Effects of Physiotherapy vs. Acupuncture in Quality of Life, Pain, Stiffness, Difficulty to Work and Depression of Women with Fibromyalgia: A Randomized Controlled Trial

Fibromyalgia is a chronic condition that affects millions of people, characterized primarily by widespread pain and muscle stiffness, frequently accompanied by fatigue, sleep disturbances, cognitive difficulties, and depression. This syndrome has a significant impact on patients' quality of life, generating limitations in daily activities, difficulties at work, and high personal, social, and health costs. The search for effective treatments that can improve symptoms and quality of life of these patients represents a priority in the medical field, especially considering that traditional pharmacologic approaches do not always provide complete symptom relief.

This scientific study aimed to compare the efficacy of two non-pharmacological treatments widely used in fibromyalgia management: a physiotherapy program based on core stabilization exercises (central trunk muscles) versus acupuncture treatment. The research was developed as a randomized, controlled clinical trial, considered the gold standard for evaluation of therapeutic efficacy. A total of 135 women diagnosed with fibromyalgia, recruited through patient associations in Spain, participated. Participants were randomly divided into three groups: 45 received physiotherapy with core exercises, 45 received acupuncture, and 45 formed the control group with no intervention.

Treatment lasted five weeks, with assessments performed before treatment, immediately after the end (sixth week), and after five weeks of follow-up (thirteenth week). The researchers used validated questionnaires to measure quality of life, pain, joint stiffness, difficulty to work, and depression.

The results showed trends of improvement in both treatment groups when compared with the control group, but these improvements did not reach statistical significance. In the physiotherapy group, there was a 7.11-point reduction on the quality-of-life questionnaire, while in the acupuncture group the reduction was 6.47 points. Both experimental groups showed decreases in levels of pain, stiffness, difficulty to work, and depression compared with the control group. Notably, these benefits were maintained during the five-week follow-up period after the end of treatments.

The control group did not show significant changes in any of the measures evaluated throughout the study, confirming that the improvements observed in the treatment groups were not due to natural fluctuations in the condition.

For patients with fibromyalgia and health professionals, these findings have important practical implications. Although the improvements were not statistically significant, the maintenance of symptoms at stable levels and the slight tendency of improvement suggest that both core-based physiotherapy and acupuncture may be useful in controlling disease progression and maintaining quality of life. Considering the chronic and fluctuating nature of fibromyalgia, any intervention that helps stabilize symptoms can be considered clinically relevant. Both approaches are relatively safe, with few reported adverse effects, and can be easily integrated with other treatments recommended for fibromyalgia, such as medications, patient education, and cognitive-behavioral therapies.

Physiotherapy with core exercises offers the additional advantage of being able to be performed in groups and, once learned, can be continued at home, promoting self-management of the condition.

The study has some important limitations that should be considered in interpreting the results. The five-week treatment period may have been insufficient to demonstrate significant improvements, especially in the physiotherapy group, where patients usually need three to four sessions to become familiar with the principles of core stabilization exercises. In addition, the application of a standardized acupuncture protocol, although necessary to maintain the methodologic quality of the study, may not reflect ideal clinical practice, where treatment would be individualized according to each patient's specific needs in line with the principles of traditional Chinese medicine. The sample size, although adequate for the statistical methods used, may not have provided sufficient statistical power to detect smaller but clinically relevant differences between groups.

Future research would benefit from longer treatment periods, larger samples, and possibly the combination of both therapies to evaluate whether synergistic effects could result in more substantial benefits for patients with fibromyalgia.