Acupuncture for Fibromyalgia Research
Understanding Fibromyalgia
Fibromyalgia is a chronic disorder known for causing widespread musculoskeletal pain along with a variety of other symptoms. People with fibromyalgia often experience persistent pain on both sides of the body and both above and below the waist. Common symptoms include widespread aching or burning pain, profound fatigue, and sleep disturbances (unrefreshing sleep). Many also report morning stiffness, cognitive difficulties often called “fibro fog” (trouble concentrating and remembering), and heightened sensitivity to stimuli like light or noise. It’s not uncommon for fibromyalgia to co-occur with other conditions such as irritable bowel syndrome, headaches, or mood disorders (anxiety and depression). Despite these varied symptoms, standard medical tests (blood work, X-rays) usually come back normal – diagnosis is based on clinical evaluation of symptoms and pain patterns.
Trigger Points (Tender Points): A hallmark of fibromyalgia is the presence of specific tender spots on the body, historically used in diagnosis. In the past, clinicians checked for 18 tender points in specific locations – these are often referred to as fibromyalgia “trigger points.” They occur in symmetrical pairs at nine locations (left and right side) including the lower neck in front, edge of the upper chest, shoulders (near the back of the neck and upper back), elbows, hips (upper outer buttocks), and inner knees. Pressing on these spots with moderate pressure causes localized pain in people with fibromyalgia, whereas the same pressure would not be as painful to someone without the condition. For example, pressing the base of the skull, upper trapezius muscle (back of the shoulder), or the outer knee might elicit intense tenderness in a fibromyalgia patient. These tender points were once central to diagnosis – typically, pain in 11 out of 18 points was the 1990 criteria – but modern guidelines have deemphasized the exact point count. Today, diagnosis focuses more on the overall pattern of widespread pain and other symptoms lasting at least 3 months. Nonetheless, patients still often report certain spots that hurt disproportionately even to light touch (reflecting an increased pain sensitivity known as hyperalgesia).
Impact on Life: The chronic pain and fatigue of fibromyalgia can be debilitating. Simple daily activities – climbing stairs, doing chores, or even prolonged sitting – can become challenging. Sleep is typically disrupted by pain, creating a vicious cycle of fatigue and increased pain sensitivity. Many patients also experience psychological effects; dealing with constant pain often leads to anxiety or depression. Overall, fibromyalgia can significantly reduce quality of life and ability to function, which is why effective management strategies (medical and non-medical) are so important.
Pathophysiology: Mechanisms and Neurotransmitters in Fibromyalgia
Fibromyalgia is understood as a disorder of pain regulation involving the nervous system. In simple terms, the volume knob for pain is turned up too high. Researchers describe fibromyalgia as a classic example of central sensitization, meaning the central nervous system (the spinal cord and brain) becomes hypersensitive to pain signals. Under central sensitization, nerve pathways that normally transmit pain are amplified, and the systems that normally dampen pain are impaired. This leads to pain from stimuli that shouldn’t be so painful (allodynia, e.g. a mild touch feels painful) and an exaggerated pain response to even moderate stimuli (hyperalgesia).
Several neurochemical imbalances have been found in people with fibromyalgia, shedding light on the biology behind this sensitization:
Substance P: Fibromyalgia patients tend to have unusually high levels of substance P in their spinal fluid. Substance P is a neurotransmitter (a chemical messenger) that amplifies pain signals in the spinal cord. Elevated substance P likely contributes to pain amplification – it’s as if the “pain volume” is turned up in the spinal cord, so normal signals are perceived as pain. High substance P is a hallmark found in fibromyalgia research and correlates with the degree of pain reported.
Serotonin and Norepinephrine: These are neurotransmitters involved in the body’s built-in pain inhibition pathways (they help tone down pain signals in the brain and spinal cord). In fibromyalgia, levels of serotonin and norepinephrine are often abnormally low. Low serotonin can also contribute to mood issues and poor sleep. Medications that boost serotonin/norepinephrine (like certain antidepressants) often help fibromyalgia, reinforcing the idea that a deficit of these calming neurotransmitters is part of the problem. Researchers have found fibromyalgia patients have reduced metabolites of serotonin and norepinephrine in cerebrospinal fluid, indicating deficient levels of these neurotransmitters in the central nervous system. This deficiency impairs the normal “brakes” on pain transmission, so pain signals are not adequately dampened.
Glutamate: Glutamate is an excitatory neurotransmitter involved in pain transmission. High levels of glutamate (or increased glutamate receptor activity) have been observed in certain brain regions of fibromyalgia patients, which may drive increased pain perception. Essentially, too much excitatory activity can make the nervous system hyper-reactive. (Some brain imaging studies of fibromyalgia have shown elevated glutamate in the insula, a region processing pain and emotion.)
GABA: In contrast to glutamate, GABA (gamma-aminobutyric acid) is an inhibitory neurotransmitter – it calms down neuronal activity. Some research suggests fibromyalgia patients may have impaired GABA function or lower GABA levels in pain-processing areas. Reduced inhibitory signals (like GABA) means the “off switch” for pain isn’t working well, further contributing to central sensitization.
Endogenous Opioids: The body produces its own pain-relief chemicals, namely endorphins, enkephalins, dynorphins, etc., which bind to opioid receptors to diminish pain (similar to how pain medications work, but naturally produced). There is some evidence that fibromyalgia patients might have an altered endogenous opioid system – for instance, some studies found lower levels of certain endorphins in people with fibromyalgia, though findings are mixed. Regardless, this system is a target for therapies because enhancing the release of these natural painkillers can help control pain.
All these factors – high substance P, low serotonin/norepinephrine, high glutamate, low GABA, and possibly blunted endorphin release – create a state where the volume of pain signaling is turned up and the body’s usual pain dampeners are turned down. This leads to the characteristic widespread pain and tenderness. Brain imaging studies back this up: fibromyalgia patients show augmented pain signal activity in pain-processing regions and sometimes reduced gray matter or receptor levels in areas that inhibit pain. In short, pain processing is out of balance, skewed toward amplification.
