A randomized controlled trial of acupuncture added to usual treatment for fibromyalgia

Fibromyalgia is a complex condition affecting approximately 2.5% of the Brazilian population, characterized by widespread muscular pain, chronic fatigue, and specific tender points throughout the body. This syndrome significantly impacts patients' quality of life, frequently leading to limitations in daily activities, sleep disturbances, anxiety, and depression. Although conventional treatment primarily involves antidepressant medications and physical exercise, many patients continue to experience persistent symptoms, which has motivated the search for complementary therapies such as acupuncture.

The present Brazilian study aimed to investigate whether the addition of acupuncture to conventional fibromyalgia treatment could provide additional benefits to patients. Researchers from the University of São Paulo conducted a randomized controlled clinical trial involving 58 women diagnosed with fibromyalgia according to rigorous criteria. Participants were randomly divided into two groups: one received acupuncture along with standard treatment, while the other received standard treatment only. Standard treatment consisted of tricyclic antidepressant medications, regular walking, and relaxation exercises.

The acupuncture group received 20 treatment sessions, performed twice a week by an experienced clinician, using specific points from traditional Chinese medicine. Patient follow-up was exceptionally long, extending two years after treatment.

Results demonstrated significant benefits of acupuncture, especially in the first months after treatment. Three months after the end of acupuncture sessions, patients who received this additional therapy showed substantial pain reduction, going from a mean intensity of 8 to 5 on a 10-point scale. In addition, these patients showed decreased numbers of tender points throughout the body and increased pain threshold, indicating greater pressure tolerance at traditionally sensitive sites. Quality of life also improved in multiple aspects, including physical functioning, vitality, mental health, and limitations related to emotional problems.

At six months, some benefits still persisted, particularly regarding tender points and pain threshold, although the improvement in pain intensity had diminished. It is important to emphasize that patients who received acupuncture maintained improvements compared to their initial pain levels even after two years, demonstrating durable benefits relative to the pre-treatment state.

For patients with fibromyalgia and healthcare professionals, these findings suggest that acupuncture can be a valuable addition to the therapeutic arsenal, especially when integrated with conventional treatment. The therapy proved safe, with only two cases of temporary hand swelling, and was very well tolerated by patients, with 97% completing all scheduled sessions. The results indicate that acupuncture can provide significant pain relief and improvement in quality of life, particularly in the first months after treatment. For professionals, the study reinforces the importance of a multimodal approach in fibromyalgia treatment, where different therapies work synergistically to provide better outcomes than when used in isolation.

However, it is essential to recognize the limitations of this study. Patients knew which treatment they were receiving, which may have influenced their perceptions of improvement. In addition, those who received acupuncture had more contact with healthcare professionals, which by itself may have contributed to the observed benefits. The study used fixed acupuncture points in all patients, while in clinical practice treatment is often individualized.

Researchers also relied on patients' reports of adherence to exercise and medications, without objective verification. Despite being the first such study conducted in a developing country and with long-term follow-up, the significant benefits of acupuncture were observed primarily in the short term. This suggests that booster sessions may be necessary to maintain beneficial effects over time. The results encourage both patients and professionals to consider acupuncture as part of a comprehensive treatment plan for fibromyalgia, especially considering its favorable safety profile and demonstrated benefits for pain and quality of life.