By Stephane Babcock, Managing Editor
Recent research suggests acupuncture may provide relief to people afflicted with fibromyalgia. In a pair of studies by two separate research groups, similar results showed a significant improvement for participants in terms of pain and other symptoms. The positive results could lead to a greater acceptance of acupuncture from primary care physicians and specialists in musculoskeletal disorders who treat this common condition.
Although it is often difficult to diagnose, numbers show that close to 4 percent of the population suffers from fibromyalgia. Symptoms of the disease include widespread pain, fatigue and interruptions in sleep patterns, irritable bowel syndrome, headaches and facial pain, and heightened sensitivity. Patients have also complained of depression, altered moods, chest pains, dizziness, difficulty concentrating and anxiety. A specific cause for fibromyalgia is still unknown, but some factors that may contribute are chemical changes in the brain, an injury or trauma, a viral or bacterial infection, abnormalities of the autonomic nervous system, or changes in muscle metabolism.
Common treatments used by physicians include analgesic medication, antidepressants and muscle relaxants. Unfortunately, these merely mask the pain and discomfort, but do not work to cure the disease. Acupuncture could help to phase out the need for medicating the disorder.
The first study,1 led by Betsy B. Singh, PhD, from the Southern California University of Health Services, recruited 24 participants from the Orange County and Los Angeles areas. Twenty-one patients remained at the end of the study - two left due to illness, one for family matters. Of the 21, two were males and 19 were female, with a range in age from 44 to 71 and an average of 53.6 years. After a baseline assessment was completed, the candidates received 16 acupuncture treatments for eight weeks, with a three- to four-day break between treatments. One session treated anterior points (GB 20, GV 14, GB 21, SI 12, GB 30, BL 25, BL 23 and BL 40), while the other treated posterior points (LR 3, GB 34, KI 25, LI 4, ST 36, LI 11, ST 40, SP 6 and LR 8). According to the authors, the acupoints were based on traditional literature, clinical experience and information from previous trials.
The second study,2 headed up by David P. Martin, MD, PhD, from the Mayo Clinic, differed from Singh's primarily in that it used a control group. The two groups, consisting of 25 applicants each, were treated six times within a two- to three-week period. The average age of the patients in the acupuncture group was 47.9 years, with 51.7 years as an average for the control group. Strong regulatory points were chosen, such as bilateral points at the LI 4, ST 36, LR 2, SP 6, P 6, and HT 7. The physicians also used electrical stimulation of 2 Hz between LI 4 and ST 36. Axial points were also placed along the bladder meridian and stimulated at 10 Hz. Both groups' acupoints were swabbed with alcohol and then covered with a bandage. Unlike the acupuncture group, the control group's bandages were affixed with a needle that stuck out of the bandage but did not pierce the skin.
One common aspect of both studies was the use of the Fibromyalgia Impact Questionnaire (FIQ) to measure the results. The first 11 of the 20 questions make up a physical functioning scale, with each item rated on a four-point Likert-type scale. The questions refer to the patient's ability to go shopping, walk several blocks, do yard work, drive a car, and so on, during the previous week. Items 12 and 13 ask the patient to mark the number of days they felt well and number of days they were unable to work because of fibromyalgia symptoms. Items 14 through 20 are visual scales on which the patient rates work difficulty, pain, fatigue, morning tiredness, stiffness, anxiety and depression from one to 10.
In the Singh study, the FIQ scores (mean score of 53.6 prior to treatment) dropped significantly after the first month to 38.9 (P = .0001) and even more after the second month, to 30.5 (P = .0001). Researchers also created a multivariate regression model for the female study participants, eliminating the two male subjects. The change in the total FIQ score between the baseline and the second month was used as the dependent variable. Covariates were also used in the model, which included age, number of weeks in treatment, number of general symptoms, number of treating clinicians and the baseline FIQ scores. Only one of the covariates indicated a significant effect, that of the age of the patients. The older subjects indicated a more noticeable change after the treatments. The outcomes of the Singh study helped to eliminate a variety of alternate explanations for the results and showed obvious benefits to using acupuncture as a treatment for fibromyalgia.
Similar results were reported in the Mayo Clinic study. In the acupuncture group, the FIQ mean fell from 42.4 to 35.7 (P = .28) immediately after treatment, to 34.8 (P = .007) after one month, and then up to 38.1 (P = .24) seven months after the treatments ended. Compared to the control group, the FIQ scores were lower by 4.3, 7.4 and 4.6, respectively. Aside from pain severity, other symptoms that showed improvement were fatigue, anxiety and affective stress. The most noticeable change came after one month, but patients still felt less pain seven months after the treatment compared to the baseline FIQ scores.
Although both studies showed marked improvement for the participants, the researchers emphasize that more studies need to be performed. Both groups were limited by number of participants, geography, race and sex. However, the findings certainly provide positive evidence of the potential for acupuncture to effectively treat fibromyalgia. As research such as this continues to support the efficacy of acupuncture and Oriental medicine, it will open the door between Western and Eastern medicine a little wider.
References
- Singh B, Wu Wen-Shuo, Hwang San Hong, et al. Effectiveness of acupuncture in the treatment of fibromyalgia. Alternative Therapies in Health and Medicine 2006;12(2):34-41.
- Martin D P, Sletten C D, Williams B A, Berger I H. Improvement in fibromyalgia symptoms with acupuncture: results of a randomized controlled trial. Mayo Clinic Proceedings 2006;81(6):749-757.
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