showed the highest improvement in the quality of life in the acupuncture group standardized mean difference (SMD) -10.28, 95% CI -14.96 to -5.59), and then in the physiotherapy group (SMD -7.48, 95% CI -14.72 to -0.23). For the pain, there was a significant reduction with acupuncture (SMD -1.69, 95% CI -2.48 to -0.89), compared with sham/placebo. Regarding depression, it showed a significant reduction with acupuncture (SMD -9.64, 95% CI -16.13 to -3.14) compared with sham/placebo. Finally, for stiffness, it showed no significant differences in the stiffness between acupuncture (SMD -8.52, 95% CI -20.40 to 3.36), fluoxetine (SMD -6.52, 95% CI -29.65 to 16.61), and physiotherapy (SMD -4.64, 95%-CI -22.83 to 13.54) compared with sham/placebo. CONCLUSIONS: The acupuncture showed a significant effect in the management of fibromyalgia patients. It reduced pain, depression, and enhanced the quality of life. While physiotherapy showed a significant improvement in the quality of life only. In contrast, intravenous lidocaine and diet showed no significant differences when compared with sham/placebo.

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