ROCHESTER, Minn–Acupuncture can help relieve the symptoms of fibromyalgia, according to a study published in the June issue of the Mayo Clinic Proceedings.1
"The full spectrum of symptoms of fibromyalgia is improved with acupuncture, and acupuncture may be a reasonable thing to recommend for patients, particularly those who have intolerable side effects from drugs," lead researcher David P. Martin, MD, PhD, an assistant professor of anesthesiology at the Mayo Clinic in Rochester, Minnesota, told CIAOMed.
Blinding has been a problem in studies of acupuncture, and the Mayo Clinic researchers used a novel approach to achieve it. Patients were positioned in a sitting position with a screen placed so that they could not see the needles. A standard set of acupuncture points were used for all patients.
"We picked strong regulatory points that commonly recur in the acupuncture literature. Specifically, we used bilateral points at large intestine 4, stomach 36, liver 2, spleen 6, pericardium 6, and heart 7. We also used axial paramedian points along the bladder meridian at the cervical spine during the first three sessions and at the lumbar spine during the last three sessions," Dr. Martin writes. Both actual and sham treatments totaled 18 needles during the first three sessions and 20 needles during the final three sessions.
For both actual and acupuncture, at each point, the skin was wiped with alcohol, and an adhesive bandage was placed over the point. The needle was inserted through the bandage to the acupuncture point (into the muscle) for patients randomized to true acupuncture. For those randomized to sham acupuncture, "the skin was indented with a dull surgical instrument, and a small circular adhesive bandage was applied that had previously been rigged with an acupuncture needle such that the needle handle stuck out of the bandage but did not pierce the skin. Instead, the needle was bent to form a tripod so that it was supported on the skin surface and appeared as if it were anchored within the skin. Patients in the control group felt the wipe with alcohol, a mild pricking sensation, and placement of an adhesive bandage," Dr. Martin writes.
Electrical stimulation was applied at 2 Hz to the same sites in both groups. "Even though the lights flashed on the pulse generator, the resistance of the skin [in the sham acupuncture group] prevented any perceptible current flow," Dr. Martin said. He noted that In preliminary trials, volunteers could not tell the difference between the two procedures.
Researchers measured symptoms via the Fibromyalgia Impact Questionnaire (FIQ) and the Multidimensional Pain Inventory at baseline, immediately after treatment, and at 1 month and 7 months after treatment.
Patients in the acupuncture group showed the greatest improvements in anxiety and fatigue, the study showed. True acupuncture reduced FIQ scores by seven points, with the largest difference in mean FIQ scores at 1 month (42.2 versus 34.8 in the control and acupuncture groups, respectively).
"The FIQ looks at all the symptoms and when we went to tease out the most significant [symptoms affected], we saw that they were fatigue and anxiety," Dr. Martin said.
Patients receiving acupuncture did not report an increased level of activity or physical functioning, however study authors point out that this was not a predesigned endpoint nor did they encourage participants to change behaviors.
All study patients had previously participated in the Mayo Fibromyalgia Treatment Program, which comprises traditional medical, educational, self-management, and occupational/physical therapy components. The improvements found in the new study were additive to those achieved by this program, which also decreased FIQ by seven points, the authors write.
The magnitude of clinical benefit produced by acupuncture is similar to that reported with pharmacological interventions such as tricyclic antidepressants, fluoxetine, tramadol, and acetaminophen, the researchers report.
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