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Manual Acupuncture in Fibromyalgia: A Long-Term Pilot Study
Linköping University, Department of Clinical and Experimental Medicine, Rehabilitation Medicine . Linköping University, Faculty of Health Sciences. Östergötlands Läns Landsting, Centre for Medicine, Pain and Rehabilitation Centre.
Division of Physiology II, Karolinska Institutet, Stockholm, Sweden.
Linköping University, Department of Clinical and Experimental Medicine, Rehabilitation Medicine . Linköping University, Faculty of Health Sciences. Östergötlands Läns Landsting, Centre for Medicine, Pain and Rehabilitation Centre.
1999 (English)In: Journal of Musculoskeletal Pain, ISSN 1058-2452, Vol. 7, no 3, 39-58 p.Article in journal (Refereed) Published
Abstract [en]

Objectives: The aim of this cross-over designed pilot study was to investigate the short-term and long-term effects on pain and other common symptoms present in fibromyalgia [FMS] of manual acupuncture with needles inserted into traditional Chinese acupuncture points.

Methods: Nine out of 10 consecutive FMS patients completed the study. Acupuncture was given in 10-14 sessions over two to three months, followed by an observation period of six months. The control regime consisted of continuous medical management. The patients were evaluated immediately after the completion of the treatment and at 4, 8, 12, and 24 weeks. Pain, sleep, medication, muscle tension, psychological tension, general well-being, the number of tender points, and range of movement in shoulders and neck were assessed.

Results: In general, significantly greater changes occurred for the variables under investigation during the acupuncture period than during the control period. Nine of the 11 outcome variables showed a significant improvement after acupuncture period. The number of tender points was significantly decreased and the sense of well-being significantly improved up to 12 week follow-up. A significant decrease in general pain persisted for eight weeks. Muscle tension and local pain in head, neck, and shoulder regions were significantly reduced throughout the whole 24 week follow-up period. According to the patients' evaluation of global treatment outcome, improvements remained significant until the four week follow-up. Base-line values of well-being and sleep patterns were the most important predictors of treatment outcome.

Conclusion: We conclude that for some FMS patients 10-14 acupuncture sessions seem to give additional benefits over a limited period.

Place, publisher, year, edition, pages
1999. Vol. 7, no 3, 39-58 p.
Keyword [en]
Fibromyalgia, acupuncture, manual needle stimulation, traditional chinese points
National Category
Medical and Health Sciences
Identifiers
URN: urn:nbn:se:liu:diva-12841DOI: 10.1300/J094v07n03_04OAI: oai:DiVA.org:liu-12841DiVA: diva2:17192
Available from: 2008-01-09 Created: 2008-01-09 Last updated: 2009-08-20
In thesis
1. Acupuncture - effects on muscle blood flow and aspects of treatment in the clinicla context
Open this publication in new window or tab >>Acupuncture - effects on muscle blood flow and aspects of treatment in the clinicla context
2004 (English)Doctoral thesis, comprehensive summary (Other academic)
Abstract [en]

The overall aim of this thesis was to elucidate and investigate psychophysiological aspects and effects of acupuncture and needle stimulation. Within this framework emphasis was directed toward the effects of needle stimulation (acupuncture) on muscle blood flow in the tibialis anterior and trapezius muscles in healthy subjects and patients suffering from chronic muscle pain. This study also included evaluation of a new application of photoplethysmography in noninvasive monitoring of muscle blood flow. The evaluation was based on experiments known to provocate skin or muscle blood flow. The psychological aspects studied comprised the effects of manual acupuncture on pain in fibromyalgia patients and the effects of electro-acupuncture on psychological distress and vasomotor symptoms in postmenopausal women in the clinical context.

The results showed that photoplethysmography have potential to noninvasively monitor muscle blood flow and to discriminate between blood flow in skin and muscle, although some considerations still have to be accounted for. It was further shown that muscle blood flow change in response to needle stimulation differed between healthy subjects and patients. Deep needle stimulation in the muscle of healthy subjects consistently increased muscle blood flow more than subcutaneous needle stimulation. In the painful trapezius muscle of FMS patients, however, subcutaneous needling was equal or even more effective in increasing muscle blood flow than deep intramuscular stimulation. Generally, needle stimuli had weak effect on blood flow in the trapezius muscle of the severely affected trapezius myalgia patients, possibly depending on older age and lesser number of patients included in the study. The different patterns of blood flow response to needle stimulation between healthy subjects and patients with chronic muscle pain might be a manifestation of altered somatosensory processing in the patients.

