Partially randomized patient preference trial: Comparative evaluation of fibromyalgia between acupuncture and cupping therapy (PRPP-FACT)

Treating fibromyalgia has been a constant challenge for patients and physicians around the world. This chronic condition causes widespread muscle pain and significantly affects quality of life. Although different therapeutic approaches are available, pharmacological options do not always provide adequate relief and may cause unwanted side effects. As a result, many patients seek alternatives such as acupuncture and cupping therapy, traditional Chinese treatments that have shown promising results for pain relief.

However, an important problem arises when researchers try to scientifically study these therapies: how can different treatments be compared when patients have specific preferences for one technique or another?

To address this question, Chinese researchers developed an innovative study using a method called "partially randomized patient preference trial." This design allows some participants to choose their preferred treatment, while others are randomly assigned to treatment groups. The main objective was to determine whether this method is suitable for evaluating non-pharmacological therapies of traditional Chinese medicine, specifically comparing acupuncture with cupping therapy for the treatment of fibromyalgia. The study was conducted over four years, from 2013 to 2017, in two hospitals in Beijing, recruiting 126 participants diagnosed with fibromyalgia according to established medical criteria.

The methodology divided participants into four distinct groups. Sixty individuals who did not show a specific preference for either treatment were randomly assigned to acupuncture or cupping therapy, with 30 in each group. The remaining 66 participants, who had clear preferences, were directed to the treatment of their choice: 39 preferred acupuncture and 27 chose cupping therapy. Both treatments used specific points called "Ashi," which are tender areas identified during physical examination.

In acupuncture, needles were inserted at these points and retained for 30 minutes. In cupping therapy, suction cups were applied to the same areas for 10 minutes, using different techniques such as fixed, moving, and flash cupping. Treatments occurred three times per week for five weeks, totaling 15 sessions for each participant.

The results revealed important aspects regarding both the efficacy of the treatments and the feasibility of the research method. Both therapies demonstrated significant benefits for patients with fibromyalgia. Pain intensity, measured by a visual analog scale from 0 to 100 points, decreased on average by 25 to 40 points in all groups, representing a clinically significant improvement. Other aspects also improved substantially, including quality of life, depressive symptoms, and patients' functional capacity.

Importantly, there were no statistically significant differences between acupuncture and cupping therapy, suggesting that both treatments are equally effective for fibromyalgia. As for the research method, the study showed that participants who chose their treatments did not present different dropout rates, expectations, or satisfaction compared to those who were randomly assigned.

For patients suffering from fibromyalgia, these results bring hope and valuable practical information. The finding that both acupuncture and cupping therapy provide significant pain relief offers complementary treatment options to conventional approaches. Since there were no significant differences between the two treatments, patients can choose based on personal preferences, local availability, or individual tolerability. For health professionals, the study scientifically validates these long-standing practices, providing evidence that may guide clinical recommendations.

The absence of serious adverse effects reported during treatment also reinforces the safety profile of these therapies when applied appropriately by qualified professionals.

The study also has important methodological implications for research in complementary medicine. The partially randomized trial method proved feasible, allowing patients with specific preferences to participate in research without compromising the scientific quality of the results. Interestingly, participants who were able to choose their treatments were recruited eight months faster than those randomly assigned, suggesting that this method may accelerate the conduct of future research. This is particularly relevant for studies of complementary therapies, where patient preferences are often an obstacle to recruitment.

However, some limitations should be considered. The study was conducted only in China, in a cultural context where these practices are widely accepted, which may limit the generalization of the results to other populations. Additionally, the evaluation focused only on the immediate effects of the treatments, without following participants long-term to verify the durability of the benefits. The inability to conduct a blinded study—where neither patients nor researchers know which treatment is being applied—also represents a limitation inherent to research with physical therapies such as acupuncture and cupping therapy.

In summary, this study offers encouraging evidence that both acupuncture and cupping therapy can be effective therapeutic options for people with fibromyalgia, providing pain relief and improvement in quality of life. The equivalence between treatments allows the choice to be based on individual preferences and availability. For the research field, it demonstrates that innovative methods can overcome traditional challenges in studying complementary therapies, paving the way for future investigations that are more inclusive and representative of patients' real preferences.