Skip to main page content
U.S. flag

An official website of the United States government

Dot gov

The .gov means it’s official.
Federal government websites often end in .gov or .mil. Before sharing sensitive information, make sure you’re on a federal government site.

Https

The site is secure.
The https:// ensures that you are connecting to the official website and that any information you provide is encrypted and transmitted securely.

Access keys NCBI Homepage MyNCBI Homepage Main Content Main Navigation
Meta-Analysis
. 2013 May 31;2013(5):CD007070.
doi: 10.1002/14651858.CD007070.pub2.

Acupuncture for treating fibromyalgia

John C Deare  1 , Zhen Zheng, Charlie C L Xue, Jian Ping Liu, Jingsheng Shang, Sean W Scott, Geoff Littlejohn
Affiliations
Meta-Analysis

Acupuncture for treating fibromyalgia

John C Deare et al. Cochrane Database Syst Rev. .

Abstract

Background: One in five fibromyalgia sufferers use acupuncture treatment within two years of diagnosis.

Objectives: To examine the benefits and safety of acupuncture treatment for fibromyalgia.

Search methods: We searched CENTRAL, PubMed, EMBASE, CINAHL, National Research Register, HSR Project and Current Contents, as well as the Chinese databases VIP and Wangfang to January 2012 with no language restrictions.

Selection criteria: Randomised and quasi-randomised studies evaluating any type of invasive acupuncture for fibromyalgia diagnosed according to the American College of Rheumatology (ACR) criteria, and reporting any main outcome: pain, physical function, fatigue, sleep, total well-being, stiffness and adverse events.

Data collection and analysis: Two author pairs selected trials, extracted data and assessed risk of bias. Treatment effects were reported as standardised mean differences (SMD) and 95% confidence intervals (CI) for continuous outcomes using different measurement tools (pain, physical function, fatigue, sleep, total well-being and stiffness) and risk ratio (RR) and 95% CI for dichotomous outcomes (adverse events). We pooled data using the random-effects model.

Main results: Nine trials (395 participants) were included. All studies except one were at low risk of selection bias; five were at risk of selective reporting bias (favouring either treatment group); two were subject to attrition bias (favouring acupuncture); three were subject to performance bias (favouring acupuncture) and one to detection bias (favouring acupuncture). Three studies utilised electro-acupuncture (EA) with the remainder using manual acupuncture (MA) without electrical stimulation. All studies used 'formula acupuncture' except for one, which used trigger points.Low quality evidence from one study (13 participants) showed EA improved symptoms with no adverse events at one month following treatment. Mean pain in the non-treatment control group was 70 points on a 100 point scale; EA reduced pain by a mean of 22 points (95% confidence interval (CI) 4 to 41), or 22% absolute improvement. Control group global well-being was 66.5 points on a 100 point scale; EA improved well-being by a mean of 15 points (95% CI 5 to 26 points). Control group stiffness was 4.8 points on a 0 to 10 point; EA reduced stiffness by a mean of 0.9 points (95% CI 0.1 to 2 points; absolute reduction 9%, 95% CI 4% to 16%). Fatigue was 4.5 points (10 point scale) without treatment; EA reduced fatigue by a mean of 1 point (95% CI 0.22 to 2 points), absolute reduction 11% (2% to 20%). There was no difference in sleep quality (MD 0.4 points, 95% CI -1 to 0.21 points, 10 point scale), and physical function was not reported.Moderate quality evidence from six studies (286 participants) indicated that acupuncture (EA or MA) was no better than sham acupuncture, except for less stiffness at one month. Subgroup analysis of two studies (104 participants) indicated benefits of EA. Mean pain was 70 points on 0 to 100 point scale with sham treatment; EA reduced pain by 13% (5% to 22%); (SMD -0.63, 95% CI -1.02 to -0.23). Global well-being was 5.2 points on a 10 point scale with sham treatment; EA improved well-being: SMD 0.65, 95% CI 0.26 to 1.05; absolute improvement 11% (4% to 17%). EA improved sleep, from 3 points on a 0 to 10 point scale in the sham group: SMD 0.40 (95% CI 0.01 to 0.79); absolute improvement 8% (0.2% to 16%). Low-quality evidence from one study suggested that MA group resulted in poorer physical function: mean function in the sham group was 28 points (100 point scale); treatment worsened function by a mean of 6 points (95% CI -10.9 to -0.7). Low-quality evidence from three trials (289 participants) suggested no difference in adverse events between real (9%) and sham acupuncture (35%); RR 0.44 (95% CI 0.12 to 1.63).Moderate quality evidence from one study (58 participants) found that compared with standard therapy alone (antidepressants and exercise), adjunct acupuncture therapy reduced pain at one month after treatment: mean pain was 8 points on a 0 to 10 point scale in the standard therapy group; treatment reduced pain by 3 points (95% CI -3.9 to -2.1), an absolute reduction of 30% (21% to 39%). Two people treated with acupuncture reported adverse events; there were none in the control group (RR 3.57; 95% CI 0.18 to 71.21). Global well-being, sleep, fatigue and stiffness were not reported. Physical function data were not usable.Low quality evidence from one study (38 participants) showed a short-term benefit of acupuncture over antidepressants in pain relief: mean pain was 29 points (0 to 100 point scale) in the antidepressant group; acupuncture reduced pain by 17 points (95% CI -24.1 to -10.5). Other outcomes or adverse events were not reported.Moderate-quality evidence from one study (41 participants) indicated that deep needling with or without deqi did not differ in pain, fatigue, function or adverse events. Other outcomes were not reported.Four studies reported no differences between acupuncture and control or other treatments described at six to seven months follow-up.No serious adverse events were reported, but there were insufficient adverse events to be certain of the risks.