How Acupuncture May Affect Fibromyalgia’s Mechanisms
Acupuncture – a therapy from Traditional Chinese Medicine involving insertion of thin needles at specific points – has been studied as a means to re-balance the nervous system and alleviate pain. From a biomedical perspective, acupuncture triggers a cascade of effects in nerves, the spinal cord, and the brain that can counteract some of the fibromyalgia abnormalities:
Stimulation of Nerves and Pain Modulation: When an acupuncture needle is inserted (and often gently manipulated), it stimulates local nerve fibers, particularly A-delta and C fibers (the small nerves that transmit pain and pressure signals). This mild nerve stimulation doesn’t cause injury but sends a burst of signals to the spinal cord and up to the brain. The body recognizes these signals and responds by activating its pain-modulating systems. Specifically, regions like the spinal cord dorsal horn, the brainstem’s periaqueductal gray, and the hypothalamus are engaged – these areas are like pain control centers that can send inhibitory signals back down the spinal cord.
Release of Endogenous Opioids: One well-demonstrated effect of acupuncture is the release of the body’s own opioid-like chemicals. Studies show that acupuncture prompts the secretion of β-endorphin, enkephalin, and other opioid peptides in the central nervous system. These natural opioids bind to pain receptors and diminish pain signal transmission, much like opioid pain medications but without the side effects of drugs. This contributes to an overall analgesic (pain-relieving) effect. In fibromyalgia, where pain is amplified, boosting endorphins is beneficial – it’s essentially increasing the availability of the body’s innate painkillers that fibromyalgia patients may be lacking. (In fact, if opioid blockers like naloxone are given, they can reduce acupuncture’s pain-relief effect, indicating the opioid pathway is key to acupuncture’s mechanism.)
Alteration of Neurotransmitters: Acupuncture also influences levels of various neurotransmitters involved in mood and pain regulation. For example, needling can cause the release of serotonin and norepinephrine in both the central nervous system and bloodstream. This is important for fibromyalgia because, as noted, those chemicals are needed to inhibit pain. By increasing serotonin and noradrenaline, acupuncture may help restore some of the deficient pain inhibition in fibromyalgia. There’s evidence that after acupuncture treatments, fibromyalgia patients show higher serotonin levels and lower substance P levels, aligning with symptom improvement. One controlled trial found that true acupuncture significantly increased serum serotonin by the end of treatment and reduced substance P, whereas sham (fake) acupuncture did not reduce substance P. This suggests acupuncture can push these neurotransmitters in the desired directions – countering the high substance P and low serotonin typically seen in fibromyalgia.
Impact on GABA and Glutamate: Emerging research indicates acupuncture may modulate other neurotransmitters like GABA and glutamate as well. Some studies (often in animal models of pain, but relevant to fibromyalgia) have found that acupuncture upregulates GABA – in other words, it can enhance the action or amount of this inhibitory neurotransmitter. Enhancing GABA would help calm the nervous system and reduce the “volume” of pain signals. Conversely, acupuncture has been noted to downregulate glutamate release or activity in the spinal cord. By reducing excitatory glutamate, acupuncture might quell one of the drivers of central sensitization. Though these findings are more experimental, they provide a plausible biochemical explanation for acupuncture’s pain relief: it increases inhibitors and decreases excitators in the nervous system.
Activation of Descending Inhibitory Pathways: The overall effect of acupuncture needle stimulation is to activate the body’s built-in pain control circuits. The brain sends signals back down the spinal cord to “close the gate” on incoming pain – a process involving neurotransmitters like serotonin, norepinephrine, and endogenous opioids. This gate control theory is a cornerstone of how acupuncture is thought to work. Essentially, acupuncture creates a controlled mild sensory input that causes the nervous system to turn on its anti-pain mechanisms widely, not just at the needle site but throughout the body. This can help raise the pain threshold in fibromyalgia patients, making ordinary touches less painful.
Reduction of Inflammation and Other Effects: Some research also suggests acupuncture may have anti-inflammatory effects, such as influencing cytokines, though this is less established. Stress hormones like cortisol might be regulated by acupuncture as well, contributing to an improved stress response. Additionally, many fibromyalgia patients have autonomic nervous system imbalances (e.g., altered heart rate variability); acupuncture can help normalize autonomic function, promoting relaxation (activating the parasympathetic “rest and digest” response).
In summary, acupuncture appears to counteract fibromyalgia’s pain amplification by triggering a flood of biochemical changes that blunt pain signals. These include releasing natural painkillers (endorphins), boosting mood/pain-inhibiting neurotransmitters (serotonin, norepinephrine, GABA), and reducing pro-pain chemicals (substance P, glutamate). It effectively nudges the body’s nervous system back toward a state of equilibrium where pain is more appropriately regulated. While the exact mechanisms are complex, the overall theme is neurochemical modulation – acupuncture helps reset some of the imbalances (see Table 1 below).
