"This study shows there is something real about acupuncture and its effects on fibromyalgia," says David Martin, M.D., Ph.D., Mayo Clinic anesthesiologist and the study's lead investigator. "Our study was performed on patients with moderate to severe fibromyalgia. It's my speculation that if acupuncture works for these patients with recalcitrant fibromyalgia -- where previous treatments had not provided satisfactory relief -- it would likely work for many of the millions of fibromyalgia patients."
Acupuncture could fill a gap in available therapies for the disease as something additive to what medications already can provide, says Dr. Martin. "There's not a cure available, so patients are often left somewhat frustrated by continuing pain and fatigue," he says. "Acupuncture is one of the few things shown to be effective for these symptoms. It may be particularly attractive to patients who are unable to take medications because of intolerable side effects."
The study, conducted by Mayo Clinic physicians specializing in pain management, included 50 patients diagnosed with fibromyalgia for whom other symptom-relief treatments were ineffective. The patients were randomly assigned to receive acupuncture or simulated acupuncture and were not informed which treatment they received; these treatments were administered in six sessions over two to three weeks.
All patients were given questionnaires before treatment, immediately after treatment, and at one and seven months after treatment to determine the degree of symptoms they experienced and how the disease affected their daily lives.
Patients who received acupuncture experienced minimal side effects. Following treatments, symptoms of pain, fatigue and anxiety were most significantly improved in the patients given acupuncture. At seven months post-treatment, the patients' symptoms of pain, anxiety and fatigue had returned to baseline levels; the patients experienced the largest improvement at one month following treatment.
"We expected the acupuncture to improve the pain," says Dr. Martin. "We didn't really expect the largest benefit to be in fatigue or anxiety."
Dr. Martin hypothesizes that acupuncture affects symptoms such as anxiety and fatigue because it may target the root cause and not the daily symptoms of fibromyalgia. "In a Western view of medicine, we're modulating sensory input through acupuncture," he says. "Whenever there's an input to the nervous system, it responds and adapts to the input -- sometimes in ways that are beneficial to patients. This is not so different from the traditional Eastern explanation of acupuncture that describes needles as altering the flow of life energy, called Qi."
The Mayo Clinic researchers noted that although the patients saw improvement in symptoms which had reduced activity level, physical function did not increase even though the patients were less tired and felt less pain. "This doesn't surprise me, as we see this pattern in other chronic pain problems: you can relieve pain, but it's a lot harder to prompt activity changes," says Dr. Martin. "A chronically ill person needs more than symptom relief to resume a normal lifestyle. We're now beginning to work on that problem."
Dr. Martin indicates that he believes the study patients would have seen sustained improvement with ongoing acupuncture. "It's a reasonable expectation that if they received more acupuncture after two to three months, they would have maintained their improvement," he says. "Acupuncture usually works for about three months, and then patients need a less-intensive treatment session. These patients would need more acupuncture periodically for as long as they experience fibromyalgia symptoms."
The patients were unable to guess whether they had been given the real or the simulated acupuncture. "This was critical, because this had been a shortcoming of other previous studies with acupuncture -- the simulated acupuncture treatments were not believable to the patients," says Dr. Martin.
He explains that fibromyalgia patients have a nervous system disorder in which they have a "revved up pain threshold" which is exacerbated by stress and inadequate sleep. "You can take blood tests, X-rays, muscle tests, and you will find nothing abnormal," he says. "Many fibromyalgia patients suffer suspicion from their spouses and friends that their symptoms are 'all in their head' or that they lack sufficient will or fortitude to meet their obligations to work, family and friends. Usually it comes as a welcome diagnosis when these patients learn it's fibromyalgia. Then they can learn ways to cope with the disorder and gain strength from sharing with others who have the same problems."
Dr. Martin describes the patients in this study as moderately debilitated. "Many have given up work, a lot of recreational activities, and made adjustments in their lives," he says. "They have had a significant psychological burden as a result of the loss of these activities; it's become part of their identities."
Dr. Martin says he'd recommend acupuncture for patients who are receptive to the concept. The acupuncture used in this study is available in most communities. Dr. Martin says that to find a qualified acupuncturist, "Talk to your doctor. Many physicians are open to complementary medical techniques and can refer you to qualified practitioners in your area. There are also excellent resources on the Internet from the National Center for Complementary and Alternative Medicine (http://nccam.nih.gov)."
Joining Dr. Martin in this research were Mayo Clinic investigators Christopher Sletten, Ph.D.; Ines Berger, M.D. (currently practicing at the Medical College of Georgia in Augusta); and Brent Williams.
NOTE: Dr. Martin will only be available for interviews Aug. 15-19, 2005.
VIDEO ALERT: Video, including b-roll and sound bites from a doctor and a patient are available through Pathfire's Digital Media Gateway (DMG). See end of this release for details.
EMBARGOED: Hold for release until abstract presentation on Wednesday, Aug. 24 at 10 p.m. CDT The International Association for the Study of Pain 11th World Congress on Pain, Sydney, Australia, www.iasp-pain.org
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