English Case Study is availible below the Abstract
This randomized controlled trial had positive results, but other studies had divergent findings, and many questions remain.
Various research groups have attempted to determine the efficacy of acupuncture as a treatment for fibromyalgia. This new, carefully designed, randomized controlled trial compared sham treatment to acupuncture with electrical stimulation. The primary outcome measure was change in score on the Fibromyalgia Impact Questionnaire (FIQ), a standardized, validated measure of many dimensions of fibromyalgia.
The 50 patients received six treatments within 3 weeks. Patients’ ability to watch the treatments was impeded, and needles were placed at traditional acupuncture sites in both groups. The treatment group received electrical stimulation through needles placed at 18 to 20 predetermined traditional acupuncture sites. In the sham procedure, the needles did not pierce the skin (patients felt mild pricks), and lights flashed during simulated electrical stimulation. The authors confirmed successful blinding.
One month after treatment, FIQ scores had improved nearly 20% in the acupuncture group compared with less than 5% in the sham group, a statistically significant difference. Acupuncture improved fatigue and anxiety but not patients’ activity levels or their physical functioning. Seven months after treatment, the FIQ scores of the acupuncture group were still 10% better than before treatment, but the difference was no longer statistically significant.
Comment: Judging whether these results are clinically significant and cost-effective is problematic. The physiologies of fibromyalgia and acupuncture have long been mysterious and controversial. In two previous controlled studies, traditional acupuncture, acupuncture at nontraditional sites, acupuncture without electrical stimulation, and simulated puncture were all equally effective in partially relieving pain or fatigue in patients with fibromyalgia (J Altern Complement Med 2005; 11:663 and Ann Intern Med 2005; 143:10). In another study, acupuncture was better than sham treatment (superficial needling at nontraditional sites with weaker electrical stimulation): Half of the treated patients had satisfactory improvement, and another quarter had almost complete resolution of symptoms (BMJ 1992; 305:1249). All of these controlled trials pose many questions, such as duration of effect, optimal treatment schedule and needling sites, and mechanism of action. Still, the results suggest that acupuncture merits further study in patients with fibromyalgia.
— Richard B. Rosenbaum, MDDr. Rosenbaum is on the staff of the Oregon Clinic and is Clinical Professor of Neurology, Oregon Health and Science University, Portland.
Published in Journal Watch Neurology September 12, 2006Citation(s):
Martin DP et al. Improvement in fibromyalgia symptoms with acupuncture: Results of a randomized controlled trial. Mayo Clin Proc 2006 Jun; 81:749-57.
Improvement in fibromyalgia symptoms with acupuncture: results of a randomized controlled trial.
Martin DP, Sletten CD, Williams BA, Berger IH.Department of Anesthesiology, Mayo Clinic College of Medicine, 200 First St SW, Rochester, MN 55905, USA. martin.david@mayo.edu
OBJECTIVE: To test the hypothesis that acupuncture improves symptoms of fibromyalgia.
PATIENTS AND METHODS: We conducted a prospective, partially blinded, controlled, randomized clinical trial of patients receiving true acupuncture compared with a control group of patients who received simulated acupuncture. All patients met American College of Rheumatology criteria for fibromyalgia and had tried conservative symptomatic treatments other than acupuncture. We measured symptoms with the Fibromyalgia Impact Questionnaire (FIQ) and the Multidimensional Pain Inventory at baseline, immediately after treatment, and at 1 month and 7 months after treatment. The trial was conducted from May 28, 2002, to August 18, 2003.
RESULTS: Fifty patients participated in the study: 25 in the acupuncture group and 25 in the control group. Total fibromyalgia symptoms, as measured by the FIQ, were significantly improved in the acupuncture group compared with the control group during the study period (P = .01). The largest difference in mean FIQ total scores was observed at 1 month (42.2 vs 34.8 in the control and acupuncture groups, respectively; P = .007). Fatigue and anxiety were the most significantly improved symptoms during the follow-up period. However, activity and physical function levels did not change. Acupuncture was well tolerated, with minimal adverse effects.
