Is acupuncture effective in the treatment of fibromyalgia?

BACKGROUND. We conducted this study to assess the effectiveness of acupunct ure in the treatment of fibromyalgia syndrome (FMS), report any adverse eff ects, and generate hypotheses for future investigation. METHODS. We searched MEDLINE, EMBASE, Manual Therapy Information System, th e Cochrane registry, the University of Maryland Complementary and Alternati ve Medicine in Pain, the Centralized Information Service for Complementary Medicine, and the National Institutes of Health Office of Alternative Medic ine databases for the key words "acupuncture" and "fibromyalgia." Conferenc e abstracts, citation lists, and letters supplemented the search. We select ed all randomized or quasi-randomized controlled trials, or cohort studies of patients with FMS who were treated with acupuncture. Methodologic qualit y, sample characteristics, type of acupuncture treatment, and outcomes were extracted. Statistical pooling was not performed because of the difference s in control groups. RESULTS. Seven studies (3 randomized controlled trials and 4 cohort studies ) were included; only one was of high methodologic quality. The high-qualit y study suggests that real acupuncture is more effective than sham acupunct ure for relieving pain, increasing pain thresholds, improving global rating s, and reducing morning stiffness of FMS, but the duration of benefit follo wing the acupuncture treatment series is not known. Some patients report no benefit, and a few report an exacerbation of FMS-related pain. Lower-quali ty studies were consistent with these findings. Booster doses of acupunctur e to maintain benefit once regular treatments have stopped have been descri bed anecdotally but not investigated in controlled trials. CONCLUSIONS. The limited amount of high-quality evidence suggests that real acupuncture is more effective than sham acupuncture for improving symptoms of patients with FMS. However, because this conclusion is based on a singl e high-quality study, further high-quality randomized trials are needed to provide more robust data on effectiveness.