Authors' conclusions: There is low to moderate-level evidence that compared with no treatment and standard therapy, acupuncture improves pain and stiffness in people with fibromyalgia. There is moderate-level evidence that the effect of acupuncture does not differ from sham acupuncture in reducing pain or fatigue, or improving sleep or global well-being. EA is probably better than MA for pain and stiffness reduction and improvement of global well-being, sleep and fatigue. The effect lasts up to one month, but is not maintained at six months follow-up. MA probably does not improve pain or physical functioning. Acupuncture appears safe. People with fibromyalgia may consider using EA alone or with exercise and medication. The small sample size, scarcity of studies for each comparison, lack of an ideal sham acupuncture weaken the level of evidence and its clinical implications. Larger studies are warranted.

PubMed Disclaimer

Conflict of interest statement

The authors plan to conduct an acupuncture clinical trial on fibromyalgia in the future. No other potential conflicts of interest have been noted.

Figures

1
1
A flow chart of study selection. ('English' refers to English databases and 'Chinese' refers to Chinese databases).
2
2
Methodological quality summary: review authors' judgements about each methodological quality item for each included study.
3
3
Methodological quality graph: review authors' judgements about each methodological quality item presented as percentages across all included studies.
1.1
1.1. Analysis
Comparison 1 Acupuncture versus non‐acupuncture treatment, Outcome 1 Pain up to 1 month after treatment.
1.2
1.2. Analysis
Comparison 1 Acupuncture versus non‐acupuncture treatment, Outcome 2 Global well‐being: rated by participants up to 1 month after treatment.
1.3
1.3. Analysis
Comparison 1 Acupuncture versus non‐acupuncture treatment, Outcome 3 Sleep up to 1 month after treatment.
1.4
1.4. Analysis
Comparison 1 Acupuncture versus non‐acupuncture treatment, Outcome 4 Fatigue up to 1 month after treatment.
1.5
1.5. Analysis
Comparison 1 Acupuncture versus non‐acupuncture treatment, Outcome 5 Stiffness up to 1 month after treatment.
1.6
1.6. Analysis
Comparison 1 Acupuncture versus non‐acupuncture treatment, Outcome 6 Adverse events.
1.7
1.7. Analysis
Comparison 1 Acupuncture versus non‐acupuncture treatment, Outcome 7 Mental well‐being up to 1 month after treatment.
2.1
2.1. Analysis
Comparison 2 Acupuncture versus placebo or sham acupuncture, Outcome 1 Pain (subgroup EA & MA) up to 1 month after treatment.
2.2
2.2. Analysis
Comparison 2 Acupuncture versus placebo or sham acupuncture, Outcome 2 Pain follow‐up to 7 months after treatment (subgroup EA vs MA).
2.3
2.3. Analysis
Comparison 2 Acupuncture versus placebo or sham acupuncture, Outcome 3 Pain: sham non‐invasive acupuncture (not breaking skin) vs sham invasive acupuncture (breaking skin).
2.4
2.4. Analysis
Comparison 2 Acupuncture versus placebo or sham acupuncture, Outcome 4 Physical function (SF‐36).
2.5
2.5. Analysis
Comparison 2 Acupuncture versus placebo or sham acupuncture, Outcome 5 Global well‐being: rated by participants (subgroup EA vs MA) up to 1 month after treatment.
2.6
2.6. Analysis
Comparison 2 Acupuncture versus placebo or sham acupuncture, Outcome 6 Global well‐being follow‐up to 7 months after treatment (subgroup EA & MA).
2.7
2.7. Analysis
Comparison 2 Acupuncture versus placebo or sham acupuncture, Outcome 7 Sleep (subgroup EA & MA) up to 1 month after treatment.
2.8
2.8. Analysis
Comparison 2 Acupuncture versus placebo or sham acupuncture, Outcome 8 Sleep follow‐up to 7 months after treatment (subgroup EA & MA).
2.9
2.9. Analysis
Comparison 2 Acupuncture versus placebo or sham acupuncture, Outcome 9 Fatigue (subgroup EA vs MA) up to 1 month after treatment.
2.10
2.10. Analysis
Comparison 2 Acupuncture versus placebo or sham acupuncture, Outcome 10 Fatigue follow‐up to 7 months after treatment (subgroup EA vs MA).
2.11
2.11. Analysis
Comparison 2 Acupuncture versus placebo or sham acupuncture, Outcome 11 Stiffness up to 1 month after treatment.
2.12
2.12. Analysis
Comparison 2 Acupuncture versus placebo or sham acupuncture, Outcome 12 Stiffness follow‐up to 7 months after treatment.
2.13
2.13. Analysis
Comparison 2 Acupuncture versus placebo or sham acupuncture, Outcome 13 Adverse events.
2.14
2.14. Analysis
Comparison 2 Acupuncture versus placebo or sham acupuncture, Outcome 14 Mental well‐being up to 1 month after treatment.
2.15
2.15. Analysis
Comparison 2 Acupuncture versus placebo or sham acupuncture, Outcome 15 Mental well‐being follow‐up to 7 months.
2.16
2.16. Analysis
Comparison 2 Acupuncture versus placebo or sham acupuncture, Outcome 16 Analgesic use (number of tablets per week) up to 1 month after treatment.
2.17
2.17. Analysis
Comparison 2 Acupuncture versus placebo or sham acupuncture, Outcome 17 Analgesic use (number of participants taking analgesics up to 1 month after treatment).
2.18
2.18. Analysis
Comparison 2 Acupuncture versus placebo or sham acupuncture, Outcome 18 Tenderness up to 1 month after treatment.
2.19
2.19. Analysis
Comparison 2 Acupuncture versus placebo or sham acupuncture, Outcome 19 Overall well‐being: rated by care giver at end of treatment.
3.1
3.1. Analysis
Comparison 3 Acupuncture versus medication, Outcome 1 Pain up to 1 month after treatment.
3.2
3.2. Analysis
Comparison 3 Acupuncture versus medication, Outcome 2 Adverse events.
3.3
3.3. Analysis
Comparison 3 Acupuncture versus medication, Outcome 3 Tenderness up to 1 month after treatment.
4.1
4.1. Analysis
Comparison 4 Acupuncture as an adjunct therapy, Outcome 1 Pain up to 1 month after treatment.
4.2
4.2. Analysis
Comparison 4 Acupuncture as an adjunct therapy, Outcome 2 Pain up to 7 months after treatment.
4.3
4.3. Analysis
Comparison 4 Acupuncture as an adjunct therapy, Outcome 3 Adverse events.
4.4
4.4. Analysis
Comparison 4 Acupuncture as an adjunct therapy, Outcome 4 Tenderness ‐ number of tender points below kg/cm2 up to 1 month after treatment.
4.5
4.5. Analysis
Comparison 4 Acupuncture as an adjunct therapy, Outcome 5 Tenderness ‐ number of tender points below kg/cm2 up to 7 month after treatment.
4.6
4.6. Analysis
Comparison 4 Acupuncture as an adjunct therapy, Outcome 6 Tenderness ‐ mean pressure threshold by pressure algometry up to 1 month after treatment.
4.7
4.7. Analysis
Comparison 4 Acupuncture as an adjunct therapy, Outcome 7 Tenderness ‐ mean pressure threshold by pressure algometry, follow up to 7 months after treatment.
5.1
5.1. Analysis
Comparison 5 Deep needling with stimulation (T/S) versus deep needling without stimulation (T/O), Outcome 1 Pain up to 1 month after treatment.
5.2
5.2. Analysis
Comparison 5 Deep needling with stimulation (T/S) versus deep needling without stimulation (T/O), Outcome 2 Physical function (SF‐36) up to 1 month after treatment.
5.3
5.3. Analysis
Comparison 5 Deep needling with stimulation (T/S) versus deep needling without stimulation (T/O), Outcome 3 Fatigue up to 1 month after treatment.
See this image and copyright information in PMC

