Note: This article includes our follow-up suggestions regarding its implications
Fibromyalgia patients treated with acupuncture in a rigorously designed randomized and placebo controlled Mayo Clinic trial achieved significant relief of total symptoms including pain, fatigue, and anxiety, according to a report in the June 2006 issue of Mayo Clinic Proceedings. The reduction of symptoms – described as “similar to that reported with pharmaceutical interventions” – is important news for fibromyalgia patients. But also, from the healthcare provider’s perspective, the study lends new support for the role of acupuncture as an effective treatment for symptoms of fibromyalgia. The ill-understood condition is described as including chronic widespread pain with various other symptoms such as sleep disturbances, fatigue, and stiffness. Though the National Institutes of Health had issued a consensus statement in 1998 indicating that acupuncture “may” be of adjunctive help in the treatment of fibromyalgia, the Mayo researchers observed that a lack of randomized controlled studies had “weakened the conclusion.” And of the two previous randomized controlled studies, one concluded acupuncture was helpful for pain relief, and the other that it was ineffective. Also, by virtue of the Mayo trial’s carefully designed protocol, the participating physicians conclude that it supports the feasibility of similar pain-relief studies employing “a control group exposed to simulated acupuncture.” Study Design
A study population of 50 patients who would participate in six treatment sessions during a two- to three-week period was recruited from patients referred by their physicians to the Mayo Fibromyalgia Treatment Program in Rochester, Minnesota. All:
- Were diagnosed with fibromyalgia by a rheumatologist.
- Reported no prior experience with acupuncture.
- Had participated in a 1.5-day program of symptom-management education, counseling, and group discussion.
- Were assessed four weeks after this program via a Fibromyalgia Impact Questionnaire (FIQ) to provide baseline values for 20 health status/symptom measures, and via selected scales on the Multidisciplinary Pain Inventory, to measure baseline perceptions of chronic pain severity and its impacts.
Of the 50 trial subjects, 25 were randomly selected to receive true acupuncture treatments involving electrical stimulation, and 25 to receive simulated treatments. The treatment processes were designed to look and feel identical, based on preliminary testing by volunteers who could not tell the difference between the two. Additionally, all trial patients were positioned so that they could not see either the equipment or its application. Acupuncture points were the same for all patients, selected to reflect common practice in the acupuncture literature. All conversation was kept uniformly neutral, and schedules avoided opportunities to compare experiences. When patients were asked at the conclusion of treatments whether they believed they were in the acupuncture or control group, the accuracy of their responses did not exceed chance. Key Findings
Follow-up FIQ surveys were conducted immediately after completion of the treatment series and at one and seven months post-treatment. The trial was “partially blinded,” in that those responsible for collecting and analyzing evaluations did not know which patients were in which groups. At one month post-treatment, the analysis indicated a “significant” 7.4-point reduction in the mean (average) total FIQ scores of the acupuncture patients (P = .007). At this point, the mean total score of treated patients was 34.8 points, down from 42.4 at baseline – about an 18 percent improvement. By comparison, the score of untreated patients at one month was 42.2 points, compared with 44.0 at baseline. More specifically, the acupuncture group experienced some improvement versus baseline on all symptoms. As for individual symptoms, pain improvement “trended toward” statistical significance, and improvements in measures of fatigue and anxiety were statistically significant. Benefits at seven months post treatment were “less significant.” The authors believe next steps in the study of acupuncture benefits should include customized point selection for individual patients. They also note that the total mean FIQ baseline measures for both groups of trial subjects reflected a 7.0-point improvement achieved in the four-week period between the 1.5-day educational and behavioral intervention program (when a preliminary FIQ was administered) and the pre-trial baseline measurement. Thus, improvements for subjects in the acupuncture trial were “additive to the benefits obtained” through this program. For more information on this trial, see the original article “Improvement in Fibromyalgia Symptoms With Acupuncture: Results of a Randomized Controlled Trial,” by David P. Martin, MD, PhD, et al., in the June 2006 issue of Mayo Clinic Proceedings, at www.mayoclinicproceedings.com What Does This Mean For You?
- Acupuncture treatment can improve fatigue, anxiety, and overall quality of life, with a more limited effect on pain alone.
- The effects of acupuncture treatment are not long lasting. It would need to be part of a continuing treatment program.