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Acupuncture for fibromyalgia

Review
Results
Comment

Because fibromyalgia is a difficult painful condition with no easy treatment options, acupuncture is often used. One reason is that 'patients want it'. One wonders whether patients are fully informed. So what is the evidence that acupuncture is effective? A review tells that there is little or no evidence of benefit, but that it might make things worse [1].

Review


The review was done by a complementary medicine group in Baltimore with a deserved reputation for good work. In particular, searching was exemplary, using not only electronic database searching, but special registries, their own registry of complementary medicine in pain and letters to nearly 100 specialised institutions or individuals.

Results


There were three randomised trials, three prospective cohort studies and one retrospective cohort study. The three randomised trials involved 135 patients. Two were of low methodological quality. All the cohort studies were deemed to be of low quality. So that left one randomised trial (done in Geneva [2]) that compared electro-acupuncture with sham electro-acupuncture over three weeks in 70 patients, with no long term outcomes. Acupuncture was reported to be better than sham acupuncture for several outcomes, but there were differences in sex split and duration of disease at baseline, so that it looked like a randomisation failure.

Comment


Does this amount to a row of beans? The review implies that it does, and talks about implications for practice.

Would this level of evidence be acceptable for a new pharmacological or surgical procedure? It would not. The double standards seen from proponents of complementary medicine is really worrying. Unproven treatments are being used that can be harmful, and the review comments that some patients suffered from exacerbation of symptoms.

The use of evidence should be qualitative first and quantitative second. That is why we spend so much time and effort looking for sources of bias. We are rightly concerned about any bias from pharmaceutical companies selling their wares. Should we not equally be concerned when reviews from special interest groups accept any old evidence and ignore the limits we impose for other treatments? And who tells patients that acupuncture for fibromyalgia has limited evidence for effectiveness, but can do real harm? And if not, why not? It should be a lawyer's paradise.

References:

  1. BM Berman et al. Is acupuncture effective in the treatment of fibromyalgia? Journal of Family Practice 1999 48:213-218.
  2. C Deluze et al. Electroacupuncture in fibromyalgia: results of a controlled trial. BMJ 1992 305:1249-1252.
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