Acupuncture in adolescents with juvenile fibromyalgia

Juvenile fibromyalgia is a chronic pain syndrome that primarily affects female adolescents, characterized by diffuse musculoskeletal pain and specific tender points on palpation. This condition, whose cause is not yet completely understood, affects between 1.2% and 6.2% of children and adolescents, causing significant impact on the quality of life of young patients and their families. Treatment traditionally involves physical exercise, medications such as analgesics and antidepressants, psychotherapy, and physiatric measures. However, many patients have difficulty adhering to conventional treatment, especially physical exercise, which is fundamental in managing the condition.

It is in this context that acupuncture, a modality of traditional Chinese medicine, emerges as a promising therapeutic alternative, although its application in pediatric patients with fibromyalgia is still poorly studied.

This retrospective study was conducted at the Instituto da Criança of the Hospital das Clínicas of USP with the objective of evaluating the use of acupuncture in adolescents with juvenile fibromyalgia. Over eight consecutive years, the researchers followed 38 patients between 10 and 18 years of age with a diagnosis of juvenile fibromyalgia, following the criteria established by the American College of Rheumatology. Of these, only 13 patients had complete data in the medical records and acupuncture charts and were included in the final analysis. The remainder were excluded due to incomplete data, relocation to other states, or follow-up difficulties.

Each patient received at least 11 weekly acupuncture sessions, performed by three experienced acupuncturists. The treatment used 14 specific points, eight ventral and six dorsal, applied alternately each week. Pre- and post-treatment evaluations included demographic data, pain characteristics, number of tender points, visual analog pain scale, and algometry to calculate the myalgic index. During the study, patients were allowed to use analgesics when needed and were instructed to engage in aerobic physical activity.

The results demonstrated significant benefits of acupuncture in the treatment of juvenile fibromyalgia. Among the 13 patients evaluated, seven showed improvement in the three main parameters analyzed: number of tender points, visual analog pain scale, and myalgic index. The median number of tender points decreased significantly from 14 to 10, while the pain scale was reduced from 6 to 3 points. The myalgic index, which measures pain tolerance, increased significantly from 3.4 to 4.2, indicating lower pain sensitivity.

In addition, associated symptoms such as headache and fatigue also showed statistically significant improvement. After treatment, two patients were completely pain-free, nine had localized pain instead of the initial diffuse pain, and only two maintained diffuse pain. The change from generalized to localized pain represents important progress in the clinical picture of these young patients.

The clinical implications of these findings are relevant both for patients and for healthcare professionals. For adolescents with fibromyalgia and their families, acupuncture represents a safe and well-tolerated therapeutic option that can be combined with conventional treatments. None of the patients experienced significant adverse events during the study, demonstrating the favorable safety profile of this therapeutic modality in the pediatric population. The good adherence observed is particularly important, considering that many young people with fibromyalgia have difficulty maintaining the regular practice of physical exercise, which is the evidence-based first-line treatment.

For healthcare professionals, especially pediatricians and pediatric rheumatologists, the study provides preliminary evidence that acupuncture may be a useful tool in the multidisciplinary therapeutic arsenal for juvenile fibromyalgia. The significant reduction in pain and associated symptoms suggests that this modality may contribute to improving patients' quality of life and reducing the impact of the disease on the school and social functioning of adolescents.

The study has important limitations that must be considered when interpreting the results. It is a retrospective analysis with a small sample and many exclusions, which limits the generalizability of the findings. The absence of a control group precludes definitive conclusions about the specific efficacy of acupuncture compared with placebo or other treatments. In addition, adherence to other therapeutic modalities, such as physical exercise, was not systematically evaluated, nor was the health-related quality of life of patients and family members.

The relatively small number of acupuncture sessions (11 sessions) may have limited the therapeutic potential, since studies in adults suggest greater efficacy with 20 sessions or more. The authors themselves acknowledge these limitations and mention that a randomized controlled trial with a broader population was being conducted at three pediatric rheumatology centers in São Paulo. Despite these limitations, this pioneering work provides important preliminary evidence on the use of acupuncture in adolescents with fibromyalgia, paving the way for more robust investigations and contributing to the development of integrated therapeutic approaches that may improve clinical outcomes in this vulnerable population.