Update of

  • doi: 10.1002/14651858.CD007070

References

References to studies included in this review

Assefi 2005 {published and unpublished data}
    1. Assefi NP, Sherman KJ, Jacobsen C, Goldberg J, Smith WR, Buchwald D. A randomised clinical trial of acupuncture compared with sham acupuncture in fibromyalgia. Annals of Internal Medicine 2005;143(1):10‐9. - PubMed
Deluze 1992 {published data only}
    1. Deluze C, Bosia L, Zirbs A, Chantraine A, Visher TL. Electroacupuncture in fibromyalgia: results of a controlled trial. BMJ 1992;305:1249‐52. - PMC - PubMed
Guo 2005 {published data only}
    1. Guo Y, Sun YZ. Clinical study on treatment of fibromyalgia syndrome with penetration needling at back. Chinese Acupuncture & Moxibustion 2005;25(2):98‐100. - PubMed
Harris 2005 {published and unpublished data}
    1. Harris RE, Tian X, Williams DA, Tian TX, Cupps TR, Petzke F, et al. Treatment of fibromyalgia with formula acupuncture: investigation of needle placement, needle stimulation and treatment frequency. Journal of Alternative and Complementary Medicine 2005;11(4):663‐71. - PubMed
Harris 2008 {published and unpublished data}
    1. Harris RE, Sundgren PC, Pang Y, Hsu M, Petrou M, Kim SH, et al. Dynamic levels of glutamate within the insula are associated with improvements in multiple pain domains in fibromyalgia. Arthritis & Rheumatism 2008;58(3):903‐7. - PubMed
Harris 2009 {published and unpublished data}
    1. Harris RE, Zubieta JK, Scott DJ, Napadow V. Traditional Chinese acupuncture and placebo (sham) acupuncture are differentiated by their effects on µ‐opioid receptors (MORs). NeuroImage 2009;47:1077‐85. [Acupuncture vs sham acupuncture] - PMC - PubMed
Itoh 2010 {published and unpublished data}
    1. Itoh K, Kitakoji H. Effects of acupuncture to treat fibromyalgia: a preliminary randomised controlled trial. Chinese Medicine 2010;5(11):1‐7. - PMC - PubMed
Martin 2006 {published and unpublished data}
    1. Martin DP, Sletten CD, Williams BA, Berger IH. Improvements in fibromyalgia symptoms with acupuncture: results of a randomised controlled trial. Mayo Clinic Proceedings 2006;81(6):749‐57. - PubMed
Targino 2008 {published and unpublished data}
    1. Targino RA, Imamura M, Kaziyama HHS, Souza PM, Hsing WT, Furian AD, et al. A randomised controlled trial of acupuncture added to usual treatment for fibromyalgia. Journal of Rehabilitation Medicine 2008;40:582‐8. - PubMed