CONCLUSION: This study paradigm allows for controlled and blinded clinical trials of acupuncture. We found that acupuncture significantly improved symptoms of fibromyalgia. Symptomatic improvement was not restricted to pain relief and was most significant for fatigue and anxiety.
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http://www.balanceacupuncture.co.uk/caseStudies.aspxMrs P. has been suffering with fifromyalgia for more than 8 years. She has been treated with conventional medicine. Her current medication include
Her medicine has been helpful to manage the symptoms most of the time. She has also tried other CAM (complementary and alternative medicine) such as homeopathy and massage therapy.
This time she was seriously considering acupuncture because all symptoms become worse. She was experiencing a paroxismal flare.
The two most important patterns identified in this case were
I used systemic points such as Back Shu points, SP6, ST36, Liv 3, LI 10, LI 11, LI 4 (not all LI points at the same time) as well as ashi points (tender points). I noticed for this patient that there were tender points along the GB channel therefore I used GB 40, GB 37, GB 41 (tender point), GB 20, LI 5 . Auricular shenmen was also part of the prescription. The yangming channels (LI and ST) are rich in qi and blood therefore they were used to promote Qi and reduce pain.
As well as providing the acupuncture treatment, I also gave some dietary advice to the patient. Treatment Frequency
The first month there were two treatments per week. The second month, frequency was reduced to one treatment per week. The third month, there was a further reduction to one treatment every other week. Outcome
I advised the patient to seek her GP permission before reducing or stopping her medication. She is currently taking the minimum dose prescribed.
Bibliography
Flaws B. (2004) Curring Fibromyalgia Naturally with Chinese Medicine, Blue Poppy Press: Boulder CO
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Some previous studies (2008, 2006, 2005, 2002, 1999)
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OBJECTIVE: To evaluate the effectiveness of acupuncture for fibromyalgia.
METHODS: Fifty-eight women with fibromyalgia were allocated randomly to receive either acupuncture together with tricyclic antidepressants and exercise (n=34), or tricyclic antidepressants and exercise only (n=24). Patients rated their pain on a visual analogue scale. A blinded assessor evaluated both the mean pressure pain threshold value over all 18 fibromyalgia points and quality of life using SF-36.
RESULTS: At the end of 20 sessions, patients who received acupuncture were significantly better than the control group in all measures of pain and in 5 of the SF-36 subscales. After 6 months, the acupuncture group was significantly better than the control group in numbers of tender points, mean pressure pain threshold at the 18 tender points and 3 subscales of SF-36. After one year, the acupuncture group showed significance in one subscale of the SF-36; at 2 years there were no significant differences in any outcome measures.
CONCLUSION: Addition of acupuncture to usual treatments for fibromyalgia may be beneficial for pain and quality of life for 3 months after the end of treatment. Future research is needed to evaluate the specific effects of acupuncture for fibromyalgia.
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CONTEXT: Fibromyalgia syndrome (FMS) is a prevalent musculoskeletal disorder associated with pain, mood state alteration, and disability. A structured and effective treatment plan for palliative care has not been established. The genesis of FMS is not clear. FMS occurs primarily in adult women.
DESIGN: Using a quasi-experimental clinical design and following the criteria of the American College of Rheumatology (ACR), for FMS, 21 participants completed the study. The mean age was 53.6 years. The data were collected at baseline and at 1 and 2 months. Acupuncture treatments included 17 points for FMS symptoms, and 8 outcome measures were collected.
RESULTS: The Fibromyalgia Impact Questionnaire (FIQ) showed significant differences at 1 and 2 months. For the SF-12, 3 subscales showed significant differences between baseline and 2 months. Four of 6 items were significantly changed. The mean number of general health symptoms was significantly decreased by 2 months. For the Catastrophe Index, significant differences were found for baseline vs 2 months. Pain threshold scores were significantly different at end of treatment for 5 bilateral tender points. There was significant improvement in Beck Depression items for both 1- and 2-month periods. In a multivariate regression model, 5 covariates were included--age, number of weeks in treatment, number of doctors treating, number of general symptoms, and baseline FIQ score. The results indicated significant age effect. This analysis showed that the higher the FIQ score, the more positive the change experienced by study participants. Number of weeks in treatment, number of doctors who treated, and total number of general health symptoms did not have a significant effect on outcomes.
