Treatment of Fibromyalgia with Formula Acupuncture: Investigation of Needle Placement, Needle Stimulation, and Treatment Frequency

University of Cologne, Köln, North Rhine-Westphalia, Germany
The Journal of Alternative and Complementary Medicine (Impact Factor: 1.59). 08/2005; 11(4):663-71. DOI: 10.1089/acm.2005.11.663
Source: PubMed


The objective of this study was to investigate whether typical acupuncture methods such as needle placement, needle stimulation, and treatment frequency were important factors in fibromyalgia symptom improvement. DESIGN/SETTINGS/SUBJECTS: A single-site, single-blind, randomized trial of 114 participants diagnosed with fibromyalgia for at least 1 year was performed.
Participants were randomized to one of four treatment groups: (1) T/S needles placed in traditional sites with manual needle stimulation (n = 29): (2) T/0 traditional needle location without stimulation (n = 30); (3) N/S needles inserted in nontraditional locations that were not thought to be acupuncture sites, with stimulation (n = 28); and (4) N/0 nontraditional needle location without stimulation (n = 2 7). All groups received treatment once weekly, followed by twice weekly, and finally three times weekly, for a total of 18 treatments. Each increase in frequency was separated by a 2-week washout period.
Pain was assessed by a numerical rating scale, fatigue by the Multi-dimensional Fatigue Inventory, and physical function by the Short Form-36.
Overall pain improvement was noted with 25%-35% of subjects having a clinically significant decrease in pain; however this was not dependent upon "correct" needle stimulation (t = 1.03; p = 0.307) or location (t = 0.76; p = 0.450). An overall dose effect of treatment was observed, with three sessions weekly providing more analgesia than sessions once weekly (t = 2.10; p = 0.039). Among treatment responders, improvements in pain, fatigue, and physical function were highly codependent (all p < or = 0.002).
Although needle insertion led to analgesia and improvement in other somatic symptoms, correct needle location and stimulation were not crucial.

