Horticultural therapy for the management of fibromyalgia: a narrative review

Abstract

Fibromyalgia (FM) is a chronic nociplastic pain syndrome characterized by widespread musculoskeletal pain, fatigue, sleep disturbance, cognitive dysfunction, and impaired quality of life. Current management supports a multidisciplinary approach. Horticultural therapy (HT), a structured therapeutic intervention that involves gardening-related activities and interaction with natural environments to achieve specific therapeutic goals, has emerged as a potential adjunctive therapeutic modality. This narrative review summarizes the available evidence related to HT and nature-based interventions in FM. Evidence specific to syndromes of chronic pain has demonstrated the efficacy of HT in increasing pain threshold. Clinical data evaluating patients with FM have shown significant improvements in validated measures of the following: global physical and mental health; depression and anxiety; insomnia; affect, mood state, friendliness, and mindfulness; kinesiophobia and physical activity; cognitive emotional regulation and coping; perceived competence, dominance and self-efficacy; and state of arousal. Proposed mechanisms include stress reduction, sensory stimulation, increased physical activity, autonomic regulation, neurochemical adaptation, and neuroendocrine-immune modulation. The current evidence base is limited by small sample sizes, heterogeneous interventions, limited follow-up, and a scarcity of adequately powered randomized controlled trials (RCTs). Although HT appears safe and may represent a useful adjunct within multidisciplinary FM management, additional high-quality studies are required before definitive conclusions regarding efficacy can be drawn.

Keywords

fibromyalgia / chronic pain / horticultural therapy / forest therapy

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