Acupuncture for fibromyalgia syndrome: an overview of systematic reviews and meta-analyses

Fibromyalgia is a complex medical condition that primarily affects women, characterized by chronic widespread pain, muscle stiffness, and other symptoms such as fatigue, sleep disturbances, anxiety, and depression. Although it affects 2 to 4% of the population, its exact causes are not yet fully understood. Conventional treatments include antidepressants and analgesics, but many patients seek alternatives because of the side effects of traditional medications. In this context, acupuncture has gained attention as a promising therapeutic option, prompting researchers to scientifically investigate its efficacy.

This study aimed to evaluate the methodological quality and strength of the available evidence on the use of acupuncture in the treatment of fibromyalgia. To this end, the investigators conducted a comprehensive review of the scientific literature, searching 11 international databases for all systematic reviews and meta-analyses published through May 2025. They applied rigorous selection criteria, including only studies that analyzed randomized controlled trials of acupuncture in patients with fibromyalgia diagnosed by established medical criteria. Methodological quality was assessed using specific tools such as AMSTAR-2, PRISMA 2020, and GRADE, which are internationally recognized instruments for evaluating the reliability of systematic reviews.

The analysis included 13 systematic reviews and meta-analyses published between 2007 and 2022, which examined a total of 45 primary studies involving hundreds of patients. The results showed that acupuncture demonstrated superiority compared with both sham acupuncture and conventional pharmacologic treatments. Specifically, acupuncture was more effective than sham acupuncture in reducing pain, with a mean difference of 1.04 points on the visual analog scale. When compared with conventional medications, the difference was even greater, reaching 1.77 points.

Beyond pain relief, acupuncture showed significant benefits in reducing fatigue, improving sleep, decreasing the number of tender points, and increasing the pressure-pain threshold. Importantly, no serious adverse events were reported — only mild reactions such as small bruises or discomfort at the needling site.

For patients with fibromyalgia and clinicians, these findings suggest that acupuncture can be considered a valid and safe therapeutic option. The observed benefits include not only pain reduction, the most limiting symptom of the condition, but also improvements in other important aspects of quality of life, such as fatigue and sleep. Treatment safety is another relevant aspect, especially considering that many traditional medications can cause significant side effects. For clinicians, the results indicate that acupuncture can be integrated into multidisciplinary treatment plans, offering a complementary approach that may reduce dependence on medications.

However, it is important that treatment be delivered by qualified, experienced clinicians.

Despite the promising results, the study identified important limitations that should be considered when interpreting the findings. The methodological quality of the reviews analyzed varied considerably, with only one classified as high quality and eight as low or critically low quality. Most primary studies had methodological problems such as inadequate blinding, insufficient description of randomization methods, and possible publication bias. In addition, there was substantial variability among studies in the types of acupuncture used, application points, treatment frequency, and comparison criteria.

The certainty of evidence, evaluated by the GRADE system, was rated as moderate to very low across most outcomes. These limitations indicate that, although the results are encouraging, more methodologically high-quality studies are needed to definitively establish the efficacy of acupuncture in fibromyalgia and guide more robust clinical recommendations.