Comparing Verum and Sham Acupuncture in Fibromyalgia Syndrome: A Systematic Review and Meta-Analysis

Abstract

Objectives. Acupuncture is often used for relieving symptoms of fibromyalgia syndrome (FMS). Our aim is to ascertain whether verum acupuncture is more effective than sham acupuncture in FMS. Methods. We collected RCTs to investigate the effects of verum acupuncture and sham acupuncture on pain, sleep quality, fatigue, and general status in FMS patients. The databases used for data retrieval were PubMed, Central Cochrane, EMBASE, PsycINFO, CNKI, VIP, OASIS, KoreaMed, and RISS. Selection/exclusion from the retrieved records was performed according to prespecified criteria, and the final selected records were assessed according to the Cochrane risk of bias tool. The results of the included trials were synthesized on the basis of outcomes, and subgroup analysis depended on the type of add-on sham acupuncture that was performed. Results. Ten RCTs (690 participants) were eligible, and eight RCTs were eventually included in the meta-analysis. The synthesis showed a sizable effect of verum acupuncture compared with sham acupuncture on pain relief (standardized mean difference (SMD) −0.49, Z = 3.26, P=0.001; I2 = 59%), improving sleep quality (SMD −0.46, Z = 3.24, P=0.001; I2 = 0%), and reforming general status (SMD −0.69, Z = 6.27, P<0.00001; I2 = 4%). However, efficacy on fatigue was insignificant (SMD −0.10, Z = 0.51, P=0.61; I2 = 46%). When compared with a combination of simulation and improper location of needling, the effect of verum acupuncture for pain relief was the most obvious. Conclusions. Verum acupuncture is more effective than sham acupuncture for pain relief, improving sleep quality, and reforming general status in FMS posttreatment. However, evidence that it reduces fatigue was not found.

Comparison between Acupuncture and Nutraceutical Treatment with Migratens® in Patients with Fibromyalgia Syndrome: A Prospective Randomized Clinical Trial

“…The role of magnesium in FMS pathophysiology is still controversial, although it is reported that the magnesium deficiency can cause muscle cramps, weakness, fatigue, and asthenia [31]. Though there has been evidence that there is a low level of serum magnesium in FMS patients, a strong correlation with the severity of the FMS symptoms has not yet been demonstrated [8,[32][33][34][35]. However, magnesium citrate treatment resulted in a significant reduction in pain symptoms and in the FIQ-R score [15].…”

“…A recent systematic review and meta-analysis of randomized controlled trials reported that acupuncture therapy is an effective, safe, and recommended treatment for management of patients with FMS [53]. Other analyses have provided evidence that verum acupuncture was more effective than sham acupuncture for pain relief, improving sleep quality, and reforming general status in FMS post-treatment, although evidence that it reduces fatigue was not found [33]. There is also evidence that acupuncture potentiates the effect of antidepressants and exercise on pain by up to 30%, with poor, almost nil, adverse effects [17].…”

Acupuncture for Fibromyalgia: An Open‐Label Pragmatic Study on Effects on Disease Severity, Neuropathic Pain Features, and Pain Catastrophizing

“…First of all, this research can be criticized for the fact that no control group was conducted for sham acupuncture to distinguish the placebo components from the verum ones of the treatment. However, on the basis of what has already been observed by some researchers, the use of a sham acupuncture (both minimally invasive and in points outside the meridian), especially in the field of painful diseases, instead of reducing the bias probably introduces others since it is a sensory stimulation not inert [34,35].…”

Best Practices for Chiropractic Management of Patients with Chronic Musculoskeletal Pain: A Clinical Practice Guideline

“…Table 7 summarizes the articles identified after searching for each specific modality from a pool of 348 articles. There were a total of 21 articles: 5 CPGs, 14,17,29,32,33 4 RCTS, [34][35][36][37] and 12 SRs, [38][39][40][41][42][43][44][45][46][47][48][49] as shown by condition and therapy in Table 7.…”

“…Spinal manipulation 97 Myofascial release 97 Acupuncture 44 LLL therapy 43,49 c. Combined active and passive: multidisciplinary rehabilitation d. Mind-body interventions, including CBT, mindfulness meditation, yoga, and t'ai chi, qigong…”