Table 1. Key Neurotransmitters/Mechanisms in Fibromyalgia and Acupuncture’s Effects
| Neurotransmitter / Mechanism | Role in Fibromyalgia | Effect of Acupuncture |
|---|---|---|
| Substance P (pain neurotransmitter) | Elevated levels in fibromyalgia amplify pain signaling pmc.ncbi.nlm.nih.gov . High substance P in spinal fluid correlates with greater pain intensity. | Shown to decrease substance P levels in fibromyalgia patients after treatment pmc.ncbi.nlm.nih.gov, thereby reducing the pain signal amplification. |
| Serotonin & Norepinephrine (mood and pain modulation neurotransmitters) | Low levels in fibromyalgia; contributes to poor pain inhibition and mood issues pmc.ncbi.nlm.nih.gov. These neurotransmitters normally activate descending pathways that blunt pain, but are deficient in FM. | Increases serotonin and norepinephrine release in the central nervous system pmc.ncbi.nlm.nih.gov. This helps enhance the body’s pain-inhibiting pathways; studies show post-acupuncture serotonin rises in FM pmc.ncbi.nlm.nih.gov. |
| Endorphins & Enkephalins (endogenous opioids) | May be underutilized or dysregulated in fibromyalgia (normal pain control via endorphins is not fully effective). | Stimulates release of endorphins and enkephalins, the body’s natural painkillers pmc.ncbi.nlm.nih.gov. These bind to opioid receptors to relieve pain, improving pain tolerance. |
| Glutamate (excitatory neurotransmitter) | Often elevated or overactive in pain pathways, contributing to central sensitization (excessive excitatory transmission). High glutamate activity can heighten pain perception. | Reduces glutamate activity in pain pathways. Research indicates acupuncture can downregulate glutamate release in the spinal cord shaftesburyclinic.com, which may calm excitatory transmission and reduce chronic pain. | GABA (inhibitory neurotransmitter) | Possibly low or ineffective in fibromyalgia’s pain pathways, failing to adequately inhibit pain signals. (Fibro patients show signs of reduced GABAA receptor density in pain areas pmc.ncbi.nlm.nih.gov.) | Upregulates GABA and its receptors. Acupuncture has been shown to increase GABA levels or activity shaftesburyclinic.com, enhancing inhibitory effects on pain transmission (helping “turn down” pain signal intensity). | Descending Pain Modulation (overall pathway) | Impaired in fibromyalgia – the “pain brakes” (from brain to spinal cord) are weak due to low serotonin/NE and other factors pmc.ncbi.nlm.nih.gov . This allows pain signals to flood in unchecked. | Activates descending inhibitory pathways: acupuncture engages brainstem and spinal cord circuits to release inhibitory neurotransmitters and opioids pmc.ncbi.nlm.nih.gov, effectively reinforcing the pain brakes and raising the pain threshold. |
Notes: FM = fibromyalgia; NE = norepinephrine. Acupuncture’s effects listed above are based on findings from clinical studies and experimental models. By modulating these biochemical factors, acupuncture aims to restore balance in pain processing for fibromyalgia patients.
Clinical Evidence: Acupuncture for Fibromyalgia
A number of clinical trials and research studies have evaluated acupuncture as a treatment for fibromyalgia. These include randomized controlled trials (RCTs) in patients, as well as systematic reviews that pool data from multiple studies. Overall, the evidence suggests that acupuncture can provide relief for some fibromyalgia symptoms, although results vary between studies and the degree of benefit (especially compared to sham acupuncture) has been debated.
Cochrane Review Findings: One of the most respected sources of evidence is the Cochrane Collaboration, which conducted a comprehensive review of acupuncture for fibromyalgia. According to a 2013 Cochrane systematic review (updated from an earlier 2008 version by Deare et al.), acupuncture showed significant benefits over no treatment in fibromyalgia patients. Specifically, fibromyalgia sufferers who received acupuncture had less pain and stiffness and reported improved overall well-being and less fatigue compared to those who had no acupuncture or standard care. Importantly, the Cochrane review noted that the type of acupuncture mattered: trials using electroacupuncture (acupuncture with mild electrical stimulation through the needles) tended to show greater improvements. Acupuncture with electrical stimulation was “probably better” than manual acupuncture alone in reducing pain and stiffness and in improving sleep and fatigue. In contrast, acupuncture without electrical stimulation (just manual needle insertion) by itself had more mixed results – the Cochrane reviewers found that ordinary acupuncture probably does not produce a large reduction in pain or fatigue when compared to a sham procedure. This suggests the possibility that stronger stimulation (via electricity) might be needed to get a robust effect, or that placebo effects play a role in the more minimal acupuncture techniques. Another observation from Cochrane was that acupuncture can enhance the effects of other therapies: fibromyalgia patients receiving combined treatments (e.g. acupuncture in addition to exercise or medications) showed better pain relief than those doing the other therapy alone. In other words, acupuncture may have an additive benefit in a multimodal treatment plan.
Randomized Controlled Trials (RCTs): Many individual RCTs have compared real acupuncture to sham acupuncture (a fake version, such as inserting needles at non-acupuncture points or using non-penetrating sham needles) or to other controls in fibromyalgia:
Karatay et al. (2018, Turkey): This RCT divided fibromyalgia patients into three groups: real acupuncture, sham acupuncture, and simulated treatment (a kind of placebo control without true needle insertion). After a course of treatments, both the real and sham acupuncture groups showed significant improvements in fibromyalgia symptoms over baseline. Patients reported less pain, fewer tender points, less fatigue, and better mood after one month of either real or sham acupuncture. (This highlights a strong placebo or expectation effect, which is common in pain trials.) However, only the true acupuncture produced objective biochemical changes consistent with fibromyalgia improvement: in the real acupuncture group, serotonin levels increased and substance P levels decreased significantly, whereas in the sham group substance P did not decrease. Additionally, the real acupuncture group maintained some improvements slightly longer than the sham group. By seven months post-treatment, the initial gains had diminished in both groups, suggesting that ongoing or booster sessions might be needed for sustained relief. This trial’s takeaway is that acupuncture can indeed lead to symptom improvement (partly via placebo response), but it also exerts specific physiological effects not seen with a simulated placebo, potentially underlying a genuine treatment benefit.
Other RCTs: Several other controlled studies have found positive short-term effects of acupuncture. For example, multiple trials reported that real acupuncture improved pain scores and quality of life more than sham acupuncture in the first 1–2 months of treatment. Some studies noted improvements in specific domains like sleep quality – one analysis of a few small RCTs found that real acupuncture led to better sleep outcomes than sham. Fatigue and anxiety symptoms have also been observed to improve more with real acupuncture in some trials. On the other hand, not every study finds a clear advantage for true acupuncture. In one 100-patient double-blind trial, real acupuncture did not significantly outperform sham acupuncture – both groups improved about equally, with no significant differences in pain scores between actual and placebo needling. Such results suggest a large placebo effect and/or that acupuncture’s specific benefits can be subtle or require larger sample sizes to detect.
Meta-analyses: Beyond Cochrane, other meta-analyses have aggregated data from RCTs. Zhang et al. (2019) conducted a meta-analysis of 12 randomized trials (across databases including PubMed) specifically examining acupuncture for fibromyalgia. They found that overall, real acupuncture was associated with greater short-term pain relief than sham (placebo) acupuncture – on average fibromyalgia pain was moderately reduced in the weeks following treatment. However, the evidence for long-term benefits (months after treatment) was of low quality or mixed; some patients tend to relapse or pain creeps back up without ongoing sessions. The meta-analysis also noted improvement in quality of life measures with acupuncture compared to sham, although again the evidence was not high quality and results varied by study. In summary, this synthesis supports that acupuncture can yield meaningful short-term improvements in fibromyalgia pain and quality of life, but maintaining those gains may require continued therapy or booster treatments, and more rigorous long-term studies are needed.
