Effect of Acupuncture at Tender Points for the Management of Fibromyalgia Syndrome: A Case Series

Abstract

Background

Affecting more women than men, fibromyalgia (FMS) is a rheumatic syndrome characterized by chronic, diffuse and widespread musculoskeletal pain, and its pathogenesis is still unknown. Among the recommended treatments, acupuncture (for its analgesic effects) is an effective option for reducing the pain sensitivity and improving quality of life. Therefore, this study aimed to investigate whether acupuncture at tender points could effectively manage FMS.

Methods

Eight female patients, with a previous diagnosis of fibromyalgia, underwent an initial assessment involving pressure algometer measurements for pain tolerance and questionnaires [Fibromyalgia Impact Questionnaire (FIQ), Heath Assessment Questionnaire (HAQ), Beck Depression Inventory (BDI), and Beck Anxiety Inventory (BAI)], followed by treatment. Over a 2-month period, acupuncture was performed once per week at five tender points, located bilaterally at the occipital bone, trapezius, rhomboid, upper chest and lateral epicondyle. At the end of treatment, the participants underwent a reassessment for a final review of the applied methods.

Results

We observed a reduction in the pain threshold and sensitivity and improvement in the areas of anxiety and depression and quality of life, which were demonstrated using the FIQ, BDI and BAI but not the HAQ.

Conclusion

The results demonstrated the effectiveness of tender-point acupuncture treatment on the patients’ overall well-being, not only by improving quality of life, but also by reducing the pain sensitivity of FMS.

Jessica Lucia Neves Bastos1, Elisa Dória Pires1, Marcelo Lourenço Silva3, Fernanda Lopes Buiatti de Araújo1, 2, Josie Resende Torres Silva3: Department of Pharmacology, Faculty of Medicine of Ribeirão Preto-USP, Avenida Bandeirantes, 3900, CEP 14049-900, Ribeirão Preto, SP, Brazil.

Copyright © 2013 Published by Elsevier B.V.

http://dx.doi.org/10.1016/j.jams.2013.02.001

COMMENTARY

Noteworthy is that this case series investigating acupuncture treatment of 8 women for fibromyalgia was successful at reducing pain and sensitivity, & anxiety and depression and increasing quality of life despite the relatively low treatment frequency (1 treatment per week), and the poor external validity regarding at least number of needles used (5 acu-points needled per treatment).  Many previous studies on painful conditions, especially those from China, typically employ a higher treatment frequency, often 2 to 3 treatments per week.  This study’s treatment methods are also not very representative of a typical acupuncture encounter in the West, as it seemed to employ a less commonly used method for determining the points to be needled: palpating for tender points in relatively broad generalized areas (1. Occipital/ trapezius/ rhomboid muscles; 2. Upper chest; 3. lateral upper forearm) for each participant as the sole (Chinese medical) diagnostic, and needling only 5 points total; more commonly points will be chosen based on the Chinese medical diagnosis, of which there may be many due to the heterogeneity of fibromyalgia symptoms, and the diagnoses are informed not solely through palpation, but also by a complete medical interview, radial pulse palpation, and a visual tongue inspection.  More commonly in a real-world private practice setting far more that 5 needles would be used – often as many as 20-25 needles, and additional physical therapies might be employed, including Cupping, Gua Sha, and Tui Na, not to mention individualized Chinese herbal medicine prescription.   -Boyd Bailey, L.Ac