Acupuncture Beats Or Complements Drugs For Fibromyalgia Relief

Acupuncture Beats Or Complements Drugs For Fibromyalgia Relief - Northfield Clinic, Texarkana

Acupuncture alleviates fibromyalgia syndrome (FMS). Researchers from multiple independent investigations conclude that acupuncture is an effective treatment modality for fibromyalgia patients. One study finds acupuncture effective for enhancing the therapeutic benefits of medications and other studies find acupuncture, as a standalone therapy, more effective than medications for the treatment of fibromyalgia.

Let’s take a look at each study, how they achieved clinical results, and the therapeutic benefits associated with each treatment protocol. First, a brief summary about fibromyalgia syndrome will get us started. FMS is characterized by widespread pain, heightened sensitivity to pain upon pressure, fatigue, and insomnia. FMS may also include other symptoms including digestion disorders, tingling, headaches, anxiety, and impaired cognition. Soft tissues are affected and there is focal tenderness at specific points. A literal translation of the word fibromyalgia is pain of the muscles and fibrous tissues.

Types of Pain
Fibromyalgia is non-nociceptive. Unlike nociceptive pain, which is triggered by pain receptors, non-nociceptive pain does not arise from pain receptors in the skin, muscles, and joints. In addition, non-nociceptive pain does not inherently involve inflammation. It results from a disruption of central processing. Non-nociceptive pain is involved in many other conditions including migraines, neuropathic cancer pain, and irritable bowel syndrome related pain. We’ll take a look at how fibromyalgia syndrome is successfully treated with acupuncture and what results can be expected.

First, we’ll examine the distinct characteristics of non-nociceptive pain. This is important because many patients with persistent non-nociceptive pain are often marginalized due to a lack of understanding. For example, patient care may not extend beyond the administration of antiinflammatory medications and analgesic drugs for the treatment of pain. However, a greater understanding of non-nociceptive pain informs us that painkillers, NSAIDS (non-steroidal antiinflammatory medications), and steroids may not contribute to the reduction of FMS related pain.

Non-nociceptive pain is often chronic. Researchers from the Good Samaritan Hospital and Medical Center (Portland, Oregon) shed some light onto this aspect of pain, noting that “persistent pain is partially or wholly of non-nociceptive afferent origin.” They add, “Non-nociceptive pain is often dependent upon central sensitization induced by prior or ongoing nociception.” [1] Essentially, nociceptive pain may lead to persistent non-nociceptive pain by disrupting central nervous system processing. University of Bristol researchers (Fang et al.) note that “Dorsal root ganglion (DRG) neurones [neurons: cells that transmit nerve impulses] convey somatosensory information as action potentials (APs) to the CNS [central nervous system]. These neurones are of two main types: non-nociceptive neurones that respond to non-noxious, low intensity, normally non-painful stimuli; and nociceptive neurones that respond to noxious, high intensity, normally painful stimuli.” [2] The Good Samaritan Hospital and Medical Center research informs us that nociceptive neuron stimulation may lead to excitation of non-nociceptive neurons. This indicates that conventional pain medications may be helpful but are not sufficient for comprehensive FMS pain management.

Once non-nociceptive pain is identified, alternate medications are often prescribed to patients. For example, Vecht et al. note that non-nociceptive cancer related pain may be treated with amitriptyline (a tricyclic antidepressant drug with tranquilizing effects) or carbamazepine (an anticonvulsant that decreases nerve impulses that cause seizures and pain). [3] In the acupuncture research reviewed in this article, acupuncture has been found to further enhance the analgesic properties associated with amitriptyline for patients with FMS. Moreover, acupuncture has also been found a clinically superior treatment option to amitriptyline when both are compared as standalone treatment modalities.

Acupuncture is an important aspect of Traditional Chinese Medicine (TCM). Treatment modalities including acupuncture and herbal medicine within the TCM system have been used for the treatment of FMS for over a millennia. FMS has been understood within TCM because of its distinct characteristics as a generalized syndrome: widespread pain, sleep disorders, fatigue, memory problems, muscle weakness, and paresthesia. In TCM, this is a classic presentation of qi, blood, and yin deficiency with liver qi stagnation, excess dampness, wei qi obstruction and deficiency, or bi (joint) pain. While these terms seem alien or nonsensical to those unfamiliar with TCM, these differential diagnostic considerations have encompassed a comprehensive clinical understanding of FMS throughout history.

An early recognition in the United States concerning the efficaciousness of acupuncture for FMS was confirmed by department of anesthesiology researchers at the Mayo Clinic College of Medicine (Rochester, Minnesota). The research team notes, “This study paradigm allows for controlled and blinded clinical trials of acupuncture. We found that acupuncture significantly improved symptoms of fibromyalgia. Symptomatic improvement was not restricted to pain relief and was most significant for fatigue and anxiety.” [4]

Complementary Medicine
The first study we review today finds Bo’s abdominal acupuncture an effective complement to amitriptyline for the alleviation of FMS. The 6 week trial compared two patient groups, one receiving Bo’s abdominal acupuncture with amitriptyline and the other receiving only amitriptyline. The results document that Bo’s abdominal acupuncture enhances the alleviation of both pain and depression for FMS patients taking amitriptyline. [5]

Patients were evaluated 3 times throughout the 6 week study: prior to treatment, at the end of the 3rd week, at the end of the 6th week. Evaluation was based on the Visual Analog Scale (VAS), FMS tender points, and the Hamilton Depression Scale (HAM-D). VAS was used to measure pain, on a scale of 0–100 (0 represents no pain at all and 100 represents maximum pain). The HAM-D rates the severity of depression. Scores range from 0–54 (0 is the least and 54 is the most severe).