Comparative Effectiveness: Some trials have compared acupuncture to other treatments rather than placebo. For instance, one study compared acupuncture to conventional transcutaneous electrical nerve stimulation (TENS) in fibromyalgia. TENS is a physical therapy technique where electrical pads on the skin deliver mild shocks to relieve pain. In that trial, both acupuncture and TENS produced significant pain reduction and increased certain indicators of central pain inhibition, with no major difference in outcomes between the two therapies. Both were better than no treatment. This suggests acupuncture’s benefits for pain might be on par with some well-established physical modalities. Another pilot trial compared acupuncture to a combination of hot pack therapy and electrotherapy (common physical therapy treatments) and found both approaches improved fibromyalgia pain and symptoms, with no significant difference between them. These results highlight that acupuncture is at least as effective as some standard non-drug therapies for fibromyalgia. Such findings are encouraging because they position acupuncture as a viable option within an integrative approach to fibromyalgia management.
Notably, many fibromyalgia patients seek out acupuncture as part of their care. An NIH survey found about 1 in 5 fibromyalgia patients try acupuncture within the first two years of diagnosis, indicating considerable patient-driven interest (even when evidence was still emerging). Over the years, the accumulation of trials has led to greater acceptance of acupuncture among clinicians as a complementary treatment for fibromyalgia – especially given its relatively low side-effect profile.
However, it’s important to acknowledge the placebo effect and study limitations in this body of research. Fibromyalgia outcomes (like pain scales and fatigue scores) are heavily subjective, and placebo responses in pain can be strong. Many acupuncture studies have small sample sizes, and “sham” acupuncture is an imperfect placebo (even inserting needles in the “wrong” locations or just under the skin can have some physiological effect). As a result, differences between real and sham acupuncture are sometimes small. Some experts argue that, placebo or not, if the patient feels better and functionality improves, the treatment is useful – especially for a difficult condition like fibromyalgia that often has no complete cure. The key is that acupuncture has shown at least modest efficacy without significant adverse effects in most trials.
To summarize the clinical evidence:
Short-term (up to 1-3 months): Acupuncture tends to improve pain, stiffness, fatigue, and wellbeing in fibromyalgia. Many patients report feeling better for days to weeks after a session. Meta-analyses indicate a real benefit beyond placebo in the short term.
Long-term: Benefits may diminish over time if acupuncture is not continued. Some trials show that by 6+ months after a course of acupuncture, pain scores can drift back up towards baseline (similar to what happens if you stop fibromyalgia medications or exercise). Ongoing maintenance sessions (e.g. monthly) might help sustain improvements, but more research is needed here.
Relative to Sham: When comparing true acupuncture to sham acupuncture, results are mixed – some studies show clear advantages for true acupuncture, especially in pain reduction and biochemical changes, while others show both real and sham help about equally (suggesting patient expectation plays a role). Electroacupuncture seems to more consistently outperform sham, hinting that the intensity of stimulation matters.
Safety: Virtually all reviews note that acupuncture is safe and well-tolerated when performed by trained professionals. The risk of serious side effects is very low (estimated well below 1 in 10,000). Minor side effects like slight bleeding, bruising, or temporary soreness at needle sites can occur, but systemic adverse effects are rare. This safety profile often contrasts favorably with medications, which can have significant side effects in some fibromyalgia patients.
For a quick overview of some key clinical studies and reviews on acupuncture for fibromyalgia, see Table 2 below.
Table 2. Selected Clinical Studies on Acupuncture in Fibromyalgia
| Study / Review (Year) | Design and Participants | Key Findings |
|---|---|---|
| Cochrane Systematic Review (2013) – Deare et al. cochrane.org | Pooled analysis of multiple RCTs comparing real acupuncture vs. sham or other controls in fibromyalgia. | Acupuncture (especially electroacupuncture) was better than no treatment for reducing pain and stiffness and improving fatigue and overall well-being. Acupuncture with electrical stimulation outperformed manual acupuncture alone in relieving symptoms cochrane.org. Manual acupuncture without electrical stim showed minimal improvement over sham for pain or sleep cochrane.org. Acupuncture also enhanced effects of standard care (e.g. added pain relief when combined with meds/exercise) cochrane.org. |
| Zhang et al. (2019) – Meta-Analysis pmc.ncbi.nlm.nih.gov | Meta-analysis of 12 RCTs (real acupuncture vs sham) in fibromyalgia patients. | Real acupuncture led to greater short-term pain reduction than sham (moderate-quality evidence) and improved quality of life scores pmc.ncbi.nlm.nih.gov. Long-term effects (beyond a few months) were less certain, with only low-quality evidence of sustained benefit pmc.ncbi.nlm.nih.gov. Overall, suggests acupuncture provides meaningful short-term symptom relief in fibromyalgia. |
| Karatay et al. (2018) – Randomized Trial pmc.ncbi.nlm.nih.gov pmc.ncbi.nlm.nih.gov | 75 women with fibromyalgia randomized to real acupuncture, sham acupuncture (needles at non-acupoints), or simulated acupuncture (no skin penetration). | After 4 weeks, both real and sham groups improved in pain, fatigue, mood, and tender point count (placebo effect notable) pmc.ncbi.nlm.nih.gov. Only real acupuncture reduced Substance P and raised serotonin levels significantly pmc.ncbi.nlm.nih.gov. Benefits in both groups waned by 7 months, but real acupuncture showed a trend of more sustained improvement. Indicates real acupuncture has a physiological effect (neurotransmitter changes) beyond placebo. |
| 100-patient Double-blind RCT (2016) – Author not stated pmc.ncbi.nlm.nih.gov | Large RCT comparing true acupuncture vs. sham (needle insertion at non-therapeutic points) under double-blind conditions. | No significant difference between real and sham acupuncture in primary outcomes. Both groups had modest improvements in pain and function, and real acupuncture was not statistically superior pmc.ncbi.nlm.nih.gov. This trial highlights a strong placebo response; results suggest that patient expectations and non-specific effects may account for much of the benefit in some cases. |
| Overview of CAM Therapies (2020) – Langhorst et al. (German review) pmc.ncbi.nlm.nih.gov | An overview of systematic reviews evaluating complementary & alternative medicine (CAM) treatments (acupuncture, massage, hydrotherapy, etc.) for fibromyalgia. | Concluded that acupuncture showed the most consistent effectiveness among CAM therapies for fibromyalgia symptom relief pmc.ncbi.nlm.nih.gov. In some analyses, acupuncture’s benefits were greater than those of other alternatives like homeopathy or herbal remedies. However, when comparing to sham acupuncture, results were mixed, leading authors to note ongoing debate about how much is specific effect vs placebo pmc.ncbi.nlm.nih.gov. Acupuncture was recommended as a reasonable adjunct therapy given its safety and patient satisfaction levels. |
Abbreviations: RCT = randomized controlled trial; CAM = complementary and alternative medicine. Sham acupuncture refers to a control procedure intended to mimic acupuncture without activating true acupoints (to act as a placebo).
