To systematically review the efficacy of acupuncture
in fibromyalgia syndrome (FMS).
METHODS: MEDLINE, PsychInfo, EMBASE, CAMBASE and the Cochrane
Library were screened (through July 2009). The reference sections
of original studies and systematic reviews for randomized controlled
trials (RCTs) on acupuncture in FMS were searched.
Seven RCTs with a median treatment time of 9 (range 6-25)
sessions and 385 patients were included. Outcomes of interest
were key symptoms of FMS, namely pain, fatigue, sleep
disturbances, reduced physical function and side effects at
post-treatment. Follow-up of two RCTs with a median
follow-up of 26 weeks was available. Standardized mean differences
(SMDs) comparing verum and control acupuncture were calculated.
Strong evidence for the reduction of pain (SMD -0.25; 95% CI
-0.49, -0.02; P = 0.04) was found at post-treatment. There was
no evidence for the reduction of fatigue and sleep disturbances,
or the improvement of physical function at post-treatment.
There was no evidence for the reduction of pain and improvement
of physical function at the latest follow-up. Subgroup analyses
resulted in moderate evidence for a significant and small reduction
of pain at post-treatment in studies with electro-stimulation
and individualized acupuncture. Stratifying the type of controls
(penetrating vs non-penetrating control acupuncture) did not
change the results. Significant reduction of pain was only present
in studies with risk of bias. Side effects were inconsistently
CONCLUSION: A small analgesic effect of acupuncture
was present, which, however, was not clearly distinguishable
Thus, acupuncture cannot be recommended for
the management of FMS.