By Michael Devitt

The National Institutes of Health estimates that between 3 percent and 6 percent of all Americans suffer from fibromyalgia.

A chronic disorder characterized by widespread musculoskeletal pain, fatigue, and tenderness in localized areas of the body called “tender points,” fibromyalgia primarily occurs in women, although it can strike people of both sexes and all ages. The pain associated with fibromyalgia often fluctuates in duration and intensity. At times, it can be quite mild; on other occasions, the pain can be so severe as to affect a person’s ability to carry out normal functions of daily living.

Just as fibromyalgia has no known cause, there is also no known cure. The medical management of fibromyalgia usually consists of a combination of approaches, including stress counseling, exercise, and a class of antidepressants known as tricyclics. These methods are considered only partially effective, however, and can sometimes cause side-effects, such as excessive drowsiness, weight gain and constipation.

One form of care being used increasingly to treat the symptoms associated with fibromyalgia is acupuncture, although the current evidence supporting acupuncture in the treatment of fibromyalgia appears mixed. The 1997 NIH Consensus Statement on Acupuncture, for example, cited fibromyalgia as one of dozens of conditions for which acupuncture could be “useful as an adjunct treatment or an acceptable alternative or be included in a comprehensive management program.”¹Â Studies published in 1998 and 2000^2,3 concluded that acupuncture could reduce pain levels and be effective in treating fibromyalgia, while a randomized clinical trial published in July 2005 suggested true acupuncture was no better than a sham treatment in relieving fibromyalgia pain.⁴

One of the most recent investigations into the effectiveness of acupuncture for fibromyalgia was presented at the 11th World Congress on Pain in Sydney, Australia in August, 2005.⁵ The trial, conducted by researchers at the Mayo Clinic, found that acupuncture provided significant improvements in a variety of symptoms associated with fibromyalgia, with the effects of care often lasting several months.

“This study shows there is something real about acupuncture and its effects on fibromyalgia,” said Dr. David Martin, the study’s lead investigator, in a news conference held during the congress. “Our study was performed on patients with moderate to severe fibromyalgia. It’s my speculation that if acupuncture works for these patients with recalcitrant fibromyalgia – where previous treatments had not provided satisfactory relief – it would likely work for many of the millions of fibromyalgia patients.”⁶

The study included 50 patients who met the American College of Rheumatology’s criteria for fibromyalgia, and who had tried other conservative treatments for relief, without success. The patients were then randomly assigned to receive either acupuncture or simulated acupuncture, but were not told which treatment they received. Acupuncture was administered for a total of six sessions over a two- to three-week period; simulated acupuncture was delivered during the same time frame.

Before the first treatment, immediately after the last treatment, and at one- and seven-month periods thereafter, patients filled out a series of questionnaires to determine the degree of symptoms they experienced, the effect fibromyalgia had on their daily lives, and the effects of acupuncture on relieving the condition.

According to the study authors, “Fibromyalgia symptoms were significantly improved in the acupuncture group as compared to the control group over the study benefit,” with the greatest improvement occurring at one month following the last treatment. While activity and physical function levels did not change between groups, significant benefits were seen in patients who received acupuncture when comparing questionnaire scores for pain, anxiety and fatigue.

“We expected the acupuncture to improve the pain,” Dr. Martin said. “We didn’t really expect the largest benefit to be in fatigue or anxiety.”

By seven months post-treatment, the symptoms of pain, anxiety and fatigue experienced by the acupuncture patients had returned to baseline levels. Martin indicated his belief that the patients given acupuncture would have seen sustained improvement in their symptoms had they continued to receive care.

“It’s a reasonable expectation that if they received more acupuncture after two to three months, they would have maintained their improvement,” he said. “Acupuncture usually works for about three months, and then patients need a less intensive treatment session. These patients would need more acupuncture periodically for as long as they experience fibromyalgia symptoms.”

Recognizing and treating fibromyalgia can be a challenge for both patients and health care providers. While acupuncture may not cure fibromyalgia, the researchers believe that at the very least, it can fill a gap in terms of the number of therapies that can help relieve the symptoms of the condition, either as a standalone form of care or as an adjunct to other therapies.

“There’s not a cure available, so patients are often left somewhat frustrated by continuing pain and fatigue,” Martin explained. “Acupuncture is one of the few things shown to be effective for these symptoms. It may be particularly attractive to patients who are unable to take medications because of intolerable side-effects.”

References

1. Acupuncture . National Institutes of Health Consensus Development Statement, Nov. 3-5, 1997. In press.
2. Sprott H, Franke S, Kluge H, et al. Pain treatment of fibromyalgia by acupuncture. Rheumatol Int 1998;18(1):35-6.
3. Berman BM, Swyers JP, Ezzo J. The evidence for acupuncture as a treatment for rheumatologic conditions. Rheum Dis Clin North Am Feb 2000;26(1):103-15, ix-x.
4. Assefi NP, Sherman KJ, Jacobsen C, et al. A randomized clinical trial of acupuncture compared with sham acupuncture in fibromyalgia. Ann Intern Med July 5, 2005;143(1):10-9.
5. Martin DP, Sletten CD, Williams BA, et al. Acupuncture Improves Symptoms of Fibromyalgia: A Randomized, Controlled Trial. Abstract #1260-P130. Presented at the 11th World Congress on Pain, Sydney, Australia, Aug. 25, 2005. Available from the International Association for the Study of Pain (http://iasp-pain.org; Tel: 206-547-6409).
6. Acupuncture relives symptoms of fibromyalgia. Newswise Medical News press release, Aug. 25, 2005. Available online at www.newswise.com/articles/view/513812.