Acupoint Stimulation for Fibromyalgia: A Systematic Review of Randomized Controlled Trials

Table 1

Characteristics of included studies.

Study ID	Diagnostic criteria	Sample size; (T/C, male/female)		Age (yr, T/C)		Duration of disease (month, T/C)		Experimental intervention	Control intervention	Duration of treatment	Outcomes
Assefi et al. 2005 [14]	ACR 1990	3/22	2/69	Unclear		144±216	112.08±120.48	Acupuncture on points chose to treat fibromyalgia according to TCM theory for 30 min, twice weekly	One of three sham acupuncture (false points, not insertion, or unrelated points) for 30 min, twice weekly	12 weeks	Visual Analogue Scores; (VAS) for pain, fatigue,; Sleep, and overall well-being; SF-36; for physical and mental; function; adverse effects
Cao and Li 2003 [15]	ACR 1990	28	28	42.1±14.5		19.3±15.1		Acupuncture plus moving cupping therapy on bilateral Jiaji points, once every 3 days, plus seroxat 20 mg daily	Seroxat 20 mg daily	4 weeks	Hamilton Depression Scale (HAMD); VAS; number of tender points; effective rate
Deluze et al. 1992 [16]	ACR 1990	3/33	13/21	46.8±2.3	49±2	172.8±40.8	82.8±15.6	Electroacupuncture on 4–10 common points with electrostimulation 1–99 Hz, 10 mA, twice weekly for 6 sessions	Sham electroacupuncture on false points (20 mm away from the point which has been chosen for real electroacupuncture) twice weekly for 6 sessions	3 weeks	Pain threshold; number of analgesic tablets; regional; pain score; VAS for pain; Sleep Quaty; morning; stiffness; patients and evaluation physicians; appreciation of the patients general status
Gong and Wang 2010 [17]	ACR 1990	9/21	11/19	35±8	34±6	15.0±3.5	13.0±2.5	Acupuncture at Ashi points and lower Dantian (CV4 and CV6) for 30 min, once daily to twice weekly	Amitriptyline 25 mg twice daily added to 150–300 mg daily for 2 months, then 50–150 mg per month for another month	12 weeks	VAS for pain; sleep quality; HAMD; effective rate
Hadianfard and Parizi 2012 [18]	ACR 1990	0/15	0/15	43.86±7.9	44.2±10.8	82.8±68.4	79.6±69.8	Acupuncture on ST36, GB34, RN6, SP6, LI4, ST44, BL40, HT7, and DU20 for 30 min, three sessions weekly	Fluoxetine 20 mg every morning	8 weeks	VAS; number of tender points; Fibromyalgia impact; questionnaire (FIQ)
Harris et al. 2005 [19]	ACR 1990	0/29; 3/27	4/24; 1/26	46±10.1; 44.5±10.9	51.3±10.0; 48.1±10.9	66±44.52; 63.12±57.96	62.04±50.88; 69.24±49.2	Acupuncture at DU20, LI11, LI4, GB34, bilateral ST36, SP6, Liv 3, and ear-shenmen with manual stimulation for 20 min once to three times weekly; Acupuncture at above points without manual stimulation for 20 min once to three times weekly	Sham acupuncture on nontraditional site with manual stimulation for 20 min, once to three times weekly; Sham acupuncture at above site without manual stimulation for 20 min, once to three times weekly	13 weeks	Numeric Rating Scale (NRS), Multi-Dimensional Fatigue; Inventory questionnaire, Reliability of Change Index; (RC), SF-36 questionnaire for function
Harris et al. 2009 [20]	ACR 1990	0/10	0/10	44.3±13.6		unclear		Acupuncture at DU20, LI11, LI4, GB34, SP6, Liv 3, ear-shenmen, and bilateral ST36 with manual stimulation	Sham acupuncture without penetration on nontraditional site for 20 min	Unclear	Short form McGill pain questionnaire (MPQ); u-opioid receptors (MORs)
