Adverse events were inconsistently reported. We conclude from the available data that acupuncture was not associated with serious harmful events. The low drop-out rate indicates a good acceptance of this treatment by the patients. Studies were conducted in the setting of primary, secondary and tertiary care in USA and middle Europe.
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Patients were recruited by various ways of referral including all levels of care. The majority of participants were adult female and Caucasians. All studies which reported these criteria excluded patients with previous acupuncture experience and bleeding disorders. The majority of studies excluded patients with severe physical diseases. Patients with mental disorders or FMS-associated litigation were excluded by a minority of studies.
Therefore, the results are applicable to the vast majority of patients in clinical practice. There was a great variability of the methodological quality of studies. The positive effect on pain at post-treatment was not robust against potential methodological biases. The inconsistent results were mainly due to one high-quality study in which sham and simulated acupuncture were superior to verum acupuncture [ 28 ]. This study differed from its design from the others: Our conclusions are not in line with the outcome of a previous qualitative systematic review on acupuncture in FMS, which concluded that there is moderate evidence for the efficacy of manual acupuncture in FMS [ 15 ].
On the other hand, the finding of a small but significant reduction of pain in this study is not in line with the conclusions of two other systematic reviews on acupuncture in FMS, indicating that acupuncture is not effective in relieving FMS symptoms [ 16 , 17 ].
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At this point, our results are in line with the conclusions of a systematic review on acupuncture, that the efficacy of acupuncture using classical points when compared with sham or minimal acupuncture is overestimated [ 37 ]. The authors also report a tendency for larger effects of verum acupuncture when the comparative placebo procedure was penetrative compared with simulated acupuncture.
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However, our results do not confirm this finding. Our review is the first study available, meta-analysing all available outcomes of acupuncture effects on FMS. Furthermore, the data were stratified to different types of verum and placebo acupuncture and the applicability of the results [ 38 ] assessed. The review includes several trials of high methodological quality.
However, for two of the studies, the means and s. Furthermore, mean and s. Nonetheless, it was possible to extract this information from the figure of a meta-analysis of acupuncture in chronic pain syndromes [ 21 ]. Overall, the techniques of acupuncture and especially the verbal instructions given to the patient were only incompletely reported. No study reported the adherence to treatment.
Some of the trials showed methodological weaknesses. However, the main weakness of the meta-analysis presented here is the limited number of studies and patients included. Moreover, the modalities and dosages of verum and sham acupuncture and the assessments used in the trials were heterogeneous.
A problem in trials evaluating acupuncture for chronic pain syndromes is that physiologically, point specificity, the crux of sham acupuncture, may not be applicable. Moreover, it is doubtful that penetrating the skin qualifies as a sham condition in FMS. In addition, even a slight touch of the skin can have positive effects on the affective level of pain perception [ 42 ]. Therefore, skin-penetrating verum acupuncture and skin-touching simulated acupuncture could simply compare two different sensory stimulating techniques and would thus not represent an inactive control for treatment.
Since acupuncture is popular among FMS patients, further rigorous studies are warranted. Moreover, different forms of stimulation manual vs electric acupuncture and intensities of stimulation should be tested [ 41 ] and specific guidelines, namely the Standards for Reporting Interventions in Controlled Trials of Acupuncture recommendations [ 43 ], should be followed when acupuncture trials are reported. A recent RCT of acupuncture for another functional somatic syndrome, namely irritable bowel syndrome, suggested that the effects of sham acupuncture can be enhanced by an empathic physician style [ 44 ].
Finally, the integration of acupuncture into multicomponent therapy e. All other authors have declared no conflicts of interest. Oxford University Press is a department of the University of Oxford. It furthers the University's objective of excellence in research, scholarship, and education by publishing worldwide.