Comparing Acupuncture with Other Fibromyalgia Treatments
Fibromyalgia is a complex condition, and typically a multidisciplinary approach is recommended. Patients often utilize a combination of treatments, including medications, physical therapies, exercise, and complementary therapies. Here we compare acupuncture with some other key treatment modalities for fibromyalgia, in terms of mechanisms, effectiveness, and practical considerations:
Medications (Pharmacological Treatments)
Standard Drugs for Fibromyalgia: There are a few medications specifically approved for fibromyalgia, and others used off-label. The main classes include:
Antidepressants: Particularly SNRIs (serotonin-norepinephrine reuptake inhibitors) like Duloxetine (Cymbalta) and Milnacipran (Savella), and tricyclics like Amitriptyline. These help boost serotonin/norepinephrine and can reduce pain and improve sleep.
Anticonvulsants/Neuropathic agents: e.g. Pregabalin (Lyrica) and Gabapentin, which calm nerve firing.
Muscle relaxants: e.g. Cyclobenzaprine, which can improve sleep and muscle pain.
Analgesics: Simple pain relievers (acetaminophen) or tramadol; opioids are generally not very effective in fibromyalgia and are not recommended long-term.
Others: SSRIs, NSAIDs, etc., have limited benefits for fibro pain but might help comorbid issues.
Effectiveness: Medications can provide partial relief. Typically, about 30–50% of patients will get a moderate improvement in pain (defined as perhaps a 30% reduction in pain intensity) with a given medication, as seen in clinical trials. However, no drug completely eliminates fibromyalgia pain, and many patients have to try different medications or combinations to find relief. A 2020 systematic review and meta-analysis (Mascarenhas et al., published in JAMA Internal Medicine) found that antidepressants and certain anticonvulsants (central nervous system depressants) do lead to small reductions in pain and improvements in quality of life in fibromyalgia. For example, duloxetine or amitriptyline might reduce pain scores by about 1 point on a 0–10 scale more than placebo on average. These improvements are statistically significant, but the review noted that often they do not reach the threshold of a clinically important difference for many patients (commonly defined as ~2 points on a 0–10 pain scale). In short, medications help, but usually don’t completely solve fibromyalgia pain.
Side Effects: Unlike acupuncture, drugs come with systemic side effects. Antidepressants can cause nausea, dry mouth, drowsiness, weight gain, or elevated blood pressure. Pregabalin and gabapentin can cause dizziness, sedation, swelling, and weight gain. These side effects can limit how high a dose patients can tolerate, and some patients discontinue meds due to side effects. There’s also a risk of medication interactions when multiple drugs are used.
Acupuncture vs Medications: Acupuncture, by contrast, has minimal systemic side effects – its risks are mostly localized and procedural. Acupuncture doesn’t cause weight gain, cognitive fog, or gastrointestinal upset like some drugs do. However, medications are convenient (oral pills) and can be taken daily, whereas acupuncture requires clinic visits. In terms of pain relief magnitude, studies suggest acupuncture’s pain reduction is comparable to or slightly better than that of some medications in the short term, but direct comparisons are few. Some clinical guidelines actually recommend considering acupuncture especially if medications are not sufficient or not tolerated. An interesting finding from Cochrane was that acupuncture combined with medications yielded better pain relief than medications alone– so they can be complementary. Many patients use both: medication for baseline control and acupuncture for additional relief.
In summary, medications are a cornerstone of fibromyalgia management, but they offer partial relief with notable side effect trade-offs, whereas acupuncture offers a non-pharmacologic alternative that can augment pain relief without adding drug side effects. Table 3 below will further compare these modalities.
Exercise and Physical Therapy
Role of Exercise: Extensive research shows that regular exercise is one of the most beneficial therapies for fibromyalgia. It may sound counterintuitive to exercise when in pain, but appropriate exercise can improve pain in the long run. Aerobic exercise (cardio activities like walking, swimming, cycling) and strength training have been studied. Aerobic exercise improves cardiovascular fitness and can modestly improve pain threshold and fatigue. Strength training (lifting light weights or resistance exercises) helps build muscle endurance and has been shown to produce large reductions in pain and tender point sensitivity in some fibromyalgia studies. Exercise likely works by enhancing blood flow, reducing inflammation, and releasing endorphins, as well as improving overall fitness which increases pain tolerance.
Evidence: A Cochrane review on exercise for fibromyalgia found that moderate-intensity aerobic training over 12 weeks improved overall well-being and physical function. Pain improvement with aerobic exercise alone was mild (and not immediate), but strength training showed larger pain reductions in the short term. Importantly, exercise also helps with fatigue and mood over time, and improves sleep quality for many. The challenge is that benefits are seen after several weeks of consistent exercise, and symptoms might flare initially as the body adapts.