FMS Tender Points
The 18 FMS tender points occur in symmetrical pairs from the back of the head to the knees. They tend to be painful when pressed and doctors often check for these tender points when diagnosing FMS. The 9 symmetrical pairs are:

  • Occiput: suboccipital muscle insertions
  • Low cervical region: anterior aspects of the intertransverse spaces at C5–C7
  • Trapezius muscle: midpoint of the upper border
  • Supraspinatus muscle: above the medial border of the scapular spine
  • Second rib: at second costochondral junctions
  • Lateral epicondyle: 2 cm distal to the lateral epicondyle
  • Gluteal: at upper outer quadrant of the buttocks
  • Greater trochanter: posterior to the greater trochanteric prominence
  • Knee: at the medial fat pad proximal to the joint line

Taking into account the above three aspects and clinical symptoms, the treatment efficacy for each patient was categorized into 1 of 4 tiers:

  • Clinical recovery: Complete alleviation of whole body pain. No painful tender points. Complete absence of symptoms and physical signs. Normal sleep quality.
  • Significantly effective: Major alleviation of whole body pain. Major decrease in number of painful tender points. ≥50% reduction in VAS and HAM-D scores. ≥2 hours increase in sleep duration for patients with sleep problems.
  • Effective: Alleviation of whole body pain. Decrease in number of painful tender points. ≥25% reduction in VAS and HAM-D scores. ≥1 hour increase in sleep duration for patients with sleep problems.
  • Not effective: No alleviation of whole body pain. No decrease in number of painful tender points. <25% reduction in VAS and HAM-D scores. <1 hour increase in sleep duration for patients with sleep problems.

Results
The treatment effective rate for each group was derived with the following formula: [Clinical recovery + Significantly effective + Effective] / [Total number of patients in group]. At the end of the 3rd week, the abdominal acupuncture with amitriptyline group recorded an 81.8% treatment effective rate, while the amitriptyline group recorded a 60.0% rate. The effective rate of abdominal acupuncture with amitriptyline was already significantly higher (P < 0.05) than standalone amitriptyline at this data point. At the end of the 6th week, the treatment effective rate of the abdominal acupuncture with amitriptyline group rose further to 86.4%, while that of the amitriptyline group showed no further improvement, staying at 60.0%. The researchers note that, based on the data, it is reasonable to infer that abdominal acupuncture strengthens the efficacy of amitriptyline and is a viable complementary therapy for FMS. The VAS, FMS tender points, and HAM-D results provide further insight.

At the end of the 3rd week, the mean VAS score for the abdominal acupuncture with amitriptyline group was 32.1 ± 15.2, and the mean score for the amitriptyline group was 40.1 ± 10.1. At the end of the 6th week, the scores were 29.7 ± 12.5 and 39.1 ± 11.9 respectively. Abdominal acupuncture with amitriptyline significantly outperformed amitriptyline as a standalone therapy (P < 0.05) at both data points. The VAS data indicates that abdominal acupuncture enhances the analgesic properties of amitriptyline therapy for FMS patients.

At the end of the 3rd week, the abdominal acupuncture with amitriptyline group recorded 8.35 ± 1.21 painful tender points on average, while the amitriptyline group recorded 10.3 ± 1.65 painful tender points on average. At the end of the 6th week, the mean number of painful tender points were 7.23 ± 1.53 and 10.2 ± 1.34 respectively. Similar to the VAS scores, abdominal acupuncture with amitriptyline significantly outperformed amitriptyline as a standalone therapy (P < 0.05) at both evaluation data points, demonstrating that abdominal acupuncture increases the efficaciousness of amitriptyline therapy for the reduction of pain in FMS patients.

The HAM-D scores showed the same trend as the previous metrics. At the end of the 3rd week, the mean HAM-D score for the abdominal acupuncture with amitriptyline group was 8.13 ± 2.6, and that for the amitriptyline group was 13.5 ± 2.1. At the end of the 6th week, the scores were 7.01 ± 1.8 and 13.2 ± 2.5 respectively. The HAM-D data demonstrates that abdominal acupuncture increases the anti-depressive effect of amitriptyline therapy, which is important in improving patients’ quality of life.

The clinical trial was set up as described hereafter. A total of 50 FMS patients from the Acupuncture-Tuina Division of Chengdu Traditional Chinese Medicine Hospital were involved in the study. Diagnoses were made in accordance with the criteria set by the American College of Rheumatology (ACR) in 1990 (patients must fulfill both criteria):

  • Whole body pain lasting ≥3 months, spanning multiple areas across the body including the cervical vertebrae, chest, thoracic vertebrae, sides, waist, lower back and lower body.
  • Pain in ≥11 of the 18 tender points upon applying pressure to those points. Pressure was steadily applied for a few seconds using the right thumb, with a force of 4 kg/cm2. Other non-tender control points were also tested to ensure an accurate diagnosis.