ON FIBROMYALGIA: more on accupuncture

A randomized clinical trial of acupuncture compared with sham acupuncture in fibromyalgia.NP Assefi, KJ Sherman, C Jacobsen, J Goldberg, WR Smith, D BuchwaldAnn Intern Med 2005 7;143(1):10-9

This study was conducted in 100 adult community dwellers with Fibromyalgia (FM). They were randomized to receive either real or sham acupuncture (biw) for 12 weeks. The diagnosis of FM was “confirmed” by a coordinator trained in the assessment of tender points (records were not reviewed and interviews not conducted to rule other disorders). The primary outcome measure was pain (10 cm. VAS); secondary outcomes included fatigue, sleep, well being and function. Patients continued any previous FM-related treatments they were on at the time of the study (acupuncture as an “adjunct” therapy study). Patients were told they had one in four probability of being assigned to a treatment that “could be effective”. Of the 100 patients randomized, four never rstarted treatment but almost all who started it, completed the study. Neither the primary nor the secondary outcomes studied were significantly different in the acupuncture group vs the sham acupuncture group (these results contrast with recently published data on the value of acupuncture in knee OA) . Given that in the clinical setting, acupuncture is used in combination with herbal, dietary and massage therapies, the possibility that acupuncture could in fact work if used in that manner cannot be ruled. However, the data regarding these other therapies for FM pain have been mixed. To date the most successful programs for FM include a combined approach of limited pharmacologic treatment and a structured exercise program. Acupuncture does not seem to be an integral and essential part of this treatment paradigm, as this study suggests.

--Graciela S. Alarcon, MD

This study is another among a mixed bag of results on treatments for Fibromyalgia. In this study, sham (fake) accupuncture was no better than "true" accupuncture. I think the take home message is this: if accupuncture works for you, do it. However, it is always better to use a combination approach. Wether or not it includes accupuncture, depends on the individual.

Ricardo Pocurull, MD