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Sign In or Create an Account. Close mobile search navigation Article navigation. Efficacy of acupuncture in fibromyalgia syndrome—a systematic review with a meta-analysis of controlled clinical trials Jost Langhorst. Rheumatology , Volume 49, Issue 4, 1 April , Pages —, https: Fibromyalgia syndrome , Acupuncture , Systematic review , Meta-analysis. View large Download slide.
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Identifying the clinical domains of fibromyalgia: What are the key symptoms of fibromyalgia syndrome? Results of a survey of the German Fibromyalgia Association [in German]. The incidence of fibromyalgia and its associated comorbidities: Medically unexplained physical symptoms, anxiety, and depression: Advance Access published February 26, Health care utilization in patients with fibromyalgia syndrome FMS [in German].
Chronic fatigue, chronic fatigue syndrome, and fibromyalgia. Disability and health-care use. Pain in adults and children.
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American Pain Society, EULAR evidence based recommendations for the management of fibromyalgia syndrome. Rules of evidence and clinical recommendations on the use of antithrombotic agents. Acupuncture for fibromyalgia—a systematic review of randomized clinical trials. Efficacy of acupuncture for the treatment of fibromyalgia: Improving the quality of reports of meta-analyses of randomised controlled trials: Quality of Reporting of Meta-analyses.
Acupuncture treatment for pain: A randomized controlled trial of acupuncture added to usual treatment for fibromyalgia.
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Comparison of therapeutic effects on fibromyalgia syndrome between dermal- neurological electric stimulation and electric acupuncture. A randomized clinical trial of acupuncture compared with sham acupuncture in fibromyalgia. Treatment of fibromyalgia with formula acupuncture: Traditional Chinese acupuncture and placebo sham acupuncture are differentiated by their effects on mu-opioid receptors MORs. Acupuncture in generalized tendomyopathia fibromyalgia syndrome [in German].
Improvement in fibromyalgia symptoms with acupuncture: The American College of Rheumatology criteria for the classification of fibromyalgia: Clinical aspects, follow-up and differential diagnosis] [in German]. Systematic review of systematic reviews of acupuncture published — Assessment of adverse effects and applicability—two areas not yet covered adequately in Cochrane reports. Are reviews based on sham acupuncture procedures in fibromyalgia syndrome FMS valid?
The affective and cognitive processing of touch, oral texture, and temperature in the brain. Standards for reporting interventions in controlled trials of acupuncture: Components of placebo effect: For Permissions, please email: Add comment Close comment form modal. I agree to the terms and conditions. You must accept the terms and conditions. You have entered an invalid code. Thank you for submitting a comment on this article.
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Dry eyes, dry mouth and kidney stones. Other pain syndromes; bleeding disorder; needle phobia; use of narcotics; litigation due to FMS; previous acupuncture. Pharmacological and non-pharmacological therapies constant through study; no further details given; direct acupuncture: Severe concomitant disease, neuropathy, bleeding disorder; treatment with morphine-like drugs or anti-coagulants; previous acupuncture. Physiotherapy; non-steroidal agents, tricyclic anti-depressants; direct acupuncture: Bleeding diathesis; inflammatory or autoimmune disorder; regular use of narcotics; history of substance abuse; disability payment or litigation related to FMS.
Continuation, but not change of normal treatment regimens, including anti-depressants allowed; acetaminophen or ibuprofen for rescue. Previous experience with acupuncture; bleeding diathesis; current use or history of opioid or narcotic analgesics; or autoimmune disorder; pregnancy or nursing; severe psychiatric disorder, including major depression.
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So from the top, I am Steve Merrick, I am also known as stevesevilempire the photographer, check the website any time you want or type that into google, really I am a one man evil empire. My life long dream has been to write good science fiction, real stories Why is it so hard to write your own Biography and why do words like pretentious and dilemma keep ricocheting around my head as I type this. My life long dream has been to write good science fiction, real stories that use the future in a n allegorical way to reflect our present. I am currently putting together the second book in the Awash in Starlight series, its called the perspective of breath, fortunately I am not going to tell you what that's about but should you be curious then check out the first book The Navigator.
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