Fibromyalgia and Acupuncture - Disappointing Results

Summarized by Robert W. Griffith, MD
November 21, 2005

Introduction

Fibromyalgia causes pain and tenderness at many sites in the body. There are often headaches, general fatigue, anxiety, depression, and sleep problems. The cause of the condition is unknown, and there are no specific lab tests for its diagnosis. And no treatments can be called 'highly effective'.

It's not surprising, therefore, that many people with fibromyalgia seek alternative treatments, such as acupuncture. Increasingly, mainstream medicine is recognizing acupuncture as an effective treatment for a variety of disorders.

Unfortunately, no studies done so far prove that acupuncture helps patients with fibromyalgia. One of the problems is the difficulty of providing a control group, i.e. a group of patients who don't receive acupuncture, so that the results of the two groups can be compared. Patients usually know whether they are getting acupuncture, and this can influence the way they report symptoms.

A new study has been reported in the Annals of International Medicine that compared true acupuncture with sham (fake or pretend) acupuncture treatment in patients with fibromyalgia. Here's a summary.

What was done

Volunteers with fibromyalgia were recruited through private acupuncturists' offices in Seattle. They had to have pain that they rated at least 4 on a scale from 0 (no pain) to 10 (worst pain ever), and they should not have received acupuncture before. They were assigned to 12 weeks of treatment, twice-weekly, with either true acupuncture or to one of three comparison groups.

All three comparison groups were a form of sham acupuncture. The first got acupuncture at points used in treating irregular menstrual periods, the second at points that are not true acupuncture points, and the third got placement of special needle-like devices that did not pierce the skin.

The subjects were allowed to continue whatever other treatments they had been using before the study started. Patient ratings of pain were collected after 1, 4, 8, and 12 weeks of treatment, and at 3 and 6 months after treatment was completed.

Care as taken to ensure that neither the patients nor the staff collecting or analyzing the pain data knew which treatment group the patients belonged to. To check this, patients were asked to 'guess' which treatment they had received, and how confident they felt about their answer.

What was found

One hundred patients were recruited, and 86 of them completed the full 12 weeks of treatment. Most of them were women; their average age was 47, and they had experienced pain for an average of 10 years. Pain intensity scores at the start of the study ranged from 6.8 to7.3 for the 4 treatment groups.

In all 4 groups, improvement in pain scores occurred most rapidly from weeks 0 to 1, weakened during weeks 1 to 8, leveled off between weeks 8 and12, and decreased slightly 3 and 6 months after the treatments stopped. There were no significant differences detected between the response to true acupuncture and the three control groups pooled together. Pain ratings at the end of 12 weeks were between 4.5 and 5.5 for all 4 groups.

At the end of the treatment period, a third of the participants believed they had received true acupuncture designed for fibromyalgia; 4% believed they had received simulated acupuncture. There were no differences in average pain scores between those who believed they had received true acupuncture and those who had received inappropriate, sham, or simulated acupuncture.

Side effects were reported by many of the participants - discomfort at the site (37%), bruising (30%), nausea (3%), and faintness (0.3%) - but none were serious.

What these findings mean

The study indicates that acupuncture was no better than sham acupuncture in relieving the pain of fibromyalgia. There was, indeed, a slight improvement - greater in the early weeks - that leveled off after about 8 weeks; however, this improvement was seen equally in all treatment groups - those that received true acupuncture, and the three controls (inappropriate, sham, or simulated acupuncture).

Why was there slight overall improvement, independent of the treatment offered? It may have been a response to the acupuncturist's healing presence, the relaxing environment of the clinic, a psychological response to participating in a clinical trial, or fluctuations in the natural course of the disease. Including a group receiving absolutely no treatment might have cleared up the relevance of some of these possibilities.

Based on these findings, it seems that fibromyalgia sufferers would do well to seek treatment modalities other than acupuncture to relieve their pain. There are, indeed, many possible effective treatments to chose from - see the links below.

Source

• A randomized trial of acupuncture compared with sham acupuncture in fibromyalgia. ANP. Assefi , SKJ. Sherman , JC. Jacobsen ,  et al., Ann Intern Med, 2005, vol. 143, pp. 10--19

Related Links
Fibromyalgia
A New Approach to Fibromyalgia
Fibromyalgia and Exercise