Acupuncture does not reduce pain in fibromyalgia patients

[Guest guest]

Acupuncture does not reduce pain in fibromyalgia patients

Jul 12, 2005 Therese Droste

Seattle, WA - Directed acupuncture was no more effective than sham

acupuncture at relieving pain in fibromyalgia in a 12-week randomized,

controlled trial reported by Dr Dedra S Buchwald (University of

Washington, Seattle) in the July 5, 2005 issue of the ls of

Internal Medicine [1].

" We were surprisedwe thought acupuncture would work for fibromyalgia

based on our clinical experience and our patients' testimonials, " says

Buchwald.

One potential explanation, says Buchwald, is that study participants

received a standardized treatment. " That's not how acupuncturists apply

acupuncture in a real-life setting. They individualize treatment to

patients and also use a lot of ancillary approaches, such as herbs and

dietary changes, " Buchwald tells rheumawire. Currently there is no gold

standard for selecting acupoints for fibromyalgia treatment. While the

study did not include adjunctive therapies, researchers allowed

participants to continue any fibromyalgia-related pharmacologic and

nonpharmacologic therapies during the study.

No effect on pain or other functions

The researchers' goal was to determine whether directed acupuncture

designed for fibromyalgia treatment relieves pain better than sham

acupuncture. Buchwald and colleagues randomized 100 adults with

fibromyalgia to one of four treatment groups (three of which were sham)

for twice-weekly treatments for 12 weeks:

* Directed acupuncture according to traditional Chinese medicine.

* A sham control in which participants received real acupuncture

for an unrelated condition using real meridians and acupoints.

* A sham control in which participants received needle insertion

but without the use of standard acupoints.

* A sham control in which participants got simulated acupuncture

that did not insert needles at all, but there was some contact with the

skin by toothpicks.

All patients were blindfolded during treatments. Inclusion criteria

were English-speaking adults over age 18 with physician-diagnosed

fibromyalgia who had a global pain score of 4 or higher on a visual

analog scale (0=no pain, 10=worst pain ever). Most participants were

white, married women who, on average, were 47 years old and had

experienced pain for 10 years.

In addition to the primary outcome measure of subjective pain measured

by a standard 10-cm visual analog scale, researchers also used a visual

analog scale to measure the intensity of fatigue (0=none, 10=worst

ever), sleep quality (0=worst ever, 10=best), and overall well-being

(0=worst ever, 10=best ever). Secondary outcomes were physical and

mental functions measured with the Medical Outcomes Study 36-item

Short-Form Health Survey.

At baseline, the average score on the visual analog scale was 7 cm for

pain intensity, 7.7 cm for fatigue intensity, 3.3 cm for sleep quality,

and 4 cm for overall well-being. Measurements were then taken at one,

four, eight, and 12 weeks, as well as three and six months after the

treatments were concluded. The three sham treatments were combined into

a single control group for comparison with the true acupuncture group.

Initiallyafter week oneparticipants showed slight improvements in pain,

but that did not proceed throughout the study. Overall, researchers

found no statistical significance in improvements in either the

sham-procedure or directed-acupuncture group.

" Possible explanations include a nonspecific response to the

acupuncturist's healing presence or the relaxing environment of the

acupuncture clinic, a psychological response to participation in a

clinical trial, or fluctuations in the natural history of disease, " the

researchers write.

Patients in this study were " very ill "

The cause of fibromyalgia, a chronic pain condition affecting up to 4%

of the US population, is unknown. After osteoarthritis (OA), it is the

second most common rheumatologic condition. Fibromyalgia is not as

widely recognized among physicians as osteoarthritis, since it is a

more recently accepted disorder.

Regardless of the fibromyalgia study results, Buchwald contends that

acupuncture is likely to help some patients. " If a patient wants to try

acupuncture, it might be helpful. Hypothetically, one thing to consider

is that our participants could have been difficult to treat because

they were very ill, as many came to us from referral clinics. Perhaps

people coming into other physicians' practices might not be as sick and

therefore might respond better to acupuncture, " Buchwald says.

Past studies, most recently in the July 9, 2005 issue of the Lancet,

have shown statistically significant results for the use of acupuncture

for osteoarthritis of the knee. Yet it is not easy to compare the use

of acupuncture for OA with fibromyalgia, as the two conditions are

quite different. Fibromyalgia pain is widespread throughout the body,

while OA of the knee is limited to one specific place on the body,

Buchwald tells rheumawire. " And while acupuncture didn't show a huge

effect [on OA], it was similar to other medications used in

osteoarthritis, " she adds.

The next step for future research into fibromyalgia is to look at other

commonly used complementary and alternative treatment methods, as

fibromyalgia patients use many other treatments that are worth looking

at, says Buchwald. Those include massage and dietary and lifestyle

changes.

Source

1. Assefi N, Sherman K, sen C, et al. A randomized clinical

trial of acupuncture compared with sham acupuncture in fibromyalgia.

Ann Intern Med 2005; 143:10-19.

http://www.jointandbone.org/viewArticle.do?primaryKey=522189