MD, PhD, FMedSci, FRSB, FRCP, FRCPEd.

fibromyalgia

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.

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