In short, invasive techniques such as acupuncture, electroacupuncture, and dry needling are likely to help reduce the severity of pain and improve function in people with fibromyalgia syndrome. Overall, the evidence is poor and so it should only be left as an additional treatment to exercise.
The syndrome affects about 2% of the world population, with women seven times more likely to suffer from this disease than men. Interestingly, 85% of the cases are between the 4th and 6th decades of life.
In short our general understanding of fibromyalgia syndrome is poor . The exact mechanics of the syndrome are currently unknown. The presence of localized areas with painful "points" that sustain pain impulses is considered an important factor as it affects the hyperactivity and hyperexcitability of the central nervous system. This drives the central awareness process. In addition to muscle pain and tenderness, the psychological symptoms suffered are an essential part of the disease and a continuous source of stress that also contributes to an increasing level of pain.
Since the disease is complex and poorly understood, fibromyalgia cannot be diagnosed for a long time. Some health professionals do not believe the condition is “real”, which invalidates the patient's experience and prevents or even blocks access to necessary treatments. The stigma surrounding the illness is a serious problem and often determines the intensity of the illness. Unfortunately, the way pain is taught during exercise programs feeds this cycle of stigma and misunderstanding, and a change in pain education is urgently needed.
It is time to rethink pain education
Exercise is the best medicine
Exercise and education form the central management strategies of fibromyalgia. According to Cochrane there are gold values that supervised aerobic exercise has positive effects on physical performance and symptoms of the syndrome. Additionally, strength training can have benefits for some FM symptoms, so a combined approach of supervised aerobic and strength training is the best strategy.
From a pharmacological point of view, traditional common analgesics are ineffective for FMS (including paracetamol and ibuprofen). Medicines, sometimes used to treat epilepsy or depression, may be effective in some people with fibromyalgia. Amitriptyline is a potentially useful alternative medicine, but it is only thought to be effective in 1 in 4 more than a placebo, and a third of these patients experience side effects from the drug. This sums up the difficulty in treating FMS. We don't really know what works because we don't understand enough about the condition.
This is one of the reasons why support and symptom control is the best approach for patients. Anecdotally, the use of invasive techniques such as dry needling, acupuncture, and electro-acupuncture are reported to be effective in reducing pain and improving function in patients. The proposed analgesic mechanism of these invasive treatments is both interesting and complex. At the spinal cord level, A-beta, A-delta, C-fibers, and GABA activation as well as activation of the endogenous opioid system have been shown to occur, providing an analgesic effect.
Other studies have shown that invasive techniques influence mental well-being and mental health and thereby reduce the severity of pain. But what does the evidence tell us?
Actupuncture may reduce pain in people with FMS, although the quality of the evidence is poor.
A new systematic review was published in the journal Pain Medicine, which aims to provide information on the effectiveness of acupuncture and dry needles in relieving pain and improving function in people with fibromyalgia syndrome. A total of 16 studies were included in the review, 8 for qualitative analysis and 8 for quantitative analysis.
The result measures used to assess the pain intensity were the visual analogue scale of the Wong-Baker assessment scale for facial pain, the quality of life of which was assessed with the MOSSF-36 or the FIQ.
The research followed a systematic review of best practices by registering with PROSPERO and following PRISMA guidelines throughout. The flowchart was published within the search strategy article. The risk of bias was assessed using CONSORT and the Cochrane RoB tool, which are both reliable tools for this type of research question.
The research followed a systematic review of best practices by registering with PROSPERO and following PRISMA guidelines throughout. The flowchart was published within the search strategy article. The risk of bias was assessed using CONSORT and the Cochrane RoB tool, which are both reliable tools for this type of research question.
The results of this systematic review show that there is evidence of poor quality which suggest that invasive techniques produce a significant reduction in pain intensity and a significant improvement in physical function. The effects of invasive techniques are greater in the short term, and therefore this treatment choice should be used as a complement to long-term management strategies such as exercise and cognitive strategies.
Fibromyalgia is one of the most stigmatized diseases. It is our professional duty to lead the way we think about pain and help improve the function of patients living with long-term complex pain. Check out this short online course created by Kristine Lew and start changing your attitude towards pain.
