Abstract
The treatment of fibromyalgia syndrome (FMS) is still far from being optimally coded, and pharmacological strategies are often unsatisfactory. Acupuncture plays a role among nonpharmacological intervention approaches; however, there is still no clarity as to when to integrate it into therapy. The objective of this study is to explore the role of acupuncture, in terms of efficacy on main disease severity measures and pain features, in patients with nonresponsive disease, defining nonresponsive FMS characterized by a revised Fibromyalgia Impact Questionnaire (FIQ-R) ≥39 and a Patient Health Questionnaire 15-item (PHQ15) ≥5 despite optimal drug therapy. Patients were treated with weekly sessions, for a total of eight acupuncture sessions. At the baseline and at the end of the treatment cycle, a comprehensive clinical evaluation was carried out to evaluate improvements in terms of disease severity and impact on neuropathic pain features (measured with the painDETECT questionnaire (PDQ)) and pain catastrophizing (measured with the Pain Catastrophizing Scale (PCS)). At the end of the eight-week treatment, patients experienced a significant improvement in all evaluated parameters (for FIQ-R, PDQ, and PHQ15 p < 0.0001, for PCS p=0.001). Of particular note is the effectiveness on manifestations that are difficult to treat such as neuropathic pain features and on negative psychological perceptions such as pain catastrophizing. It can be stated that acupuncture can be proposed also in phases of high severity of disease. Intervention with multimodal strategies, including acupuncture, could be of great benefit to patients.
Highlights
Fibromyalgia syndrome (FMS) still represents an “hard to treat” disease, and current treatment strategies leave a large number of unmet needs in patients. e pharmacological approach is still unsatisfactory considering that drugs currently available provide only modest benefits on pain, often with significant side effects, without having substantial efficacy on fatigue and quality of life compared to placebo [1]
To define nonresponsive FMS, reference was made to the Fibromyalgia Impact Questionnaire (FIQ-R) and to Patient Health Questionnaire 15-item (PHQ15) cutoffs proposed by Hauser and colleagues in 2017 [12]. ese cutoffs considered the achievement of a FIQ-R
We demonstrated the short-term efficacy of an eight-week course of acupuncture, added to the ongoing drug therapy, in patients affected by severe FMS
Summary
Fibromyalgia syndrome (FMS) still represents an “hard to treat” disease, and current treatment strategies leave a large number of unmet needs in patients. e pharmacological approach is still unsatisfactory considering that drugs currently available provide only modest benefits on pain, often with significant side effects, without having substantial efficacy on fatigue and quality of life compared to placebo [1].In 2016, the European League against Rheumatism (EULAR) experts updated the recommendations on the management of FMS, addressing a “weak for” agreement for the use of acupuncture in FMS. E pharmacological approach is still unsatisfactory considering that drugs currently available provide only modest benefits on pain, often with significant side effects, without having substantial efficacy on fatigue and quality of life compared to placebo [1]. Several studies have explored the effects of acupuncture, all showing good effects on pain and health in general in FMS patients [3,4,5,6,7,8]. While until a few years ago, the analgesic effect of acupuncture was considered indistinguishable from that of the bias of studies [9] and acupuncture was not recommended in the treatment of FM, the most recent systematic reviews have reconsidered this position and have confirmed a favourable opinion of acupuncture for FM [10]
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