Acupuncture does not reduce pain in fibromyalgia patients

Directed acupuncture was no more effective than sham acupuncture at relieving pain in fibromyalgia in a 12-week randomized, controlled trial reported by Dr Dedra S Buchwald (University of Washington, Seattle) in the July 5, 2005 issue of the Annals of Internal Medicine.

“We were surprised we thought acupuncture would work for fibromyalgia based on our clinical experience and our patients’ testimonials,” says Buchwald. One potential explanation, says Buchwald, is that study participants received a standardized treatment. “That’s not how acupuncturists apply acupuncture in a real-life setting. They individualize treatment to patients and also use a lot of ancillary approaches, such as herbs and dietary changes,” Buchwald tells rheumawire. Currently there is no gold standard for selecting acupoints for fibromyalgia treatment. While the study did not include adjunctive therapies, researchers allowed participants to continue any fibromyalgia-related pharmacologic and nonpharmacologic therapies during the study. No effect on pain or other functionsThe researchers’ goal was to determine whether directed acupuncture designed for fibromyalgia treatment relieves pain better than sham acupuncture. Buchwald and colleagues randomized 100 adults with fibromyalgia to one of four treatment groups (three of which were sham) for twice-weekly treatments for 12 weeks: – Directed acupuncture according to traditional Chinese medicine. – A sham control in which participants received real acupuncture for an unrelated condition using real meridians and acupoints. – A sham control in which participants received needle insertion but without the use of standard acupoints. – A sham control in which participants got simulated acupuncture that did not insert needles at all, but there was some contact with the skin by toothpicks.All patients were blindfolded during treatments. Inclusion criteria were English-speaking adults over age 18 with physician-diagnosed fibromyalgia who had a global pain score of 4 or higher on a visual analog scale (0=no pain, 10=worst pain ever). Most participants were white, married women who, on average, were 47 years old and had experienced pain for 10 years. In addition to the primary outcome measure of subjective pain measured by a standard 10-cm visual analog scale, researchers also used a visual analog scale to measure the intensity of fatigue (0=none, 10=worst ever), sleep quality (0=worst ever, 10=best), and overall well-being (0=worst ever, 10=best ever). Secondary outcomes were physical and mental functions measured with the Medical Outcomes Study 36-item Short-Form Health Survey. At baseline, the average score on the visual analog scale was 7 cm for pain intensity, 7.7 cm for fatigue intensity, 3.3 cm for sleep quality, and 4 cm for overall well-being. Measurements were then taken at one, four, eight, and 12 weeks, as well as three and six months after the treatments were concluded. The three sham treatments were combined into a single control group for comparison with the true acupuncture group. Initiallyafter week oneparticipants showed slight improvements in pain, but that did not proceed throughout the study. Overall, researchers found no statistical significance in improvements in either the sham-procedure or directed-acupuncture group.”Possible explanations include a nonspecific response to the acupuncturist’s healing presence or the relaxing environment of the acupuncture clinic, a psychological response to participation in a clinical trial, or fluctuations in the natural history of disease,” the researchers write. Patients in this study were “very ill” The cause of fibromyalgia, a chronic pain condition affecting up to 4% of the US population, is unknown. After osteoarthritis (OA), it is the second most common rheumatologic condition. Fibromyalgia is not as widely recognized among physicians as osteoarthritis, since it is a more recently accepted disorder.Regardless of the fibromyalgia study results, Buchwald contends that acupuncture is likely to help some patients. “If a patient wants to try acupuncture, it might be helpful. Hypothetically, one thing to consider is that our participants could have been difficult to treat because they were very ill, as many came to us from referral clinics. Perhaps people coming into other physicians’ practices might not be as sick and therefore might respond better to acupuncture,” Buchwald says.Past studies, most recently in the July 9, 2005 issue of the Lancet, have shown statistically significant results for the use of acupuncture for osteoarthritis of the knee. Yet it is not easy to compare the use of acupuncture for OA with fibromyalgia, as the two conditions are quite different. Fibromyalgia pain is widespread throughout the body, while OA of the knee is limited to one specific place on the body, Buchwald tells rheumawire. “And while acupuncture didn’t show a huge effect [on OA], it was similar to other medications used in osteoarthritis,” she adds. The next step for future research into fibromyalgia is to look at other commonly used complementary and alternative treatment methods, as fibromyalgia patients use many other treatments that are worth looking at, says Buchwald. Those include massage and dietary and lifestyle changes.(Source: Assefi N, Sherman K, Jacobsen C, et al. A randomized clinical trial of acupuncture compared with sham acupuncture in fibromyalgia. Ann Intern Med 2005; 143:10-19: Rheumawire: Joint and Bone: July 2005.)