Acupuncture for treating fibromyalgia

This Cochrane systematic review analyzed nine studies involving 395 participants to evaluate the efficacy and safety of acupuncture in the treatment of fibromyalgia. Fibromyalgia is a condition characterized by widespread, chronic musculoskeletal pain accompanied by symptoms such as sleep disturbances, fatigue, stiffness, and mood changes, affecting more than 2% of the population, predominantly women. The included studies were conducted mainly in the United States (five studies), in addition to Switzerland, Brazil, Japan, and China. All participants were diagnosed according to the American College of Rheumatology (ACR) criteria for fibromyalgia.

The methodology included different comparisons: acupuncture versus no treatment, acupuncture versus sham/placebo acupuncture, acupuncture versus standard treatment, acupuncture as adjuvant therapy, and comparisons between different acupuncture styles. The studies used both manual acupuncture and electroacupuncture, with treatment duration ranging from 3 to 13 weeks and 6 to 28 sessions. The results showed low to moderate quality evidence that acupuncture, compared with no treatment or standard treatment, improves pain and stiffness in people with fibromyalgia. When compared with sham acupuncture, real acupuncture showed no significant differences for pain or fatigue in the overall analysis, but electroacupuncture demonstrated superior benefits to manual acupuncture.

Specifically, electroacupuncture showed a 13% reduction in pain (from 70 to 57 points on a 0-100 scale), an 11% improvement in global well-being, and improvements in sleep and fatigue. Manual acupuncture, in turn, did not demonstrate significant benefits for pain or physical function, and in one study showed worsening of physical function. As adjuvant therapy to standard treatment (antidepressants and exercise), acupuncture demonstrated a 30% reduction in pain. Compared with antidepressants alone, acupuncture showed a 17% reduction in pain.

The benefits of acupuncture persisted up to one month after treatment but were not maintained at six-month follow-up. Regarding safety, no serious adverse events were reported. Adverse events were mild and short-duration (less than one day), including localized edema. The adverse event rate was lower in the acupuncture group (16%) compared with the sham group (33%).

Limitations of the review include small sample sizes, scarcity of studies for each comparison, lack of an ideal sham control for acupuncture, and heterogeneity among studies. Clinical implications suggest that people with fibromyalgia may consider using electroacupuncture alone or in combination with exercise and medication. Electroacupuncture appears to be more effective than manual acupuncture for reducing pain and stiffness and improving global well-being, sleep, and fatigue.