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Three Part Question

In [adults with Fibromyalgia] does [acupuncture] have an effect on [reducing pain].

Clinical Scenario

A 42-year-old female with a diagnosis of fibromyalgia is assessed by a physiotherapist in an out-patient department. The patient is presenting with widespread pain, which is impairing her function. You wonder whether acupuncture is an effective treatment to use with your patient to decrease pain.

Search Strategy

MEDLINE 1946-06/16, EMBASE 1974-06/16.

[Exp. Acupuncture] and [Exp. Fibromyalgia].

Search Outcome

Five hundred and fifty-six articles were retrieved. One Cochrane review has been included with completed search up to 2012. Subsequent publications were included as five additional papers

Relevant Paper(s)

Author, date and country	Patient group	Study type (level of evidence)	Outcomes	Key results	Study Weaknesses
Deare et al 2013	Systematic Cochrane review	Systematic review of randomised and quasi-randomised studies evaluating any type of invasive acupuncture for fibromyalgia	FOR PAIN Acupuncture versus non-acupuncture treatment Acupuncture versus placebo or sham acupuncture Acupuncture versus medication Acupuncture as an adjunct therapy Deep needling with stimulation (T/S) versus deep needling without stimulation	Favours acupuncture (N=13) No significant difference (N=286) Favours acupuncture (N=38) Favours acupuncture as an adjunct (N=58) No significant difference (N=41)	Extensive search of many databases including Chinese. No language restrictions
Casanueva et al 2014 Spain	120 patients with fibromyalgia	Open-label randomised controlled trial (RCT): six sessions of weekly dry needling, 1 h per week+standard treatment (N=60) versus Standard treatment (N=60)	Visual analogue score for pain post-treatment	Dry needling 6.5 (2.1) Standard care 8.0 (1.3) p=0.002	Multiple outcomes assessed Open label
Collazo et al 2014 Spain	99 patients with fibromyalgia	RCT Acupuncture versus moxibustion versus scalp acupuncture	Pain Scale	Pain scale showed the most improvement by 6 months in the scalp acupuncture group	This is a report from the abstract. It was not possible to source the paper No details given on the type of pain scale, the outcome data or statistical comparisons
Khabbazi et al 2014 Iran	90 patients with fibromyalgia	RCT: Acupuncture versus acupuncture+fluoxetine versus fluoxetine	Fibromyalgia Impact Questionnaire	Total number of symptoms were lowest in the acupuncture and the acupuncture+fluoxetine groups (p<0.0001)	Did not measure pain alone as an outcome Conference abstract only
Stival et al 2014 Brazil	36 patients with fibromyalgia from a rheumatology clinic	RCT: Acupuncture versus sham acupuncture	Mean change in visual analogue scale for pain (0–10) from before to after one session of treatment	Acupuncture −1.70±1.55 Sham −4.36±3.23	Small sample
Dias et al 2016 Brazil	30 women with fibromyalgia from a pain clinic	Open-label RCT: Randomised to acupuncture versus electroacupuncture versus moxibustion	Wong-Baker Faces Pain Scale Number of tender points with pain-pressure threshold <4 kg/cm2	No difference between modalities in either outcomes	Small sample size No placebo or sham therapy

Clinical Bottom Line

Acupuncture may reduce pain in fibromyalgia syndrome. Most studies do not report on long-term pain outcomes and there are no large-scale studies.

References

1. Deare JC , Zheng Z , Xue CCL , et al . Acupuncture for treating fibromyalgia. Cochrane Database Syst Rev 2013:(5):Art. No.: CD007070.
2. Casanueva B , Rivas P , Rodero B , et al . Short-term improvement following dry needle stimulation of tender points in fibromyalgia. Rheumatol Int 2014;34:861–6.
3. Collazo E , Munoz R , Aragones MA , et al . A Randomized prospective study to assess the effectiveness of several therapeutic procedures of traditional Chinese medicine in alleviation of pain and improvement in the standard of living in patien ts with fibromyalgia.Revista Internacional de Acupuntura 2014:8:21–128.
4. Khabbazi A , Kolahi S , Tabatabaee M , et al . Acupuncture and fluoxetine versus fluoxetine in fibromyalgia. Conference: 16th Asia Pacific League of Associations for Rheumatology Congress Cebu City Philippines . Conference Publication International Journal of Rheumatic Diseases. 2014;17:115.
5. Stival RS , Cavalheiroa PR , Stasiaka CE , et al . [Acupuncture in fibromyalgia: a randomized, controlled study addressing the immediate pain response] Rev Bras Reumatol 2014;54:431–6.
6. Dias PA , Guimarães AB , Albuquerque Ade O , et al . Short-term complementary and alternative medicine on quality of life in women with fibromyalgia. J Integr Med 2016;4:29–35.