Australian researchers wanted to know whether acupuncture is effective for alleviating the symptoms of fibromyalgia, a common painful condition for which no universally accepted treatment exists. For this purpose, they conducted a Cochrane review. After extensive literature searches, they identified 9 RCTs, extracted their data and assessed risk of bias.
The results show that all studies except one were at low risk of selection bias; five were at risk of selective reporting bias; two were subject to attrition bias (favouring acupuncture); three were subject to performance bias (favouring acupuncture) and one to detection bias (favouring acupuncture).
Three studies utilised electro-acupuncture (EA) and the remainder manual acupuncture (MA) without electrical stimulation.
Low quality evidence from one study (13 participants) showed EA improved symptoms with no adverse events at one month following treatment.
Moderate quality evidence from six studies (286 participants) indicated that acupuncture (EA or MA) was no better than sham acupuncture, except for less stiffness at one month. Subgroup analysis of two studies (104 participants) indicated benefits of EA. Mean pain was 70 points on 0 to 100 point scale with sham treatment; EA reduced pain by 13% (5% to 22%).
Low-quality evidence from one study suggested that MA resulted in poorer physical function: mean function in the sham group was 28 points (100 point scale); treatment worsened function by a mean of 6 points.
Moderate quality evidence from one study (58 participants) found that, compared with standard therapy alone (antidepressants and exercise), adjunct acupuncture therapy reduced pain at one month after treatment.
Low quality evidence from one study (38 participants) showed a short-term benefit of acupuncture over antidepressants in pain relief.
Moderate-quality evidence from one study (41 participants) indicated that deep needling with or without deqi did not differ in pain, fatigue, function or adverse events.
Four studies reported no differences between acupuncture and control or other treatments described at six to seven months follow-up.
No serious adverse events were reported, but there were insufficient adverse events to be certain of the risks.
The authors draw the following conclusions: There is low to moderate-level evidence that compared with no treatment and standard therapy, acupuncture improves pain and stiffness in people with fibromyalgia. There is moderate-level evidence that the effect of acupuncture does not differ from sham acupuncture in reducing pain or fatigue, or improving sleep or global well-being. EA is probably better than MA for pain and stiffness reduction and improvement of global well-being, sleep and fatigue. The effect lasts up to one month, but is not maintained at six months follow-up. MA probably does not improve pain or physical functioning. Acupuncture appears safe. People with fibromyalgia may consider using EA alone or with exercise and medication. The small sample size, scarcity of studies for each comparison, lack of an ideal sham acupuncture weaken the level of evidence and its clinical implications. Larger studies are warranted.
What does all that mean? In my view, it means that there is no sound evidence base for acupuncture as a treatment of fibromyalgia – or as we expressed it in our own systematic review of 2007: The notion that acupuncture is an effective symptomatic treatment for fibromyaligia is not supported by the results from rigorous clinical trials. On the basis of this evidence, acupuncture cannot be recommended for fibromyalgia.
9 Responses to No sound evidence-base for acupuncture as a treatment of fibromyalgia
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I’ve continue to cut down my acupuncture practice and am looking forward to getting out of the field altogether. I’m not accepting new patients. A few of my remaining patients are fibromyalgia sufferers who report significant relief from my treatments. I’ve also grown close to them and spend quite a bit of time talking, particularly about stresses in their lives. One has told me that I know more about her than anyone else, and the other has said she will not let me quit doing acupuncture. Given that my services cost less than counseling, involve some massage or electroacupuncture, and have these happy customers, what would you recommend? Referring them to another acupuncturist isn’t a good idea if the reason I’m quitting is that acupuncture doesn’t work (especially if that acupuncturist promotes other woo). If I tell them that the best evidence shows acupuncture is no better than fake acupuncture for fibromyalgia but they still choose to get acupuncture, is it then ethical for me to accept money for doing acupuncture?
S.A.: What you are describing is exactly what makes CAM tick. TLC is the abbreviation for what we call this kind of healthcare. It means “Tender, loving Care” and is the core element in treating worries, stress and anxiety, which are incidentally the main elements in those conditions where CAM shows promising effects.
Ample time with the patient, caring body contact, listening patiently, reassurance that you both know exactly what the problem is and last but not least having not only one effective cure but sometimes many…
Oh I just wish we doctors had such powerful tools for every patient all the time!
I am sorry.
An inadvertent extra word in line 4 in my reply to Skeptical Acupuncturist.
…that you both know exactly… should read: …that you know exactly…
Your” notion that acupuncture is an effective symptomatic treatment for fibromyaligia is not supported by the results from rigorous clinical trials.” made you conclude that “acupuncture cannot be recommended for fibromyalgia.”
The evidence they examined (note that they found some moderate level evidence) though does not EXCLUDE the possibility that this therapy might be even moderately beneficial and they think that more research is needed.
I think that their view is more rational than yours. IF there is some moderate level good evidence shown that this therapy might work then it is worth looking into it. I thought this is the way science works.
I could easily use Tooth Fairy Science to startup a business offering therapies that do indeed provide benefits to some of the incurably chronically ill and I’m perfectly capable of accurately recording statistics that would pass independent auditing.
Using your definition of rational, my therapies would be worth looking into; many might say “In dire need of further research.”
However, I know the importance of a high-fibre diet: moral fibre is essential for human health. Selling overpriced placebos does not cure fibromyalgia — an agonising illness.
Why don’t you try to publish your research about Tooth Fairy Science? Since you can easily produce the necessary data and convince all the people who work in the field that you are correct……
Wow…! I did not know it was so easy to produce positive results and fool all the scientific committees who studied and practice for decades to develop tools to accurately measure and evaluate evidence. Please let us know how you do it, so we can start a business.
Seriously, now this is not MY definition of rationality. This is logic – which is only one in the last 100 years and it is used in pure and applied mathematics.
Since the researchers found – using sophisticated tools – some moderate good evidence, it is rational to say that more research in needed.
Saying that you are convinced that is all placebo – is indeed less rational and shows that you are preoccupied – not a very good thing for research because that makes you susceptible to bias —-according to any good scientist.
After long contemplation, much reading, and talking with a counselor about my disenchantment with acupuncture, I’ve officially announced a complete sabbatical for “at least 6 to 9 months” and am kindly dismissing my patients with appropriate referrals (mainly encouraging them to consult a compassionate MD in prioritizing their health goals). I’m so excited to think that in a couple weeks I won’t be doing acupuncture any more. Wrestling with the cognitive dissonance of my increased recognition that acupuncture is a fancy placebo and my awareness that my patients have other beliefs and expectations for acupuncture services has grown both tiring and scary (due to ethical implications). Thanks, Edzard and crew, for continuing to write reasonable, well-documented investigations into these matters. Your books and blogs have been instrumental in helping me adapt my beliefs to a more scientifically sound and ethical reality.
Ex-acupuncturist
Thank you for your comment, I can’t tell you how cheered I am by it. I understand how hard it is for people who’ve invested so much in becoming practitioners of various sorts, to meet the challenge of science-based critiques of what they do and when the usual response is defensiveness and insults, I tend to dismiss them as people without the necessary critical thinking skills to be able to look at what they do objectively.
Thank for proving me wrong. I know you’re not the only one.