Acupuncture

Pain is the most salient feature, ranging from deep muscle aches, throbbing and stabbing to shooting pains and a burning sensation. Patients may have tender points in the knees, hips, spine, shoulders and neck. Hyperalgesia and allodynia are two types of pain that are commonly characterised by FM (NHS, 2014). Other related issues include depression, anxiety, chronic fatigue, cognitive dysfunction, sleep disturbances, morning stiffness, gastrointestinal disorders, irritable bowel syndrome (IBS), and temporomandibular disorder.

The cause of FM is idiopathic – meaning it arises spontaneously or the exact cause is unknown. Some research points towards an injury or trauma to the central nervous system or changes in muscle and connective tissue metabolism, which produces decreased blood flow initiating a pathological cycle of weakness, fatigue and decreased strength that eventually leads to full-blown FM. Another factor could be an undiscovered virus or infectious agent that attacks people who are naturally susceptible to infection.

Diagnosis is based on the American College of Rheumatology (ACR) criteria developed in 1990 and subsequently updated in 2010 (ACR, 2016). There is no definite test for diagnosis and no cure – and medical conditions that mimic the symptoms would need to be ruled out (NHS, 2014).

Focus is based on treatment and management – with medication being the first-line of treatment and a broad range of drugs being used to treat the symptoms.

Medication does not work effectively for all patients, however, and alternative therapies such as acupuncture are often sought (see below).

The effectiveness of treatment is measured by the outcomes on one or more of the key domains of FM:

• Sleep
• Fatigue
• Pain
• Health Related Quality of Life (HRQOL)
• FM impact
• Anxiety and depression

Research has shown that acupuncture can be used to enhance the efficacy of medication and potentially manage the adverse effects. It is thought that acupuncture may overcome the early delay in the therapeutic effects of medication and the early intervention of acupuncture could contribute to a reduction of adverse effects. We use two types of acupuncture to ease the symptoms of FM:

• Dry needling

Trigger points are common amongst FM patients and are a constant source of peripheral pain. Dry needling can reverse some of the central sensitisation, reduce local and referred pain and improve range of motion.

Effective dry needling involves a ‘muscle twitch’ response. When the needle is inserted, biochemical changes take place to inhibit the spasm and reduce the pain and dysfunction on an immediate and short-term basis.

• Electro acupuncture

Electro acupuncture (EA) can also be effective for pain relief and produces analgesic effects that can outlast the needling period. New evidence has emerged that electrical pulse stimulation could be a successful treatment for FM.

Results of research in healthy subjects showed that EA can assist in the treatment of sleep disturbance, fatigue, poor energy, pain and other fatigue-associated chronic diseases and plays a critical role in the pathophysiology of FM (Cordero, 2014).