Meta-Analysis of 17 Trials Confirms: Acupuncture Reduces Pain, Fatigue, and Depression in Fibromyalgia

Fibromyalgia is a syndrome of generalized chronic pain characterized by central sensitization, persistent fatigue, sleep disturbances, and mood alterations — with prevalence estimated between 2% and 8% in the adult population, predominantly affecting women. Available pharmacologic options offer limited benefit and present relevant adverse effects, which keeps the demand for effective non-pharmacologic interventions high. A systematic review published in Frontiers in Medicine analyzed 17 randomized clinical trials with 1,066 patients and found consistent evidence that medical acupuncture improves the main outcomes of fibromyalgia.

What was evaluated

Researchers Zhengfeng Ye and colleagues from the rheumatology section of Frontiers in Medicine conducted searches in international and Chinese databases, selecting 17 RCTs published through 2025. The primary outcomes were pain intensity (Visual Analogue Scale), the Fibromyalgia Impact Questionnaire (FIQ) — which evaluates the global impact of the syndrome —, the number of tender points, depression, fatigue, and sleep quality. All included studies compared acupuncture with control groups (sham acupuncture, medication, or standard care).

Why tender points respond better

The largest effect size was observed in the reduction of the number of tender points (SMD -1.36), which is compatible with the mechanism of action of acupuncture on peripheral sensitization. The tender points of fibromyalgia share characteristics with myofascial trigger points: they are sites of mechanical hyperalgesia in taut muscle bands. Needle stimulation may deactivate these foci through local mechanisms (release of ATP, normoxygenation of muscle fiber) and central mechanisms (modulation of descending pain inhibitory pathways via endogenous opioids and serotonin).

The authors acknowledge heterogeneity among the included studies, arising from variability in point protocols, number of sessions, and studied populations. Larger-scale studies and standardized protocols are needed to define the ideal session frequency and the acupoints with greatest efficacy for each symptomatic domain of fibromyalgia. Even só, the consistency of positive effects in 17 independent trials strengthens the indication of medical acupuncture as a complementary analgesic and antidepressant intervention in the management of this complex syndrome.