References to studies excluded from this review

Cao 2003 {published data only}
    1. Cao JQ, Li Y. The combined therapy of anti‐depressants and acupuncture‐moxibustion for fibromyalgia syndrome‐a report of 56 cases. Journal of Chinese Medicine and Drugs 2003;21(5):813‐7.
Cassisi 1994 {published data only (unpublished sought but not used)}
    1. Cassisi G, Roncaglione A, Ceccherelli F, Donolato C, Gagiardi G, Todesco S. Acupuncture treatment for primary fibromyalgia. Confronted with Mianserina [Trattamento agopunturale della fibromialgia primaria. Confronto con Mianserina]. Giornale Italiano Di Riflessoterapia 1994;6(2‐3):5‐9.
Cassisi 1995 {published data only (unpublished sought but not used)}
    1. Cassisi G, Roncaglione A, Ceccherelli F, Donolato C, Gagliardi G, Todesco S. Acupuncture treatment for primary fibromyalgia. Confronted with Mianserina [Trattamento agopunturale della fibromialgia primaria. Confronto con Mianserina]. Giornale Italiano Di Riflessoterapia 1995;7(1):33‐6.
Chen 2009 {published and unpublished data}
    1. Chen ZL. Acupuncture treatment of 32 cases of fibromyalgia syndrome. World Health Digest Medical Periodical 2009;6(24):270‐1.
Collazo Chao 2010 {published data only}
    1. Collazo Chao E. Effectiveness of acupuncture therapy for pain relief in patients with fibromyalgia. Revista Internacional de Acupuntura 2010;4(1):52‐8.
Dai 2009 {published data only}
    1. Dai JZ. Combined therapy of Chinese herbal medicine for primary fibromyalgia: clinical observation of 396 cases. Journal of Beijing University of Traditional Chinese Medicine 2009;32(4):278‐9.
Feldman 2001 {published data only (unpublished sought but not used)}
    1. Feldman D, Mariano E. Treatment of fibromyalgia with acupuncture: a randomised, placebo controlled trial of 16 weeks duration. American College of Rheumatology Meeting. 2001:Abstract 91.
Gong 2010 {published data only}
    1. Gong WZ, Wang YQ. Observation on the therapeutic effect of acupuncture on fibromyalgia syndrome. Shanghai Journal of Acupuncture and Moxibustion 2010;29(11):725‐7.
Gou 2010 {published data only}
    1. Gou AS, Li AH. The effect of electroacupuncture combined with TDP treatment for 36 cases of fibromyalgia syndrome. Journal of Communication 2010;24(4):410‐1.
Guan 2005 {published data only}
    1. Guan BS, Li J. The combined therapy of acupuncture and cupping for fibromyalgia syndrome ‐ a report of 28 cases. Chinese Journal of Gerontology 2005;25:826‐7.
Guevara 2007 {published data only (unpublished sought but not used)}
    1. Guevara M, Scott D, Zubieta J, Clauw D, Harris R. Relationship between expectation and µ‐opioid receptor (MOR) blinding prior acupuncture and sham acupuncture treatment in fibromyalgia. Journal of Pain 2007;8(4):A1‐14.
Guo 2003 {published data only}
    1. Guo XJ, Jia J. Comparison of therapeutic effects transcutaneous electrical nerve stimulation and electroacupuncture on fibromyalgia syndrome. Chinese Acupuncture & Moxibustion 2003;23(11):653‐5.
Guo 2005a {published data only}
    1. Guo X, Jia J. Comparison of therapeutic effects on fibromyalgia syndrome between dermal‐neurological electric stimulation and electric acupuncture. Chinese Journal of Clinical Rehabilitation. 2005;9(46):171‐3.
Harris 2006 {published data only}
    1. Harris RE, Gracely RH, McLean SA, Williams DA, Giesecke T, Petzke F, et al. Comparison of clinical and evoked pain measures in fibromyalgia. Journal of Pain 2006;7:521‐7. - PubMed
Harris 2007 {published data only}
    1. Harris RE, Clauw DJ, Scott DJ, McLean SA, Gracely RH, Zubieta JK. Decreased central µ‐opioid receptor availability in fibromyalgia. Journal of Neuroscience 2007;27(37):10000‐6. - PMC - PubMed
Harris 2007a {published data only}
    1. Harris RE, Zubieta JK, Scott DJ, Gracely RH, Clauw DJ. Differential sustained changes in µ‐opioid receptor (MOR) availability following acupuncture and sham acupuncture therapy in fibromyalgia. Journal of Pain 2007;8(4):A1‐14.
Harris 2007b {published data only}
    1. Harris RE, Scott D, Guevara M, Gracely R, Zubieta J, Clauw D. mu‐Opioid receptor (MOR) binding predicts differential responsiveness to acupuncture and sham acupuncture therapy in fibromyalgia. Journal of Pain 2007;8(4):A1‐14.
Jiang 2010 {published data only}
    1. Jiang ZY, Li CD, Xiou L, Guo JH, He LN, Yue Y, et al. Combination of acupuncture, cupping and medicine for treatment of fibromyalgia syndrome: a multi‐central randomised controlled trial. Chinese Acupuncture and Moxibustion 2010;30(4):265‐9. - PubMed
Lautenschlager 1989 {published data only}
    1. Lautenschlager J, Schnorrenberger CC, Muller W. Acupuncture for generalised Tendomyopathie (fibromyalgia syndrome) [Akupunktur bei generalisierter Tendomyopathie (fibromyalgie‐syndrom)]. Deutsche Zeitschrift Fur Akupunktur 1989;32:122‐8.