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    • "Study ID Diagnostic criteria Sample size (T/C, male/female) Age (yr, T/C) Duration of disease (month, T/C) Experimental intervention Control intervention Duration of treatment Outcomes Assefi et al. 2005 [14] ACR 1990 3/22 2/69 Unclear 144 ± 216 112.08 ± 120.48 Acupuncture on points chose to treat fibromyalgia according to TCM theory for 30 min, twice weekly One of three sham acupuncture (false points, not insertion, or unrelated points) for 30 min, twice weekly 12 weeks Visual Analogue Scores (VAS) for pain, fatigue, Sleep, and overall well-being; SF-36 for physical and mental function; adverse effects Cao and Li 2003 [15] ACR 1990 28 28 42.1 ± 14.5 19.3 ± 15.1 Acupuncture plus moving cupping therapy on bilateral Jiaji points, once every 3 days, plus seroxat 20 mg daily Seroxat 20 mg daily 4 weeks Hamilton Depression Scale (HAMD); VAS; number of tender points; effective rate Deluze et al. 1992 [16] ACR 1990 3/33 13/21 46.8 ± 2.3 49 ± 2 172.8 ± 40.8 82.8 ± 15.6 Electroacupuncture on 4–10 common points with electrostimulation 1–99 Hz, 10 mA, twice weekly for 6 sessions Sham electroacupuncture on false points (20 mm away from the point which has been chosen for real elec- troacupuncture) twice weekly for 6 sessions 3 weeks Pain threshold; number of analgesic tablets; regional pain score; VAS for pain; Sleep Quaty; morning stiffness; patients and evaluation physicians appreciation of the patients general status Gong and Wang 2010 [17] ACR 1990 9/21 11/19 35 ± 8 34 ± 6 15.0 ± 3.5 13.0 ± 2.5 Acupuncture at Ashi points and lower Dantian (CV4 and CV6) for 30 min, once daily to twice weekly Amitriptyline 25 mg twice daily added to 150–300 mg daily for 2 months, then 50–150 mg per month for another month 12 weeks VAS for pain; sleep quality; HAMD; effective rate Hadianfard and Parizi 2012 [18] ACR 1990 0/15 0/15 43.86 ± 7.9 44.2 ± 10.8 82.8 ± 68.4 79.6 ± 69.8 Acupuncture on ST36, GB34, RN6, SP6, LI4, ST44, BL40, HT7, and DU20 for 30 min, three sessions weekly Fluoxetine 20 mg every morning 8 weeks VAS; number of tender points; Fibromyalgia impact questionnaire (FIQ) Evidence-Based Complementary and Alternative Medicine Table 1: Continued. Study ID Diagnostic criteria Sample size (T/C, male/female) Age (yr, T/C) Duration of disease (month, T/C) Experimental intervention Control intervention Duration of treatment Outcomes Harris et al. 2005 [19] ACR 1990 0/29 3/27 4/24 1/26 46 ± 10.1 44.5 ± 10.9 51.3 ± 10.0 48.1 ± 10.9 66 ± 44.52 63 "
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    ABSTRACT: Background. Acupoint stimulation is popular for treatment of fibromyalgia though there is lack of comprehensive evaluation of current clinical evidence for its effect and safety. Objective. To systematically review the beneficial effects and safety of acupoint stimulation for fibromyalgia. Methods. We searched six electronic databases for randomized trials on acupoint stimulation for treatment of fibromyalgia. Two authors extracted data and assessed the trial quality independently. RevMan 5.2 software was used for data analyses with effect estimate presented as (standard) mean difference and a 95% confidence interval. We defined minimum, medium, and large SMD effect sizes as 0.3, 0.5, and 0.75. Results. 16 RCTs with 1081 participants were involved in this review. Only two trials were evaluated as low risk of bias. Meta-analysis showed that acupuncture alone or combined with cupping therapy was superior to conventional medications on reducing pain scores and/or the number of tender points. However, acupuncture showed no better than sham acupuncture on pain reduction. There was no serious adverse event reported to be related to acupoint stimulation. Conclusions. Acupoint stimulation appears to be effective in treating fibromyalgia compared with medications. However, further large, rigorously designed trials are warranted due to insufficient methodological rigor in the included trials.
    Full-text · Article · Dec 2013 · Evidence-based Complementary and Alternative Medicine
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    • "Since it is widely acknowledged that acupuncture is effective in relieving pain, there have been many studies on acupoint specificity with respect to migraine [6, 12, 26, 61, 72], fibromyalgia [14, 73, 74], lumbago [62, 75–77], osteoarthritis [1, 78, 79], and other painful diseases. These studies produced mixed results. "
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    ABSTRACT: The theory of acupoint specificity is the basis for elucidating the actions of acupoints as employed in clinical practice. Acupoint specificity has become a focus of attention in international research efforts by scholars in the areas of acupuncture and moxibustion. In 2006, the Chinese Ministry of Science approved and initiated the National Basic Research Program (973 Program), one area of which was entitled Basic Research on Acupoint Specificity Based on Clinical Efficacy. Using such approaches as data mining, evidence-based medicine, clinical epidemiology, neuroimaging, molecular biology, neurophysiology, and metabolomics, fruitful research has been conducted in the form of literature research, clinical assessments, and biological studies. Acupoint specificity has been proved to exist, and it features meridian-propagated, relative, persistent, and conditional effects. Preliminarily investigations have been made into the biological basis for acupoint specificity.
    Full-text · Article · Oct 2012 · Evidence-based Complementary and Alternative Medicine
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    • "They found that 25-35% of subjects experienced significant decreases in pain, regardless of the location of acupoint stimulation. Other acupuncture studies of fibromyalgia have reported similar results [32,33]. Because acupuncture frequently involves stimulation of Ashi points, which lie on painful points of the body without relation to meridians and acupoints, it is reasonable to speculate that non-acupoints used in fibromyalgia studies often are Ashi points [31]. "
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