This Month's Clinical Focus: FIBROMYALGIA
Acupuncture found lacking for
fibromyalgia
Fibromyalgia, a debilitating pain syndrome that
affects an estimated 2 to 4 percent of the population, is characterized by
chronic pain, fatigue and difficulty sleeping. It's a somewhat mysterious
condition with no clear-cut cause.
Acupuncture may provide some temporary pain relief for people with fibromyalgia, but does not help with fatigue, sleep problems, or physical function, according to a new research review. However, the results are too inconsistent to recommend acupuncture as a treatment fibromyalgia, the reviewers conclude.
Winfried Hauser of the Klinikum Saarbrucken in Germany and colleagues reviewed seven randomized controlled trials of acupuncture that included a total of 385 people with fibromyalgia. The study subjects were mostly white middle-aged women.
All of the studies used traditional Chinese acupuncture, where fine needles are inserted into specific points in the skin. In addition, two of the studies used electroacupuncture, where the practitioner fits the needles with clips that are attached to a small device that delivers a continuous electrical impulse to stimulate the acupuncture point. Three of the studies used control groups with various kinds of sham or simulated acupuncture, and one compared simulated acupuncture to no treatment.
While the investigators found "strong evidence" that acupuncture relieves fibromyalgia pain, they caution that the results were too inconsistent to recommend it for the management of the condition.
They came to this conclusion mainly because, in one of the seven studies, sham and simulated acupuncture yielded better results than real acupuncture treatment. Furthermore, the authors found that acupuncture-related pain relief only occurred right after treatment, and did not last until the next follow-up.
"Choosing appropriate control conditions in clinical acupuncture trials on chronic pain syndromes is a particularly difficult problem," Hauser noted in an email to Reuters Health.
"Acupuncture is an effective treatment for several painful conditions, and most acupuncture therapists achieve good results for treatment. However, in most studies on acupuncture and pain, there is no difference between acupuncture and the control condition (often sham or minimal acupuncture)," the investigator added.
Despite this lack of strong evidence for acupuncture
in treating fibromyalgia, the authors acknowledge that the treatment is
still popular among patients.
They therefore recommend that further studies be
undertaken, including larger, multi-center studies; studies involving
comparisons with traditional medical treatments; and different forms and
intensities of stimulation (i.e., manual vs. electric
stimulation).
(SOURCE: Rheumatology,
January 25, 2010.)
Immune treatment helps chronic pain patients
Treating the
immune system can dramatically ease suffering
Treating the immune system can dramatically ease the suffering of people with chronic pain from an injured limb or following an amputation, a finding that could change the way such pain is treated, scientists reported.
Researchers from the University of Liverpool said a dose of a blood product called intravenous immunoglobin (IVIG) significantly reduced pain in almost half of patients with Complex Regional Pain Syndrome (CRPS) -- an unexplained chronic condition that can develop after injury to, or loss of, a limb.
"The discovery is expected to have a real impact on the treatment of other unexplained chronic pain conditions; if one pain condition can be effectively treated with an immune drug, then it is possible that other types will also respond," said Andreas Goebel, an expert in pain medicine who led the study.
IVIG is a human blood antibody used to treat immune disorders and some forms of leukemia. It balances immune systems, strengthening those that are weak and reducing activity in those that are overactive.
The researchers, whose study was published in the
Annals of Internal Medicine journal, gave a single low-dose transfusion of
IVIG to 13 volunteers with pain syndrome and found it significantly eased
the pain in just under 50 percent of them.
The pain relief lasted five weeks on average and the treatment had few adverse side effects, they said. "The real effect of this treatment...may turn out to be even greater than what we have already seen," said Goebel.
He said that while the patients in the study were given a single, low-dose infusion of IVIG, the treatment could in future be given in higher doses, and repeated to give extra benefits.
The scientists said they were trying to develop ways to allow patients to administer IVIG treatment in their own homes. According to the researchers, complex regional pain syndrome -- also commonly called reflex sympathetic dystrophy -- can arise after any type of injury.
Some forms follow damage to a nerve, and in some
cases the pain can be so severe that patients request amputation, only to
find that the pain returns in the stump.
(by Kate Kelland, editing by Jon Boyle for
Reuters Health)
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