Background & Aims

Background: The use of acupuncture is related to patients’ expectations, and therapeutic interactions effect remains a topic of debate in the literature. Accordingly, it is still unclear whether acupuncture can generate positive clinical effects in patients with FM. Objective: To determine the effectiveness of acupuncture versus placebo for clinical outcomes and determine the overall effect attributed to contextual effects in patients with FM.

Methods

Design: Umbrella review of systematic reviews and meta-analyses. Data sources and methods: An electronic search was performed in MEDLINE (via PubMed), Web of Science, CENTRAL, EMBASE, LILACS, CINAHL, PEDro, and SPORTDiscus databases from inception until December 2023. Were selected studies with a clinical diagnosis of FM and assesed Pain intensity, functional status, fatigue, sleep quality, and depression symptoms. Effect sizes were calculated as the mean difference (MD) or standard mean difference (SMD) with 95% CI, using the random-effects inverse-variance model with the Hartung–Knapp–Sidik–Jonkman variance estimator. The quality of intervention reporting was assessed using the Assessment of Multiple Systematic Reviews version 2 tool. Updated meta-analyses with risk of bias (ROB) by Cochrane ROB 2.0 were performed, and certainty of evidence was assessed using GRADE approach.

Results

Results: Eleven systematic reviews with 8,399 participants were included. Compared with placebo, acupuncture was associated with reductions in pain intensity (MD= -1.13 cm [95% CI -2.09 to -0.17], p<0.001), physical function (SMD= -0.63 [95% CI -1.67 to 0.41], p = 0.06), sleep quality (SMD= -0.25 [95% CI -1.39 to 0.88], p=0.06) and fatigue (SMD= 0.20 [95% CI = 0.17 to 0.22], p<0.001). The proportion attributable to contextual effects (PCE) of acupuncture was 58% for pain intensity (PCE= 0.58 [95% CI 0.45 to 0.71]), 57% for physical function (PCE= 0.57 [95% CI -0.07 to 1.20) and 69% for fatigue (PCE= 0.69 [95% CI 0.18 to 1.21]).

Conclusions

Conclusion: Acupuncture showed a statistically significant difference in decreased pain intensity and fatigue in women with FM. However, the certainty of evidence was low to very low. In addition, more than 50% of the total treatment effect of acupuncture can be attributed to contextual effects in terms of reduction of pain intensity (58%), improvement of physical function (57%), and reduction of fatigue (69%).

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Presenting Author

Felipe Araya-Quintanilla

Poster Authors

Felipe Araya-Quintanilla, BPT, MsC. PhD

PT, MSc, PhD

Escuela de Kinesiología, Facultad de Odontología y Ciencias de la Rehabilitación, Universidad San Se

Lead Author

E-mail

Robinson Ramírez-Vélez

PhD

Department of Health Sciences, Public University of Navarra, Navarrabiomed-IdiSNA, Complejo Hospital

Lead Author

E-mail

Guillermo Mendez-Rebolledo

PT

Escuela de Kinesiología, Facultad de Salud, Universidad Santo Tomás, Talca 110231, Chile.

Lead Author

E-mail

Iván Cuyul-Vásquez

PT

Dpto. de Procesos Terapéuticos, Facultad de Cs. de la salud. Universidad Católica de Temuco, Chile

Lead Author

E-mail

Alexis Arce-Álvarez

PhD

Universidad San Sebastián

Lead Author

E-mail

Héctor Gutiérrez-Espinoza

PT

Universidad de las Americas, Quito. Ecuador

Lead Author

E-mail

Topics

  • Models: Musculoskeletal

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