Li 2005 {published data only}
    1. Li A, Wang ZL, Ping Y. Clinical observation of the treatment of primary fibrositis syndrome by Ding Tongtang combined with acupuncture. Chinese Journal of Current Clinical Medicine 2004;2(9A):1387‐8.
Li 2005a {published data only}
    1. Li J, Yu HB, Yu Z. The clinical effect of acupuncture and computer intermediate frequency for fibromyalgia syndrome. Chinese Journal of Modern Medicine and Drugs 2005;7(1):42‐4.
Li 2006 {published data only}
    1. Li CD, Fu XY, Jiang ZY, Yang XG, Huang SQ, Wang, et al. Clinical studies on combination of acupuncture, cupping and western medicine for treatment of fibromyalgia syndrome. Chinese Acupuncture & Moxibustion 2006;26(1):8‐10. - PubMed
Li 2008 {published data only}
    1. Li FJ. Shu‐mu combination for the treatment of 26 cases of fibromyalgia. Information on Traditional Chinese Medicine 2008;25(5):75‐6.
Li 2010 {published data only}
    1. Li R, Guo LG. The nursing management for fibromyalgia syndrome. West China Medical Journal 2010;25(3):644.
Lui 2002 {published data only}
    1. Lui Q, Li F. Clinical observation of acupuncture for 30 cases of fibromyalgia. Anthol Med 2002;21:183‐4.
Sandberg 1999 {published data only}
    1. Sandberg M, Lundeberg T, Gerdle B. Manual acupuncture in fibromyalgia: long term pilot study. Journal of Musculoskeletal Pain 1999;7(3):39‐58.
Sandberg 2004 {published data only}
    1. Sandberg M, Lindberg LG, Gerdle B. Peripheral effects of needle stimulation (acupuncture) on skin and muscle blood flow in fibromyalgia. European Journal of Pain 2004;8:163‐71. - PubMed
Sprott 1995 {published data only (unpublished sought but not used)}
    1. Sprott H. [Schmerzbehandlung der generalisierten tendomyopathie (GTM, fibromyalgie) durch akupuntur]. Natura Medicine 1995;10:43‐9.
Sprott 1998 {published data only}
    1. Sprott H. Efficiency of acupuncture in patients with fibromyalgia. Clinical Bulletin of Myofascial Therapy 1998;3(1):37‐43.
Sprott 2000 {published data only}
    1. Sprott H, Jeschonneck M, Grohmann G, Heln G. Changes in blood flow over tender points of fibromyalgia patients after acupuncture (measured with the laser‐doppler flowmeter) [Anderung der Durchblutung uber den tender points bei Fibromyalgie‐Patienten nach einer Akupunkturtherapie (gemessen mit der Laser‐doppler‐flowmetrie)]. Wiener Klinische Wochenschrift 2000;112(13):580‐6. - PubMed
Sun 2008 {published data only}
    1. Sun Y. Acupuncture and moxibustion the treatment for 28 cases of fibromyalgia syndrome. World Chinese Medicine 2008;3(3):170‐1.
Targino 2002 {published data only (unpublished sought but not used)}
    1. Targino RA, Imamura M, Kaziyama HHS, Souza LPM, Hsing WT, Imamura ST. Pain treatment with acupuncture for patients with fibromyalgia. Current Pain and Headache Reports 2002;6:379‐83. - PubMed
Uhlemann 2001 {published data only (unpublished sought but not used)}
    1. Uhlemann C, Schreiber TU, Smolenski UC, Loth D. [Randomisierte studle zur akupunktur und bindegewebsmassage als therapieoption bei patienten mit fibromyalgiesyndrom (FMS)]. Physikalische Medizin Rehabilitationsmedizin Kurortmedizin. 2001; Vol. 11:153.
Wang 2002 {published data only}
    1. Wang SP, Wang XF, Zhang DX, Yang HB. Clinical observation on therapeutic effect of acupuncture treatment based on syndrome differentiation of meridians on fibromyalgia. Chinese Acupuncture & Moxibustion 2002;22(12):807‐9.
Wang 2004 {published data only}
    1. Wang WX, Liu ZT, Wu YC. Clinical observation on acupuncture treatment with differentiation diagnosis for fibromyalgia syndrome: a report of 42 cases. Forum on Traditional Chinese Medicine 2004;19(1):26‐7.
Wei 2006 {published data only}
    1. Wei S, Qu L, Chen ZH, Xu MC. Point injection of snake venom for fibromyalgia syndrome: a report of 50 cases. Journal of Anhui TCM College 2006;25(6):9‐10.
Wu 2003 {published data only}
    1. Wu HJ, Fu LP, Wang RH. Clinical observation on acupuncture treatment of 57 patients with fibromyalgia syndrome. Shanghai Journal of Acupuncture and Moxibustion 2003;22(6):15‐6.
Yao 2006 {published data only}
    1. Yao YP, Zhang XR, Wang X. Acupuncture to regulate DU meridian for treatment of fibromyalgia syndrome. Journal of Clinical Acupuncture and Moxibustion 2006;22(2):24‐5.
Zhang 2001 {published data only}
    1. Zhang YG. Clinical observation on acupuncture treatment of primary fibromyalgia syndrome. Chinese Acupuncture & Moxibustion 2001;21(1):19‐20.
Zhou 2003 {published data only}
    1. Zhou ZH, Yu WT, Wu ZH, Wu BX, Dai YY. Clinical observation of ultra‐laser therapy on primary fibromyalgia syndrome. China Chinese Medicine for Emergency Medicine 2003;12(6):522, 552.

