Efficacy of acupuncture in fibromyalgia syndrome--a systematic review with a meta-analysis of controlled clinical trials.

Objective. To systematically review the efficacy of acupuncture in fibromyalgia syndrome (FMS). Methods. MEDLINE, PsychInfo, EMBASE, CAMBASE and the Cochrane Library were screened (through July 2009). The reference sections of original studies and systematic reviews for randomized controlled trials (RCTs) on acupuncture in FMS were searched. Results. Seven RCTs with a median treatment time of 9 (range 6-25) sessions and 385 patients were included. Outcomes of interest were key symptoms of FMS, namely pain, fatigue, sleep disturbances, reduced physical function and side effects at post-treatment. Follow-up of two RCTs with a median follow-up of 26 weeks was available. Standardized mean differences (SMDs) comparing verum and control acupuncture were calculated. Strong evidence for the reduction of pain (SMD -0.25; 95% CI -0.49, -0.02; P = 0.04) was found at post-treatment. There was no evidence for the reduction of fatigue and sleep disturbances, or the improvement of physical function at post-treatment. There was no evidence for the reduction of pain and improvement of physical function at the latest follow-up. Subgroup analyses resulted in moderate evidence for a significant and small reduction of pain at post-treatment in studies with electro-stimulation and individualized acupuncture. Stratifying the type of controls (penetrating vs non-penetrating control acupuncture) did not change the results. Significant reduction of pain was only present in studies with risk of bias. Side effects were inconsistently reported. Conclusion. A small analgesic effect of acupuncture was present, which, however, was not clearly distinguishable from bias. Thus, acupuncture cannot be recommended for the management of FMS.