Jiang et al. 2010 [21]	ACR 1990	19/43; 15/49	9/51	41.9±9.85; 43.89 ± 10.53	42.83±11.27	22.82±12.26; 21.64±13.80	21.3±12.84	Electroacupuncture at B42, B44, B47, B49, and B52 with 2 Hz/50 Hz stimulation for 20 min, then moving cupping along bilateral 1.6, 4.8, and 10 cm beside the spine for 5 min, three times weekly; Electroacupuncture and moving cupping, plus amitriptyline 25 mg once every night	Amitriptyline 25 mg once every night	4 weeks	MPQ; HAMD; respond time; adverse events; laboratory; tests; effective rate; number of tender points
Lautenschlager; et al. 1989 [22]	Clinical symptoms	25	25	Unclear		unclear		Acupuncture at 8–10 of 25 predefined points with manual stimulation for 45 min, 6 sessions	Sham acupuncture (nonpenetrating) with disconnected laser equipment	2 weeks	VAS
Liu and Li 2002 [23]	IASR	4/26	3/27	29–68	31–69	45.6±16.8	46.8±14.4	Acupuncture at Ashi points with heavy manual stimulation once every 2 min for 6 min, once daily	Ibuprofen 0.3 g three times daily	2 weeks	VAS, number of tender points
Liu 2012 [24]	ACR 1990	5/27; 4/28	4/28	39±6.7; 41±6.4	40±6.6	23±8.7; 23±8.5	23±8.4	Acupuncture at GV20, BI18, BI20, Jiaji, P6, and Ashi for 30 min, once daily; Acupuncture at above points, then injection with 2 mL Vit B12 at BI23 and ST36 once daily	Amitriptyline 25–50 mg once per night	4 weeks	VAS, number of tender points, Ahtens for insomnia; assessment; adverse events; effective rate
Martin et al. 2006 [25]	ACR 1990	25	25	51.7±14.1		47.9±11.2	unclear	Acupuncture at bilateral LI4, ST36, Liv2, SP6, pericardium 6, heart 7, and axial paramedian points along the bladder meridian at cervical spine during first 3 sessions and at the lumbar spine during last 3 sessions; electrical stimulation applied at 2 Hz between LI4 and ST36, and 10 Hz over axial circuits for 20 min once every 2 to 4 days	Sham electroacupuncture (not insertion) 20 min once every 2 to 4 days	2 to 3 weeks	FIQ, Multidimensional Pain Inventory (MPI)
Ruan 2010 [26]	ACR 1990	6/27	5/28	49.0±3.6	50±2.1	9±3.8	10±3.2	Moxibustion at two of the below points: Ashi, Jiaji, GV4, DU3, CV9, GV14, LI10, GB34, B40, B12, once daily	Amitriptyline 10–30 mg twice daily	4 weeks	MPQ; effective rate
Sprott 1998 [27]	ACR 1990	10	10; 10	55		unclear		Electroacupuncture on points according to TCM twice weekly plus basic therapy	Sham acupuncture with disconnected laser equipment plus basic therapy; Sham acupuncture with nonpuncture treatment plus basic therapy	2–4 weeks	Number of tender points; VAS
Targino 2008 [28]	ACR 1990	0/34	0/24	52.09 ± 10.97	51.17±11.20	118.8±117.3	93±75.25	Acupuncture at Ex-HN-3 and bilateral LR3, LI4, PC6, GB34, SP6 for 20 min twice weekly plus standard care (same with control)	Tricyclic antidepressants 12.5–75 mg once daily; walk for 30 min twice weekly; mental relaxation exercise for another 30 min; stretching excise twice weekly	10 weeks	VAS; number of tender points; mean pressure pain; threshold (PPT); SF-36
Yao 2006 [29]	ACR 1990	5/15	4/15	40±8.6	41±8.5	12±3.4	12±4.5	Acupuncture at G20, SI11, LI11, P6, LI4, BI18, Liv14, ST36, SP6, SP10, GB34, SP9, and Ashi for 30 min, once daily	Amitriptyline 30–50 mg once per night	4 weeks	VAS, number of tender points, Ahtens for insomnia; assessment; adverse events; effective rate

T: treatment, c: control.
ACR: American College of Rheumatology criteria for the classification of fibromyalgia.
IASR: International Academy of Soreness Research.