References to ongoing studies

Vas 2011 {published data only}
    1. Vas J, Modesto M, Aguilar I, Santos‐Rey K, Benitez‐Parejo N, Rivas‐Ruiz F. Effects of acupuncture on patients with fibromyalgia: study protocol of a multi centre randomised controlled trial. Trials 2011;12(59):1‐11. - PMC - PubMed

Additional references

Arnold 2006
    1. Arnold LM. Biology and therapy of fibromyalgia. New therapies in fibromyalgia. Arthritis Research Therapy 2006;8(4):212. - PMC - PubMed
Arnold 2011
    1. Arnold LM, Clauw DJ, McCarberg BH, FibroCollaborative. Improving the recognition and diagnosis of fibromyalgia. Mayo Clinic Proceedings 2011;86(5):457‐64. - PMC - PubMed
Bennett 2005
    1. Bennett R. The Fibromyalgia Impact Questionnaire (FIQ): a review of its development, current version, operating characteristics and uses. Clinical and Experimental Rheumatology 2005;23(Suppl 39):S‐154‐62. - PubMed
Bennett 2009
    1. Bennett RM, Friend R, Jones KD, Ward R, Han B, Ross RL. The revised Fibromyalgia Impact Questionnaire (FIQR): validation and psychometric properties. Arthritis Research and Therapy 2009;11(R120):1‐14. - PMC - PubMed
Bergman 2007
    1. Bergman S. Management of musculoskeletal pain. Best Practice & Research Clinical Rheumatology 2007;21(1):153‐66. - PubMed
Berman 1999
    1. Berman BM, Ezzo J, Hadhazy V, Swyers J. Is acupuncture effective in the treatment of fibromyalgia. Journal of Family Practice 1999;48(3):213‐8. - PubMed
Birch 2006
    1. Birch S. A review and analysis of placebo treatments, placebo effects, and placebo controls in trials of medical procedures when sham is not inert. Journal of Alternative and Complementary Medicine 2006;12(3):303‐10. - PubMed
Birtane 2006
    1. Birtane M, Uzunca K, Tastekin Tuna H. The evaluation of quality of life in fibromyalgia syndrome: a comparison with rheumatoid arthritis by using SF‐36 Health Survey. Clinical Rheumatology 2006;5:679‐84. - PubMed
Bombardier 1996
    1. Bombardier CH, Buchwald D. Chronic fatigue syndrome and fibromyalgia. Disability and health‐care use. Medical Care 1996;34(9):924‐30. - PubMed
Boomershine 2009
    1. Boomershine CS, Crofford LJ. A symptom‐based approach to pharmacologic management of fibromyalgia. Nature Reviews Rheumatology 2009;5:191‐9. - PubMed
Burckhardt 1991
    1. Burckhardt CS, Clark SR, Bennett RM. The Fibromyalgia Impact Questionnaire: development and validation. Journal of Rheumatology 1991;18:728‐34. - PubMed
Burke 2006
    1. Burke A, Upchurch DM, Dye C, Chyu L. Acupuncture use in the United States: findings from the National Health Interview Survey. Journal of Alternative and Complementary Medicine 2006;12(7):639‐48. - PubMed
Cao 2002
    1. Cao X. Scientific bases of acupuncture. Acupuncture Electro‐therapeutics Research 2002;27(1):1‐14. - PubMed
Cao 2010
    1. Cao H, Liu JP, Lewith GT. Traditional Chinese Medicine for treatment of fibromyalgia: a systematic review of randomised controlled trials. Journal of Alternative and Complementary Medicine 2010;16(4):397‐409. - PMC - PubMed
Dworkin 2010
    1. Dworkin RH, Turk DC, Peirce‐Sandner S, Baron R, Bellamy N, Burke LB, et al. Research design considerations for confirmatory chronic pain clinical trials: IMMPACT recommendations. Pain 2010;149(2):177‐93. - PubMed
Ezzo 2000
    1. Ezzo J, Berman B, Hadhazy A, Jadad AR, Lao L, Singh BB. Is acupuncture effective for the treatment of chronic pain? A systematic review. Pain 2000;86(3):217‐25. - PubMed
Finniss 2010
    1. Finniss DG, Kaptghuk TJ, Miller F, Benedetti F. Biological, clinical and ethical advances of placebo effects. The Lancet 2010;375:686‐95. - PMC - PubMed
Han 1997
    1. Han J. Acupuncture activates endogenous systems of analgesia. National Institutes of Health Consensus Development Conference on acupuncture. Program and abstracts; 1997 Nov 3‐5; Bethesda (MD). 1997:56.
Higgins 2011
    1. Higgins JPT, Green S (editors). Cochrane Handbook for Systematic Reviews of Interventions Version 5.1.0 [updated March 2011]. The Cochrane Collaboration, 2011. Available from www.cochrane‐handbook.org.
Hudson 2009