Physical Therapy Modalities: In addition to prescribed exercise, physical therapists can provide targeted treatments such as stretching routines, hydrotherapy (water therapy), gentle range-of-motion exercises, heat therapy (hot packs), and TENS (Transcutaneous Electrical Nerve Stimulation). These modalities aim to reduce muscle tension, increase circulation, and alter pain signal transmission. For example, TENS uses mild electrical currents on the skin to interfere with pain signaling, somewhat analogous to acupuncture’s goal (but without needles). As noted, studies have found TENS can yield similar pain relief to acupuncture in fibromyalgia– both tapping into the body’s nerve modulation mechanisms.
Adherence and Safety: Exercise and PT are generally very safe, though patients must start slowly to avoid flares (post-exertional pain increases can happen if overdoing it). The key is gradual progression. Many patients find it hard to stick to an exercise routine due to fatigue and pain; behavior strategies or supervised exercise programs can help with adherence.
Acupuncture vs Exercise: These are quite different modalities – one passive, one active. Exercise directly addresses deconditioning and can empower patients to manage symptoms, while acupuncture is a passive treatment given by a practitioner. Both have roles. Exercise is strongly recommended by experts as a foundational therapy for fibromyalgia, because of its broad benefits (physical and mental). Acupuncture can be an add-on for pain relief, especially during periods when pain is too high to exercise comfortably. Some comparative insight: a study in BMJ (2018) involving 226 fibromyalgia patients found that Tai Chi (a gentle form of exercise combining movement and mindfulness) was actually more effective at relieving fibromyalgia symptoms than aerobic exercise over 24 weeks. Tai Chi incorporates slow movement, deep breathing, and meditative aspects – interestingly, it’s rooted in the same tradition as acupuncture (Chinese medicine) – so it may share some neurobiological effects (stress reduction, endorphin release). The takeaway is not that exercise is unhelpful, but that mind-body exercises can be particularly potent.
In practice, many patients will do mild exercise and stretching daily, see a physical therapist for specific therapies, and possibly use acupuncture for additional relief. They address fibromyalgia from multiple angles.
Cognitive Behavioral Therapy (CBT) and Psychological Support
Fibromyalgia is not “all in the head” by any means, but the mind-body connection is strong. Chronic pain can be exacerbated by stress, and conversely, techniques that improve coping can reduce the perception of pain. Cognitive Behavioral Therapy (CBT) is a structured therapy that helps patients reframe negative thoughts and develop strategies to manage symptoms. It has one of the highest levels of evidence among non-drug therapies: high-quality studies show CBT provides short-term pain relief in fibromyalgia, with a meta-analysis finding a modest but significant reduction in pain scores (about 0.9 points on a 0–10 scale better than controls). CBT can also help with fatigue and insomnia by teaching pacing strategies and sleep hygiene.
Other psychological approaches include mindfulness-based stress reduction (MBSR), meditation, or biofeedback. These aim to reduce the stress and anxiety that often aggravate fibromyalgia symptoms. By calming the central nervous system (lowering stress hormone levels and muscle tension), these methods can indirectly lessen pain. For example, mindfulness meditation has shown improvements in quality of life and pain acceptance in some fibro trials.
Acupuncture vs CBT: They’re quite different; one alters physiology through physical intervention, the other through mental training. Interestingly, acupuncture itself can have relaxing, anxiety-reducing effects – many patients report improved well-being and lower stress after sessions (possibly due to endorphin and serotonin release). CBT requires active patient participation and has no physical risks, whereas acupuncture requires needles but no homework. Both can be combined: some fibromyalgia programs include both acupuncture and CBT (acupuncture to reduce pain enough so patients can engage in exercise/CBT more effectively). High-quality evidence supports CBT for pain and antidepressants for quality of life in the short term, so these are considered key components; acupuncture is considered an adjunct that can further help pain and other symptoms.
Other Complementary and Alternative Therapies
Beyond acupuncture, fibromyalgia patients explore many alternative therapies. A few popular ones include:
Massage Therapy: Therapeutic massage can loosen tight muscles, improve circulation, and reduce stress. Fibromyalgia often involves muscle knots and myofascial trigger points; massage (especially specific types like myofascial release or lymphatic massage) can significantly reduce pain and improve quality of life for some patients. One study found that certain massage techniques (manual lymph drainage and connective tissue massage) led to less pain and better daily functioning in women with fibromyalgia. Massage provides temporary relief and relaxation; it’s safe when done gently (deep, aggressive massage might be too painful for fibro patients).
Chiropractic and Osteopathic Manipulation: Some patients seek chiropractic adjustments or osteopathic manual therapy to address musculoskeletal pain. The evidence is limited, and while some people report improvement in back or neck pain, it’s not a core fibromyalgia treatment in guidelines.
Supplements: Various vitamins and supplements have been tried (magnesium, vitamin D, B12, CoQ10, etc.). There is some evidence that certain supplements (like magnesium or vitamin D if the patient is deficient) can help fatigue or pain, but results are inconsistent. They may be used on an individual basis.
Herbal Remedies: Herbs like turmeric (for inflammation) or CBD oil (cannabidiol) are used by some. Rigorous evidence is sparse; some patients find them helpful anecdotally.
Mind-Body Practices: We discussed exercise and Tai Chi; similarly Yoga (which combines physical activity with stretching and mindfulness) has shown promise. Preliminary studies and patient reports suggest yoga can improve pain, fatigue, and mood in fibromyalgia. Yoga’s gentle movements and breathing exercises might act through similar pathways as exercise and stress reduction techniques. Meditation and guided imagery can help reduce the perception of pain by refocusing the mind.
Other TCM (Traditional Chinese Medicine) approaches: Some patients use herbal medicine or cupping in conjunction with acupuncture. There’s not much high-quality evidence for these specifically in fibromyalgia, but they may provide some relief or placebo benefit for certain individuals.
In comparison to these, acupuncture stands out as one of the more studied and supported alternative therapies for fibromyalgia. Reviews of multiple alternative therapies have concluded that acupuncture had the best evidence for effectiveness relative to things like homeopathy, reflexology, or aromatherapy. That said, alternative therapies are often complementary rather than either-or. For example, a patient might do acupuncture weekly and also attend a gentle yoga class twice a week – the combination might yield better results than either alone.