The clinical studies showed that best pain relief of acupuncture in FMS patients was achieved in the neck-shoulder region, while the effect on the generalised symptoms was of short duration. Well-being and sleep was found to best predict treatment outcome. The results suggest that acupuncture treatment may be used for the alleviation of neck-shoulder pain, primarily, but it is not an alternative as the sole treatment. Electro-acupuncture, significantly decreased psychological distress and climacteric symptoms in postmenopausal women, but not better than a (near-) placebo control, implying pronounced non-specific effects.

Abstract [sv]

Akupunktur ingår som en del i traditionell kinesisk medicin (TCM) och har använts i över 2000 år för att lindra sjukdom och symptom. I Sverige blev akupunktur godkänd som smärtlindringsmetod inom Hälso- och Sjukvården 1984. Sedan nästan 10 år är akupunktur jämställd med övrig behandling i sjukvården vilket innebär, att akupunktur kan användas även för behandling av annat än smärta. Förutsättningen är emellertid, att det finns tillräckligt med vetenskapliga belägg, s.k. evidens, för detta. I de allra flesta fall saknas det idag. För att säkerställa att evidens föreligger krävs omfattande forskning om effekter av akupunktur.

Syftet med de olika studierna i avhandlingen var att belysa och studera psykologiska och fysiologiska aspekter och effekter av akupunktur och nålstimulering. Effekt på blodflöde i hud och muskel undersöktes på friska personer och på patienter med kronisk muskelsmärta. Normalt krävs ett mindre kirurgiskt ingrepp för att mäta blodflöde i muskel, men i dessa studier användes en mätmetod, som enkelt och utan ingrepp (icke-invasivt) i normala fall används för att mäta blodflöde i huden, s.k. fotopletysmografi (PPG, eng.). Med hjälp av ny teknik användes PPG i dessa studier för att mäta även muskelblodflöde. En studie för utvärdering av den nya PPG-tekniken ingick också i avhandlingen.

Utvärderingen av mätmetoden visade goda möjligheter att mäta muskelblodflöde icke-invasivt med hjälp av PPG. Hos friska personer blev effekten på blodflödet störst vid djup stimulering i muskeln och där den s.k. DeQi-känslan framkallades (som vid klassisk akupunktur). Hos patienter med fibromyalgi var nålstimulering i huden lika, eller t.o.m. mer, effektiv att öka muskelblodflödet i skuldran än den djupa nålstimuleringen. De olika mönstren av blodflödesökning mellan de friska personerna och patienterna kan bero på ett förändrat reaktionssätt i nervsystemet som svar på smärtsam stimulering.

I två kliniska studier studerades den smärtlindrande effekten av manuell akupunktur vid fibromyalgi och effekten av elektroakupunktur på stress och klimakteriebesvär hos kvinnor i övergångsåldern. Akupunktur vid fibromyalgi visade sig ha bäst smärtlindrande effekt i nack-skulderområdet, medan effekten på de generella symptomen var kortvarig. Patienter som mådde och sov relativt bra erhöll bäst effekt. Efter en behandlingsserie, bestående av elektroakupunktur, minskade stress och klimakteriebesvär påtagligt hos kvinnorna i övergångsåldern, men inte mer än hos en grupp kvinnor, som fick en kontrollbehandling bestående av mycket ytligt placerade nålar i huden. Detta tyder på att en betydlig del av behandlingsresultatet utgjordes av ospecifika effekter eller, s.k. eller placeboeffekter.

Place, publisher, year, edition, pages
Linköping: Linköping University Electronic Press, 2004. 83 p.
Series
Linköping University Medical Dissertations, ISSN 0345-0082 ; 867
Keyword
Acupuncture, muscle blood flow, non-invasive, photoplethysmography, fibromyalgia, pain, postmenopausal symptoms, psychological distress
National Category
Physiotherapy
Identifiers
urn:nbn:se:liu:diva-10456 (URN)91-7373-841-7 (ISBN)
Public defence
2004-11-19, Berzeliussalen, Campus US Linköping University, Linköping, 09:00 (English)
Opponent
Supervisors
Available from: 2008-01-09 Created: 2008-01-09 Last updated: 2012-01-25Bibliographically approved

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Sandberg, MargaretaGerdle, Björn

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