    1. Hudson JI, Arnold LM, Bradley LA, Choy EH, Mease PJ, Wang F, et al. What makes patients with fibromyalgia feel better? Correlations between Patient Global Impression of Improvement and changes in clinical symptoms and function: a pooled analysis of 4 randomised placebo‐controlled trials of duloxetine. Journal of Rheumatology 2009;36(11):2517‐22. - PubMed
Katz 2005
    1. Katz RS, Wolfe F, Michaud K. Fibromyalgia diagnosis: a comparison of clinical, survey, and American College of Rheumatology criteria. Arthritis & Rheumatism 2005;54(1):169‐76. - PubMed
Kerr 2011
    1. Kerr CE, Shaw JR, Conboy LA, Kelley JM, Jacobson E, Kaptvhuk TJ. Placebo acupuncture as a form of ritual touch healing: a neuro‐phenomenological model. Consciousness and Cognition 2011;Article in press:1‐8. - PMC - PubMed
Langevin 2011
    1. Langevin HM, Wayne PM, MacPherson H, Schnyer R, Milley RM, Napadow V, et al. Paradoxes in acupuncture research: strategies for moving forward. Evidence Based Complementary and Alternative Medicine 2011;2011(180805):1‐11. - PMC - PubMed
Langhorst 2010
    1. Langhorst J, Klose P, Musial F, Irnich D, Hauser W. Efficacy of acupuncture in fibromyalgia syndrome: a systematic review with a meta‐analysis of controlled clinical trials. Rheumatology (Oxford) 2010;49(4):778‐88. - PubMed
Lawson 2006
    1. Lawson K. Emerging pharmacological therapies for fibromyalgia. Current Opinion Investigating Drugs 2006;7(7):631‐6. - PubMed
Lewith 1983
    1. Lewith GT, Machin D. On the evaluation of the clinical effects of acupuncture. Pain 1983;16:111‐27. - PubMed
Linde 2007
    1. Linde K, Witt CM, Streng A, Weidenhammer W, Wagenpfeil S, Brinkhaus B, et al. The impact of patient expectations on outcomes in four randomised controlled trials of acupuncture in patients with chronic pain. Pain 2007;128(3):264‐71. - PubMed
Linde 2009
    1. Linde K, Allais G, Brinkhaus B, Manheimer E, Vickers A, White AR. Acupuncture for tension‐type headache. Cochrane Database of Systematic Reviews 2009, Issue 1. [DOI: 10.1002/14651858.CD007587] - DOI - PMC - PubMed
Lundeberg 2007
    1. Lundeberg T, Lund I. Are reviews based on sham acupuncture procedures in fibromyalgia syndrome (FMS) valid?. Acupuncture in Medicine 2007;25(3):100‐6. - PubMed
MacPerson 2001
    1. MacPherson H, Thomas K, Walters S, Fitter M. A prospective survey of adverse events and treatment reactions following 34,000 consultations with professional acupuncturists. Acupuncture in Medicine 2001;19(2):93‐102. - PubMed
MacPherson 2002
    1. MacPherson H, White A, Cummings M, Jobst K, Rose K, Niemtzow R. Standards for reporting interventions in controlled trials of acupuncture: the STRICTA recommendations. Acupuncture in Medicine 2002;20(1):22‐5. - PubMed
MacPherson 2004
    1. MacPherson H, Scullion A, Thomas KJ, Walters S. Patients reports of adverse events associated with acupuncture treatments: a prospective national survey. Quality & Safety in Health Care 2004;13(5):349‐55. - PMC - PubMed
Martin‐Sanchez 2009
    1. Martin‐Sanchez E, Torralba E, Diaz‐Dominguez E, Barriga A, Martin JLR. Efficacy of acupuncture for the treatment of fibromyalgia: systematic review and meta‐analysis of randomised trials. Open Rheumatology Journal 2009;3:25‐9. - PMC - PubMed
Mayhew 2007
    1. Mayhew E, Ernst E. Acupuncture for fibromyalgia: a systematic review of randomised clinical trials. Rheumatology (Oxford) 2007;46(5):801‐4. - PubMed
Mease 2005
    1. Mease P. Fibromyalgia syndrome: review of clinical presentation, pathogenesis, outcome measures, and treatment. Journal of Rheumatology 2005;32(Suppl 75):6‐21. - PubMed
Mease 2009
    1. Mease P, Arnold LM, Choy EH, Claw DJ, Crofford L, Glass JM, et al. Fibromyalgia syndrome module at OMERACT 9. Journal of Rheumatology 2009;36(10):2318‐29. - PMC - PubMed
Mense 2003
    1. Mense S. The pathogenesis of muscle pain. Current Pain and Headaches Reports 2003;7(6):419‐25. - PubMed
Muller 2007
    1. Muller W, Schneider EM, Stratz T. The classification of fibromyalgia syndrome. Rheumatology International 2007;27:1005‐10. - PubMed
Ni 1995
    1. Ni M. The Yellow Emperor’s Classic of Medicine. Boston: Shambhala Publications, Inc., 1995.
NIH 1998
    1. National Institutes of Health. NIH Consensus Conference. Acupuncture. JAMA 1998;280(17):1518‐24. - PubMed
Nüesch 2012
