FM

June 21, 2009

Fibromyalgia Treatment Update: Complementary Therapies: Acupuncture

In recent years, complementary and alternative therapies have garnered increased

attention as potential treatments for fibromyalgia and are used by patients.[57]

Acupuncture is a treatment in traditional Chinese medicine with more than 2500

years of history for use in chronic pain and has been suggested for use in

fibromyalgia.[58,59] According to traditional Chinese medicine, fibromyalgia is

caused by dysfunction of the liver, spleen and kidney that interrupts or

depletes the body's internal energy (Qi) and blood flow, resulting in clinical

symptoms.[60] Two recent randomized controlled studies examining acupuncture in

fibromyalgia samples contribute to the body of well designed studies in this

area; however, the studies do little to clarify the role of acupuncture as a

possible treatment for fibromyalgia.

In a well designed study, Assefi and colleagues[61*] randomized 100

acupuncture-naïve, fibromyalgia patients into one of four groups (actual

acupuncture designed to treat fibromyalgia and three sham acupuncture).

Participants received two treatment sessions per week for 12 weeks. After good

adherence to the interventions (=80% of 24 sessions), no differences were seen

between groups in any of the outcome variables - pain, fatigue, sleep quality,

overall well-being and physical and mental function. Similar findings were seen

in a study by Harris and colleagues,[62] where the level of analgesia reported

was independent of needle placement or stimulation.

Conflicting findings were reported by Martin and colleagues[63] from a

randomized controlled trial in 50 patients with fibromyalgia, half of whom

received six sessions of actual acupuncture and the other half sham acupuncture

over 3 weeks. FIQ scores improved in both acupuncture and sham groups during

treatment (6.7 compared with 4.0 points). One month after treatment ended, the

acupuncture group maintained the improvement while the sham group scores receded

toward baseline, resulting in a mean difference of 7.4 points on the FIQ total

score (P < 0.007). Significant differences were also observed between groups in

scores for pain severity, fatigue, and anxiety 1 month after treatment.

Differences between groups in all measures were not sustained at 7-month

follow-up.

The studies by Assefi, Harris and Martin et al. provide examples of methodologic

differences that may explain their disparate findings and intrinsic challenges

associated with acupuncture trials. First, acupuncture is known to have a

powerful placebo effect in these types of trials[64] and individuals with

fibromyalgia have shown a strong placebo response in other blinded intervention

trials.[35*] Second, needling has beneficial effects on the variables being

measured in these studies independent of placement location.[62] Additionally,

needling results in similar physiological responses in people with and without

fibromyalgia.[65] Third, it is not known what dose of acupuncture is sufficient

to produce reliable results in fibromyalgia patients. The three studies used

different numbers of sessions in their intervention, with Martin having the

fewest. A final difference is the source of study participants and a possible

selection bias. This may best explain the difference in findings of Assefi and

Martin et al. Assefi and colleagues[61*] recruited patients from outside their

clinic, whereas participants in the study by Martin et al.[63] were recruited

after successfully completing an affiliated fibromyalgia-treatment program.

Patients who had recently succeeded in the treatment program had additional

interaction time with clinical staff. This interaction history may have

translated to greater confidence in the clinicians performing the study

intervention and an increased credibility of the research team, which could have

promoted a placebo effect.

At this time, the benefits of acupuncture for treating fibromyalgia remain

unclear and require well designed controlled trials to identify its potential

role in managing this patient population. Treatment should center on

evidence-based interventions. However, because studies have not reported safety

issues unique to the person with fibromyalgia, acupuncture could be considered

as an option in certain patients who are unresponsive or resistant to

pharmacotherapy and self-management approaches.

June 21, 2009

Thank you for this, Alon.

Study results I have seen for acupuncture treatment of fibromyalgia have been

varied; some pro, some con. My own experience as a person living with FM, and

treating others who have it, is that acupuncture is indeed helpful for reducing

and managing symptoms, increasing the patient's sense of available energy for

activity, reducing fatigue, improving sleep, and reducing depression and

stress. Over the years since I started studying TCM in 1997, I can also say my

underlying constitutional (contributing) factors have also gradually improved.

I see different patterns presenting among the FM-diagnosed population, but

liver, qi, and blood stagnation are present in all of them, often with a mix of

underlying deficiencies.

LAc's should be aware that, just as FM patients present with different patterns,

they commonly also present with different symptoms. For example, FM is most

well-known as a pain disorder, but the pain presentation is extremely variable -

and this is not well-known among practitioners. Pain varies from burning to

aching to stabbing to paresthesias and more, and very commonly varies with

weather changes. In my own case, I don't have a sensation of constant pain, but

I am tender to the touch just about everywhere. My own greatest problematic

symptom is muscle stiffness and cramping - which used to commonly persist for

months at a time. With my own education in TCM helping me to make better

choices in self-care, my FM symptoms are greatly reduced, to the point that for

several months out of every year, I can almost say I no longer have it.

The main things I do are keep my stress low, avoid foods that increase dampness

and phlegm, daily Tai Qi, and acupuncture and herbs to address my underlying

patterns. When I do have flareup, I do an auricular treatment focusing on the

spine area, since my cramps always occur in the mid-thoracic area.

LAc's who do not have fibromyalgia often have questions about what can be done

to help patients who do have it. I hope this is helpful, and folks are always

welcome to contact me if they get stuck in treating someone who has FM.

Andrea Beth

Traditional Oriental Medicine

Happy Hours in the CALM Center

635 S. 10th St.

Cottonwood, AZ 86326

(928) 274-1373

--- On Sun, 6/21/09, alonmarcus2003 <alonmarcus wrote:

alonmarcus2003 <alonmarcus

FM

Chinese Medicine

Sunday, June 21, 2009, 10:10 AM