"We saw benefit from acupuncture in a variety of symptoms of FM, including anxiety, fatigue, and pain in patients who had already tried a variety of interventions," lead researcher David P. Martin, MD, PhD, an anesthesiologist at the Mayo Clinic's division of pain medicine in Rochester, Minnesota, tells CIAOMed.
The new study followed 50 patients who were randomly assigned to receive acupuncture or simulated acupuncture in six sessions spanning 2 to 3 weeks. Patients were given questionnaires before treatment, immediately after treatment, and at 1 and 7 months posttreatment to determine the degree of symptoms they experienced and how the disease affected their daily lives.
Following the brief treatments, symptoms of pain, fatigue, and anxiety were shown to be significantly improved in the patients given acupuncture, with the largest benefit in fatigue and anxiety, according to Dr. Martin. Still, acupuncture "is not a cure," he tells CIAOMed. "In our study, the maximum benefit was achieved at 1 month, and patients' symptoms went back to baseline by 7 months."
According to Dr. Martin, acupuncture may be worthwhile in FM patients who have tried various treatments for the syndrome without relief or those who find the side effects of the medications intolerable. "[Acupuncture] should be offered to patients who are open to complementary techniques and who are looking for an option without side effects," he says.
Exactly how acupuncture relieves the pain and symptoms of FM is not fully understood, but Western physicians believe the treatment modulates sensory input. "Whenever there's an input to the nervous system, it responds and adapts to the input—sometimes in ways that are beneficial to patients, Dr. Martin says. "This is not so different from the traditional Eastern explanation of acupuncture, which describes needles as altering the flow of life energy, or qi."
Differences in two studies account for conflicting outcomes
A study in the July 5, 2005, issue of the Annals of Internal Medicine2 reported that acupuncture was no more effective than sham acupuncture at relieving pain in persons with FM. In this study from the Group Health Cooperative Center for Health Studies and the University of Washington, Seattle, 100 patients with FM received twice-weekly acupuncture treatment for 12 weeks, or one of three sham acupuncture treatments. Other FM therapies were permitted, so acupuncture was considered an adjunctive treatment in this study. The primary outcome of subjective pain was measured by a 10-cm visual analogue scale ranging from 0 (no pain) to 10 (worst pain ever), with measurements obtained at baseline and at 1, 4, 8, and 12 weeks of treatment, as well as 3 and 6 months posttreatment.
The mean subjective pain rating among patients who received acupuncture for FM did not differ from that in the pooled sham acupuncture group, the researchers report.
Yet there are significant differences between the University of Washington study and the Mayo study. For one, the former studied "all comers" in the community who had FM, whereas the Mayo study was more restricted. "Our patients were drawn from the Mayo fibromyalgia treatment program, and so may have been more homogenous and possibly more severely affected," Dr. Martin says.
Secondly, the University of Washington study was done at multiple sites by eight different acupuncturists, whereas the Mayo study was done at one site by two acupuncturists. "This may have reduced the variability in our results," Dr. Martin notes. In addition, the University of Washington study looked primarily at pain, and used different tools to measure pain. "[The University of Washington study's] ‘quality of life' measurement, the SF-36, is not designed specifically for patients with fibromyalgia," explains Dr. Martin. "[The Mayo study] looked at all symptoms of fibromyalgia with a disease-specific, validated measurement tool, the Fibromyalgia Impact Questionnaire."
Lastly, the treatment durations varied. The University of Washington study provided 24 treatments over 12 weeks; the Mayo study "performed 6 treatments over 2 to 3 weeks," Dr. Martin points out, adding that "when it comes to acupuncture, more may not be better. In our experience, patients become sore at the acupuncture points over time, and so more acupuncture may increase FM pain after a point."
Regarding the efficacy of acupuncture for FM, the jury is still out, Dr. Martin concludes. "There are a lot of questions to be answered. We need more research with larger groups of patients to find out who benefits and for how long."
References
1. Acupuncture relieves symptoms of fibromyalgia [press release]. The International Association for the Study of Pain 11th World Congress on Pain; August 21–26, 2005; Sydney, Australia.
2. Assefi NP, Sherman KJ, Jacobsen C, et al. A randomized clinical trial of acupuncture compared with sham acupuncture in fibromyalgia. Ann Intern Med. 2005;143:10-19.