Thursday, March 18, 2010

Acupuncture Unhelpful for Fibromyalgia: Review

Briefly NotedGerman investigators conducted a systematic review and data meta-analysis to assess the efficacy of acupuncture for managing fibromyalgia syndrome (FMS). Although some pain relief was achieved immediately after treatment, acupuncture did not confer longer-term pain relief, or any improvements in fatigue, sleep disturbance, or physical function.

A search of clinical research on acupuncture for FMS through July 2009 uncovered 7 randomized controlled trials (RCTs), which included a total 385 patients receiving a median of 9 acupuncture sessions (range 6-25). Two of the trials reported longer followup of 26 weeks (median time). Immediately after treatment there was significant pain reduction (p = 0.04) conferred by acupuncture versus sham therapy (control), but no reductions in fatigue and sleep disturbances, or improvements in physical function. During followup of roughly 6-months there was no evidence for sustained pain reduction or other beneficial outcomes. Adjusting for the type of control condition (ie, penetrating versus non-penetrating sham acupuncture) did not change the results. Side effects of treatment were inconsistently reported. The researchers conclude that observed reductions in pain, although statistically significant, were modest, short-term, and most apparent in studies with potential sources of bias. Therefore, they do not recommend acupuncture for the management of FMS.

COMMENT: The total sample size (n=385) is not huge and long-term outcomes were available from only two trials, so further investigations of acupuncture for FMS might be worthwhile. It is remarkable that, even after centuries of use, neurobiological mechanisms behind acupuncture are still poorly understood, as we discussed in a prior blogpost [here].

REFERENCE: Langhorst J, Klose P, Musual F, et al. Efficacy of acupuncture in fibromyalgia syndrome — a systematic review with a meta-analysis of controlled clinical trials. Rheumatology. 2010;49(4):778-788 [abstract here].