Each therapy has its pros and cons, and often a combination is tailored to the patient’s preferences and responses. The table below (Table 3) summarizes and compares acupuncture with other treatments on key points:
Table 3. Comparison of Acupuncture with Other Fibromyalgia Treatments
| Treatment Modality | Examples / Approach | Benefits for Fibromyalgia | Considerations / Limitations |
|---|---|---|---|
| Acupuncture (with or without electrostimulation) | Fine needles inserted at specific points (1–3 sessions per week typical initial course). | – Can reduce pain, stiffness, and fatigue in many fibromyalgia patients
cochrane.org.
– Especially effective when electrostimulation is used (enhanced pain relief, better sleep) cochrane.org. – Minimal side effects (no systemic effects; low risk if done by qualified practitioner). – Also helps anxiety, stress, and overall well-being (holistic benefit). |
– Results can be variable; some patients have strong improvement, others modest changes.
– Mixed evidence vs. placebo: some benefit likely due to placebo effect, and not all studies show acupuncture outperforming sham pmc.ncbi.nlm.nih.gov. – Requires time and access to a trained acupuncturist (ongoing sessions for sustained relief). – Often not fully covered by insurance, so cost can accumulate for long-term use. |
| Medications (Pharmacotherapy) | Duloxetine, Milnacipran (SNRIs); Pregabalin, Gabapentin; Amitriptyline; Cyclobenzaprine; etc. | – Convenient (oral daily treatments) that can reduce pain and improve sleep in many patients.
– Some drugs (e.g. duloxetine, pregabalin) are FDA-approved for fibromyalgia, backed by RCTs showing moderate symptom improvements. – Meds like antidepressants can also help mood and fatigue, addressing comorbid depression/anxiety. | – Partial relief only: average pain reductions are small to moderate, often not meeting “clinically important” thresholds
healio.com (e.g., <2 points on a 10-point scale).
– Side effects are common: e.g. weight gain, drowsiness, cognitive dulling, high blood pressure, dry mouth, etc., depending on the drug healio.com. – Finding the right medication can be trial-and-error; some patients don’t tolerate or respond to certain meds. – Long-term medication use requires monitoring; risk of polypharmacy if multiple drugs combined. |
| Exercise & Physical Therapy | Aerobic exercise (walking, swimming, biking); Strength training; Stretching; Physical therapy sessions (heat therapy, TENS, hydrotherapy). | – Improves overall function and fitness: regular exercise increases strength/endurance, which correlates with less pain and fatigue in daily life
cochrane.org.
– Can lead to pain reduction: e.g., strength training showed large pain decrease in some trials cochrane.org; aerobic exercise improves pain thresholds and mood. – Enhances energy and sleep over time; reduces deconditioning. – PT modalities like TENS or warm water therapy can provide short-term pain relief and relaxation of muscles. |
– Requires consistent effort and motivation, which is challenging when in pain. Many patients struggle with adherence.
– Benefits are not instant – may take weeks of gradual training to see improvement. Pain may flare in early stages (requires patience and pacing). – If done improperly or too intensely, exercise can temporarily worsen pain (need tailored gentle programs). – Physical therapy appointments (for modalities) may have logistical/insurance limitations. – Comparative: Exercise is foundational for long-term management, whereas acupuncture might provide quicker short-term pain relief; ideally used together (acupuncture can reduce pain enough to allow more exercise). |
| Cognitive Behavioral Therapy (CBT) and Mind-Body Therapies | CBT sessions with a therapist (typically weekly for ~8 weeks); Mindfulness meditation; Yoga, Tai Chi classes. | – CBT has proven benefits: helps patients cope better, leading to small but real reductions in pain and improvements in mood
healio.com. Equips patients with mental tools to manage flare-ups and stress.
– Mind-body exercises like Tai Chi and yoga can improve both mental and physical aspects: one study found Tai Chi outperformed aerobic exercise in symptom reduction health.harvard.edu; yoga can alleviate pain and mood symptoms health.harvard.edu. – These therapies can empower patients, reduce distress, and improve quality of life (addressing the psychosocial component of fibromyalgia). | – Time and commitment needed for therapy and practice (CBT requires active mental work; yoga/Tai Chi require attendance and practice).
– Access can be an issue: need a trained CBT therapist or suitable classes, which may not be available everywhere or covered by insurance. – Benefits might be subtle or gradual – some patients don’t perceive immediate pain relief, but rather improved coping. – Not a direct “fix” for pain; works best as part of a comprehensive plan (e.g., combining CBT with exercise and/or acupuncture for multidimensional care). |
| Massage & Other Complementary Therapies | Therapeutic massage (myofascial release, lymphatic drainage); Chiropractic adjustments; Supplements (e.g. magnesium, vitamin D); Herbal remedies; etc. | – Massage: Can provide significant temporary relief, reducing muscle tension and pain, and improve mood and sleep (hands-on care is comforting). Studies show improved pain thresholds and quality of life with certain massage techniques
healthline.com.
– Relaxation therapies (spa, hydrotherapy): Warm baths, flotation therapy, etc., can soothe aches and reduce stress short-term. – Supplements: If a patient has deficiencies (like low vitamin D or magnesium), correcting them can improve energy and possibly pain. Some supplements (CoQ10, amino acids) are being studied for fibromyalgia with some positive preliminary results pmc.ncbi.nlm.nih.gov. |
– Short-lived effects: Massage or a hot tub may ease pain for hours or days but typically needs repetition; it’s symptomatic relief.
– Evidence for most supplements/herbals is limited or anecdotal. What helps one patient might do nothing for another. Quality control of supplements can also be an issue. – Chiropractic manipulation has mixed reviews in fibromyalgia and could even trigger pain if not gentle. – Cost/access: These therapies (especially regular massage) can be expensive and are not always covered by insurance. – Best used as adjuncts for additional relief or relaxation, rather than sole treatments. |
As the comparison shows, each modality addresses fibromyalgia in a different way, and no single treatment is universally effective. Multimodal therapy – combining medication, exercise, education, and complementary therapies – often yields the best overall outcome. Acupuncture fits into this as a relatively low-risk option that can target pain and associated symptoms. For some patients, it can make a significant difference, especially when standard treatments fall short or cause side effects.
