Efficacy of Acupuncture, Intravenous Lidocaine, and Diet in the Management of Patients with Fibromyalgia: A Systematic Review and Network Meta-Analysis

Fibromyalgia is a complex medical condition that affects millions of people worldwide and is characterized by chronic, widespread musculoskeletal pain accompanied by a range of debilitating symptoms. Patients with fibromyalgia frequently experience specific tender points, cognitive disturbances, sleep problems, psychiatric symptoms, and multiple somatic complaints that significantly impact their quality of life. The condition can severely compromise functional capacity, hindering daily activities and the ability to work. Recent studies indicate that fibromyalgia is associated with higher risks of suicidal ideation and suicide attempts, making the investigation of effective therapeutic options critical.

Although there is promising evidence regarding different treatment approaches, including acupuncture, intravenous lidocaine, and dietary interventions, there remains a significant gap in the scientific literature on the comparative efficacy of these interventions.

This study performed a systematic review and network meta-analysis to evaluate and compare the efficacy of acupuncture, intravenous lidocaine, and diet against other treatments such as physical therapy and placebo in patients with fibromyalgia. The methodology rigorously followed PRISMA guidelines and included a systematic search of four major medical databases — Embase, PubMed, Scopus, and Web of Science — through September 2021. The investigators used comprehensive search terms related to fibromyalgia, acupuncture, diet, and lidocaine. Only randomized controlled trials were included in the analysis, ensuring the scientific quality of the data.

Data extraction was performed by multiple independent researchers, and study quality was assessed using the Cochrane risk-of-bias tool. Statistical analysis was conducted using R software, with results expressed as standardized mean difference and 95% confidence intervals.

The analysis included 23 randomized controlled trials with a total of 1,409 patients, most of them women. The results demonstrated that acupuncture offered superior benefits across multiple dimensions of fibromyalgia. For quality of life — the study's primary outcome — acupuncture showed the largest significant improvement compared with placebo, followed by physical therapy, which also demonstrated significant improvement. Other interventions such as fluoxetine, weight reduction, nutraceuticals, soy, and lidocaine did not show significant differences from placebo for quality of life.

For pain control, only acupuncture demonstrated a significant reduction compared with placebo, while other approaches such as the IGUBAC diet, olive-based dietary supplements, transcutaneous electrical stimulation, cupping, physical therapy, fluoxetine, nutraceuticals, and lidocaine did not show significant differences. For depression, acupuncture was again superior, showing significant reduction of depressive symptoms compared with placebo, while physical therapy and weight reduction did not show significant differences. For muscle stiffness, none of the interventions evaluated — including acupuncture, fluoxetine, and physical therapy — demonstrated significant differences from placebo.

The clinical implications of these results are substantial for patients and healthcare professionals. Acupuncture emerges as a preferred therapeutic option for managing fibromyalgia, offering multidimensional benefits including improvements in quality of life, reductions in pain, and relief of depressive symptoms. These findings are particularly relevant given that many patients with fibromyalgia are refractory to conventional treatments or experience intolerable adverse effects with traditional oral medications. The analgesic mechanisms of acupuncture involve activation of peripheral and central pain-control systems through the release of endogenous compounds such as beta-endorphins, enkephalins, dynorphins, serotonin, and norepinephrine.

Physical therapy also demonstrated therapeutic value, specifically for improving quality of life, suggesting it can be a valuable complementary intervention. Contrary to expectations, intravenous lidocaine did not demonstrate significant benefits, despite earlier pilot studies suggesting promising results. Similarly, dietary interventions did not show significant efficacy, in contrast to some prior evidence suggesting benefits from nutritional modifications.

The study has several important limitations that should be considered when interpreting the results. Most of the included studies had relatively small sample sizes, which may limit the generalizability of the findings. There is heterogeneity in the diagnostic criteria used for fibromyalgia across studies, even when the American College of Rheumatology criteria were employed. The acupuncture studies included varied significantly in terms of acupuncture types, points used, and number of sessions, making it difficult to define optimal protocols.

Some studies used different time points for assessment, and the heterogeneity found in the analyses could not be fully resolved through sensitivity analyses. In addition, few studies specifically investigated the effects of diet and lidocaine, limiting conclusions about those interventions. The authors recommend that future studies focus on more rigorously evaluating the effects of diet and lidocaine in patients with fibromyalgia, use comparable assessment time points and consistent disease-specific scales for each outcome, and include larger sample sizes to increase statistical power and the reliability of the findings.