    1. Nüesch E, Häuser W, Bernardy K, Barth J, Jüni P. Comparative efficacy of pharmacological and non‐pharmacological interventions in fibromyalgia syndrome: network meta‐analysis. Annals of the Rheumatic Disease 2012 Jun 27 [Epub ahead of print]. - PubMed
Pioro‐Boisset 1996
    1. Pioro‐Boisset M, Esdaile JM, Fitzcharles MA. Alternative medicine use in fibromyalgia syndrome. Arthritis Care Research 1996;9(1):13‐7. - PubMed
Pomeranz 1988
    1. Bars D, Willer JC, Broucker T, Villanueva L. Neurophysiological mechanisms involved in the pain‐relieving effects of counter‐irritation and related techniques including acupuncture. In: Pomeranz B, Stux G editor(s). Scientific Bases of Acupuncture. Berlin: Springer Verlag, 1988:79‐112.
Price 2005
    1. Price DD, Staud R. Neurobiology of fibromyalgia syndrome. Journal of Rheumatology 2005;32(Suppl 75):22‐8. - PubMed
Schneider 2005
    1. Schneider MJ, Brady DM, Perie SM. Commentary: differential diagnosis of fibromyalgia syndrome: proposal of a model and algorithm for patients presenting with the primary symptom of chronic widespread pain. Journal of Manipulative and Physiological Therapeutics 2006;29:493‐501. - PubMed
Scott 2006
    1. Scott SW, Deare JC. Acupuncture for migraine: a systematic review. Australian Journal of Acupuncture and Chinese Medicine 2006;1(1):3‐14.
Sherman 2002
    1. Sherman KJ, Hogboom CJ, Cherkin DC, Deyo RA. Description and validation of a non‐invasive placebo acupuncture procedure. Journal of Alternative and Complementary Medicine 2002;8:11‐9. - PubMed
Sims 1997
    1. Sims J. The mechanism of acupuncture analgesia: a review. Complementary Therapies in Medicine 1997;5(2):102‐11.
Sutton 2000
    1. Sutton AJ, Duval SJ, Tweedie RL, Abrams KR, Jones DR. Empirical assessment of effect of publication bias on meta‐analyses. BMJ 2000;320(7249):1574‐7. - PMC - PubMed
Vickers 2012
    1. Vickers AJ, Cronin AM, Maschino AC, Lewith G, MacPherson H, Foster NE, et al. Acupuncture for chronic pain. Archives of Internal Medicine 2012;September 10:E1‐E10. - PMC - PubMed
Vincent 2001
    1. Vincent C. The safety of acupuncture. BMJ 2001;323(7311):467‐8. - PMC - PubMed
Wallace 2005
    1. Wallace DJ, Clauw DJ. Fibromyalgia & Other Central Pain Syndromes. Philadelphia: Lippincott Williams & Wilkins, 2005.
White 2001
    1. White A, Hayhoe S, Hart A, Ernst E. Survey of adverse events following acupuncture (SAFA): a prospective study of 32,000 consultations. Acupuncture in Medicine 2001;19(2):84‐92. - PubMed
WHO 2002
    1. World Health Organization. Collection of WHO's documents for acupuncture. Beijing, China: The World Federation of Acupuncture‐Moxibustion Societies (WFAS), 2002.
WHO 2007
    1. World Health Organization. WHO International Standard Terminologies on Traditional Medicine in the Western Pacific Region. Manila, Philippines: World Health Organization, 2007. [ISBN 9789290612487]
Wilke 2009
    1. Wilke WS. New developments in the diagnosis of fibromyalgia syndrome: say goodbye to tender points?. Cleveland Clinic Journal of Medicine 2009;76(6):345‐52. - PubMed
Wilson 2009
    1. Wilson HD, Robinson JP, Turk DC. Toward the identification of symptom patterns in people with fibromyalgia. Arthritis & Rheumatism 2009;61(4):527‐34. - PMC - PubMed
Wolfe 1990
    1. Wolfe F, Smythe HA, Yunas MB, Bennett RM, Bombardier C, Goldenberg DL, et al. The American College of Rheumatology criteria for the classification of fibromyalgia. Report of the Multicenter Criteria Committee. Arthritis and Rheumatism 1990;33(2):160‐72. - PubMed
Wolfe 2003
    1. Wolfe F, Editorial. Stop using the American College of Rheumatology criteria in the clinic. Journal of Rheumatology 2003;8:1671‐2. - PubMed
Wolfe 2010
    1. Wolfe F, Clauw DJ, Fitzcharies MA, Goldenberg DL, Katz RS, Mease P, et al. The American College of Rheumatology preliminary diagnostic criteria for fibromyalgia and measurement of symptom severity. Arthritis Care & Research 2010;62(5):600‐10. - PubMed
Zheng 2010
    1. Zheng Z, Feng SJQ, Costa C, Li CC, Lu D, Xue CC. Acupuncture analgesia for temporal summation of experimental pain: a randomised controlled study. European Journal of Pain 2010;14(7):725‐31. - PubMed

Publication types