Conclusion
Fibromyalgia is a challenging chronic pain syndrome with diverse symptoms. Its hallmark widespread pain is linked to amplified pain processing in the nervous system, involving neurotransmitter imbalances and central sensitization. Acupuncture, with its roots in ancient practice and its growing evidence base in modern medicine, offers a valuable complementary approach to fibromyalgia management. It works by modulating the very mechanisms that fibromyalgia disrupts – boosting pain-inhibiting chemicals (like endorphins, serotonin, and norepinephrine) and calming overactive pain pathways (reducing substance P, glutamate, and hyper-excitability).
Human studies, including randomized trials and systematic reviews, generally support that acupuncture can alleviate fibromyalgia symptoms, especially pain and stiffness, and often improve fatigue, sleep, and overall well-being at least in the short term. While results can vary and the placebo effect must be considered, acupuncture’s risk-benefit profile is favorable. Many patients report meaningful relief, and objective improvements (such as normalized neurotransmitter levels and better sleep) have been documented.
When comparing acupuncture to other treatments, it is not necessarily a standalone “cure” but rather one piece of the puzzle. Conventional treatments like medications and exercise address fibromyalgia from other angles – addressing chemical imbalances and physical deconditioning – and acupuncture can augment these approaches. In fact, the best outcomes often come from a combination: for example, a patient might take an SNRI for baseline pain control, do swimming or yoga for fitness and stress reduction, and receive acupuncture weekly for additional pain and sleep improvements. This integrative strategy leverages the strengths of each modality.
In practical terms, a fibromyalgia patient considering acupuncture should ensure they see a licensed acupuncturist (or an MD/DO with acupuncture training). Typically, a trial of about 6–8 sessions is recommended to gauge response. If the patient notices improvements, they can continue with maintenance sessions as needed. If there’s no benefit, other therapies should be prioritized. Communication between the patient’s healthcare providers is also key – letting the rheumatologist or primary doctor know about acupuncture (and any other alternative therapies) ensures coordinated care.
To conclude, acupuncture is a scientifically supported complementary therapy for fibromyalgia that can safely provide relief for many patients. It aligns well with our understanding of fibromyalgia’s neurochemical basis, offering a means to nudge the body back toward pain regulation. While not a magic bullet, it can significantly improve quality of life for some individuals when used as part of a holistic treatment plan. As research continues, we’ll better understand how to optimize acupuncture (e.g. ideal frequency, point selection, use of electrostimulation) to maximize benefits for fibromyalgia. For now, patients and clinicians can be cautiously optimistic that this age-old therapy has a place in the modern care of fibromyalgia – helping turn down the volume on widespread pain and giving patients another tool to regain control over their lives.
Sources:
Bennett, R. M., & Goldenberg, D. L. (2011). Fibromyalgia, myofascial pain, tender points and trigger points: splitting or lumping? Arthritis Research & Therapy, 13(3), 117. Retrieved from http://www.ncbi.nlm.nih.gov/pmc/articles/PMC3218900
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Karatay, S., Okur, S. C., Uzkeser, H., Yildiz, M., & Koca, S. S. (2018). Effects of Acupuncture Treatment on Fibromyalgia Symptoms, Serotonin, and Substance P Levels: A Randomized Sham and Placebo-Controlled Clinical Trial. Pain Medicine, 19(3), 615–628. DOI: 10.1093/pm/pnx263. Retrieved from https://academic.oup.com/painmedicine/article/19/3/615/4689181
Langhorst, J., et al. (2014). Complementary and Alternative Therapies for Fibromyalgia. Current Rheumatology Reports, 16(4), 1–8. (Referenced in Efficacy of acupuncture review). Overview of CAM interventions finding acupuncture effective. Retrieved from https://orthopedicreviews.openmedicalpublishing.org/article/8560-acupuncture-in-fibromyalgia (content referenced in text)
Mascarenhas, R. O., et al. (2021). Association of Therapies With Reduced Pain and Improved Quality of Life in Patients With Fibromyalgia: A Systematic Review and Meta-analysis. JAMA Internal Medicine, 181(1), 104–112. DOI:10.1001/jamainternmed.2020.5651. (Summarized in Healio article by Miller, 2020). Retrieved from https://www.healio.com/news/rheumatology/20201026/most-fibromyalgia-therapies-lack-highquality-evidence-supporting-their-use
National Institute of Arthritis and Musculoskeletal and Skin Diseases (NIAMS). (2024, May). Fibromyalgia: Overview, Symptoms, & Causes. Retrieved from https://www.niams.nih.gov/health-topics/fibromyalgia
Uçeyler, N., Häuser, W., & Sommer, C. (2011). A systematic review on the effectiveness of treatment with antidepressants in fibromyalgia syndrome. Arthritis Care & Research, 63(1), 79–93. DOI: 10.1002/acr.20327. (Provides context on serotonin/norepinephrine role and antidepressant use).
U.S. Department of Health and Human Services, Centers for Medicare & Medicaid Services (CMS). (2020). Decision Memo for Acupuncture for Fibromyalgia. (Indicated insufficient evidence at that time, prompting further studies). Retrieved from https://www.cms.gov/medicare-coverage-database (Referenced for historical context).
Wang, C., et al. (2018). Effect of tai chi versus aerobic exercise for fibromyalgia: comparative effectiveness randomized controlled trial. BMJ, 360, k851. DOI: 10.1136/bmj.k851. Retrieved from https://www.bmj.com/content/360/bmj.k851
Wolfe, F., et al. (1990). The American College of Rheumatology 1990 Criteria for the Classification of Fibromyalgia. Arthritis & Rheumatism, 33(2), 160–172. (Established the tender point criteria; historical reference).
Wolfe, F., & Häuser, W. (2011). Fibromyalgia diagnosis and diagnostic criteria. Annals of the Rheumatic Diseases, 70(5), 641–648. DOI: 10.1136/ard.2010.131 bus. (Discusses evolution from tender points to symptom-based diagnosis).
Web Sources for Patient Education (accessed 2025): Healthline – Fibromyalgia Tender Points: Locations and Coping; Mayo Clinic – Fibromyalgia: Diagnosis & Treatment (notes on acupuncture evidence); Harvard Health Blog – Fibromyalgia: Exercise helps — here’s how to start (Kelly Bilodeau, 2020).