Verum acupuncture was found to be more effective than sham acupuncture in improving pain, sleep quality, and general status recovery, but not fatigue in patients with fibromyalgia syndrome (FMS), according to a systematic review and meta-analysis published in Evidence-Based Complementary and Alternative Medicine.

The treatment of FMS focuses mainly on symptom control and amelioration and includes the use of alternative medicine approaches such as acupuncture.

A total of 10 randomized controlled trials (RCTs; n=690) conducted between 1990 and 2018, in which the efficacy of verum vs sham acupuncture was examined in patients >17 years of age diagnosed with FMS were analyzed. Eight of these 10 RCTs (n=561) included a meta-analysis. The RCTs were selected through searches of the PubMed, EMBASE, Cochrane Central Register of Controlled Trials, PsycINFO, Chongqing VIP, China National Knowledge Infrastructure, KoreaMed, Oriental Medicine Advanced Searching Integrated System, and Research Information Sharing Service databases.

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In the RCTS, the primary outcome was pain intensity, evaluated with methods that included the visual analog and numeric rating scales. Secondary outcomes included sleep quality, fatigue severity, and general status. Adverse events were also summarized. All included RCTs were assessed using the Cochrane risk for bias tool. The Grading of Recommendations Assessment, Development, and Evaluation tool was used to evaluate the level and quality of evidence.

In 8 of the RCTs, manual acupuncture was examined, and in the other 2, the efficacy of electroacupuncture was investigated. Treatment duration ranged from 1 session to 12 weeks of sessions 1 to 3 times per week. Seven trials were deemed at low risk for bias, and 3 trials were found to have an unclear risk for bias.

Verum vs sham acupuncture was found to be more effective for: pain relief (P =.001), sleep quality (P =.001), and general status recovery (P <.00001), but not for relief from fatigue (P =.61).

The evidence levels for verum vs sham acupuncture efficacy were assessed as moderate for pain relief, low for fatigue, and high for sleep quality, moderate to high for general status. There were 5 RCTs that reported adverse events, including headache, tiredness, bruising, edema, needle insertion point soreness, worsening FMS symptoms, and mild vasovagal symptoms.

Study strengths include subgroup division by sham procedure type, use of validated scales, and effect size estimation based on changed values. Study limitations include a lack of participant blinding in half of the RCTs, and the lack of an adequate number of long-term studies for review.

“The result of this review implies that acupuncture can be used to manage various accompanying symptoms rather than simply using it as a means to reduce pain in FMS,” noted the authors.


Kim J, Kim S-R, Lee H, Nam D-H. Comparing verum and sham acupuncture in fibromyalgia syndrome: a systematic review and meta-analysis. Evid Based Complement Alternat Med. 2019;2019:8757685.

This article originally appeared on Clinical Pain Advisor