Around 1 in 25 of the UK population has fibromyalgia, a lifelong condition involving widespread musculoskeletal pain and tenderness, fatigue, sleep disturbance, and functional impairment, without any known structural or inflammatory cause (Annemans 2008; Hauser 2008; De Silva 2010; Burckhardt 1994). This problem is costly in terms of consultations, prescriptions and sick leave (Annemans 2008; Busch 2007; Boonen 2005; Hauser 2010).
In fibromyalgia, abnormalities in central pain-processing and the release of neurotransmitters including serotonin and noradrenaline lead to lower pain thresholds (Holman 2005; Clauw 2008). Predisposing factors for the condition include female gender, anxiety, trauma and viral infection (Clauw 2009). American College of Rheumatology diagnostic criteria for fibromyalgia are widespread pain lasting at least 3 months, affecting both sides of the body, above and below the waist; plus pain at 11 or more of 18 designated possible tender points, when 4kg/cm2 force is exerted at each point Wolfe 1990).
The main aims of therapy are to reduce symptoms, to improve function, and to help patients adapt to the condition (Hauser 2008). Treatments include cognitive behavioural therapy and medication such as simple analgesics or NSAIDs, tramadol, antidepressants (low-dose tricyclics or antidepressant doses of selective serotonin re-uptake inhibitors or serotonin-noradrenaline re-uptake inhibitors) and antiepileptics (e.g. gabapentin, pregabalin).
Annemans L et al. Health economic consequences related to the diagnosis of fibromyalgia syndrome. Arthritis Rheum 2008; 58: 895-902.
Clauw DJ. Fibromyalgia: an overview. Am J Med 2009; 122 (12 suppl): S3-13.
Boonen A et al. Large differences in cost of illness and wellbeing between patients with fibromyalgia, chronic low back pain, or ankylosing spondylitis. Ann Rheum Dis 2005; 64: 396-402.
Burckhardt CS et al. A randomized, controlled clinical trial of education and physical training for women with fibromyalgia. J Rheumatol 1994; 21: 714-20.
Busch AJ et al. Exercise for treating fibromyalgia syndrome. Cochrane Database Syst Rev 2007, Issue 4. Art. No.: CD003786. DOI: 10.1002/ 14651858.CD003786.pub2 [Last assessed as up-to-date: 16 August 2007].
De Silva V et al. Evidence for the efficacy of complementary and alternative medicines in the management of fibromyalgia: a systematic review. Rheumatology (Oxford) 2010; 49: 1063-8.
Häuser W et al. Management of fibromyalgia syndrome - an interdisciplinary evidence-based guideline. Ger Med Sci 2008; 6: Doc 14.
Häuser W et al. Comparative efficacy and harms of duloxetine, milnacipran, and pregabalin in fibromyalgia syndrome. J Pain 2010; 11: 505-21.
Holman AJ, Myers RR. A randomized, double-blind, placebo-controlled trial of pramipexole, a dopamine agonist, in patients with fibromyalgia receiving concomitant medications. Arthritis Rheum 2005; 52: 2495-505.
Wolfe F et al. The American College of Rheumatology 1990 Criteria for the Classification of Fibromyalgia. Report of the Multicenter Criteria Committee. Arthritis Rheum 1990; 33: 160-72.
How acupuncture can help
Western-based systematic reviews of acupuncture for fibromyalgia are dependent on rather few, rather small, randomised trials in which the verum treatment has been compared to a sham version of acupuncture. Given that the sham interventions are not inactive placebos, but effectively different versions of acupuncture, it is not surprising that most reviews have not found acupuncture to be superior. The most recent (Langhorst 2010), with more trials included, reported acupuncture to have a significantly better analgesic effect than sham (though it was not superior for other symptoms). Another recent review, with access to the Chinese literature, was able to assess the effectiveness of acupuncture against conventional medication, as well as against sham (Cao 2010). This found it to be better than drugs in terms of pain relief.
Acupuncture may have the greatest benefit when applied together with medication or other therapeutic options (Targino 2008, Jang 2010). Further trials are needed, of larger size and with sounder methodology, and especially those that compare acupuncture to existing conventional interventions. [See Table below]
In general, acupuncture is believed to stimulate the nervous system and cause the release of neurochemical messenger molecules. The resulting biochemical changes influence the body's homeostatic mechanisms, thus promoting physical and emotional well-being. Stimulation of certain acupuncture points has been shown to affect areas of the brain that are known to reduce sensitivity to pain and stress, as well as promoting relaxation and deactivating the 'analytical' brain, which is responsible for anxiety (Wu 1999).
Acupuncture may help relieve pain in patients with fibromyalgia by:
- altering the brain's chemistry, increasing endorphins (Han 2004) and neuropeptide Y levels (Lee 2009; Cheng 2009), and reducing serotonin levels (Zhou 2008);
- evoking short-term increases in mu -opioid receptors binding potential, in multiple pain and sensory processing regions of the brain (Harris 2009);
- stimulating nerves located in muscles and other tissues, which leads to release of endorphins and other neurohumoral factors, and changes the processing of pain in the brain and spinal cord (Pomeranz 1987, Zhao 2008);
- reducing inflammation, by promoting release of vascular and immunomodulatory factors (Kavoussi 2007, Zijlstra 2003)
- improving muscle stiffness and joint mobility by increasing local microcirculation (Komori 2009), which aids dispersal of swelling.