CONCLUSIONS: Significant improvement was experienced by participants at 8 weeks of treatment. Acupuncture treatment as delivered was effective at reducing FMS symptoms in this outcome study
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Objectives: The objective of this study was to investigate whether typical acupuncture methods such as needle placement, needle stimulation, and treatment frequency were important factors in fibromyalgia symptom improvement.
Design/settings/subjects: A single-site, single-blind, randomized trial of 114 participants diagnosed with fibromyalgia for at least 1 year was performed.
Intervention: Participants were randomized to one of four treatment groups: (1) T/S needles placed in traditional sites with manual needle stimulation (n = 29): (2) T/0 traditional needle location without stimulation (n = 30); (3) N/S needles inserted in nontraditional locations that were not thought to be acupuncture sites, with stimulation (n = 28); and (4) N/0 nontraditional needle location without stimulation (n = 2 7). All groups received treatment once weekly, followed by twice weekly, and finally three times weekly, for a total of 18 treatments. Each increase in frequency was separated by a 2-week washout period.
Outcome measures: Pain was assessed by a numerical rating scale, fatigue by the Multi-dimensional Fatigue Inventory, and physical function by the Short Form-36.
Results: Overall pain improvement was noted with 25%-35% of subjects having a clinically significant decrease in pain; however this was not dependent upon "correct" needle stimulation (t = 1.03; p = 0.307) or location (t = 0.76; p = 0.450). An overall dose effect of treatment was observed, with three sessions weekly providing more analgesia than sessions once weekly (t = 2.10; p = 0.039). Among treatment responders, improvements in pain, fatigue, and physical function were highly codependent (all p
Conclusions: Although needle insertion led to analgesia and improvement in other somatic symptoms, correct needle location and stimulation were not crucial
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Abstract: Fibromyalgia is a chronic, painful musculoskeletal syndrome of unknown etiopathogenesis. In addition to medicamentous and physical and psychologic therapies, several other adjunct therapies have been used as alternatives in the attempt to obtain analgesia and decrease the symptoms that are characteristic of this problem. This article presents a literary review on the use of acupuncture as an adjunct or chief treatment for patients with fibromyalgia, comparing it with an ongoing clinical experience that has been carried out at Hospital das Clinicas in the city of Sao Paulo. The results were found by applying traditional acupuncture, which demonstrated positive rates in the Visual Analogue Scale, myalgic index, number of tender points, and improvement in quality of life based on the SF-36 questionnaire.
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BACKGROUND: We conducted this study to assess the effectiveness of acupuncture in the treatment of fibromyalgia syndrome (FMS), report any adverse effects, and generate hypotheses for future investigation.
METHODS: We searched MEDLINE, EMBASE, Manual Therapy Information System, the Cochrane registry, the University of Maryland Complementary and Alternative Medicine in Pain, the Centralized Information Service for Complementary Medicine, and the National Institutes of Health Office of Alternative Medicine databases for the key words "acupuncture" and "fibromyalgia." Conference abstracts, citation lists, and letters supplemented the search. We selected all randomized or quasi-randomized controlled trials, or cohort studies of patients with FMS who were treated with acupuncture. Methodologic quality, sample characteristics, type of acupuncture treatment, and outcomes were extracted. Statistical pooling was not performed because of the differences in control groups.
RESULTS: Seven studies (3 randomized controlled trials and 4 cohort studies) were included; only one was of high methodologic quality. The high-quality study suggests that real acupuncture is more effective than sham acupuncture for relieving pain, increasing pain thresholds, improving global ratings, and reducing morning stiffness of FMS, but the duration of benefit following the acupuncture treatment series is not known. Some patients report no benefit, and a few report an exacerbation of FMS-related pain. Lower- quality studies were consistent with these findings. Booster doses of acupuncture to maintain benefit once regular treatments have stopped have been described anecdotally but not investigated in controlled trials.
CONCLUSIONS: The limited amount of high-quality evidence suggests that real acupuncture is more effective than sham acupuncture for improving symptoms of patients with FMS. However, because this conclusion is based on a single high-quality study, further high- quality randomized trials are needed to provide more robust data on effectiveness
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