ACUPUNCTURE ET FIBROMYALGIE

ACUPUNCTURE ET FIBROMYALGIE
QUESTION:
Est ce que l'acupuncture est efficace en fibromyalgie?
AUTEURE :
Nancy Guirguis (MOIS – ANNÉE)
P
:
Patient diagnostique avec fibromyalgie
I
:
Acupuncture
C
:
Rien
O
:
Control des douleurs
CONTEXTE:
Je croyais que l’acupuncture pouvait être efficace pour les douleurs de fibromyalgie.
Toutefois, Up to date, mentionne que c'est peu efficace mais, que c'est efficace en
douleur chronique!!
RECHERCHE:
Mots de recherche :Fibromyalgie et acupuncture
Cochrane: 18 résultats, 1 protocole pertinent
Acupuncture for treating fibromyalgia JC Deare, Z Zheng, CC Xue, J Liu, J Shang,
SW Scott Year: 2008
DARE: 5 résultats, 3 pertinents, et 1 étude sur la douleur chronique en général, pas
incluse
1. Complementary and alternative medicine in fibromyalgia and related syndromes
(Structured abstract)
2. Is acupuncture effective in the treatment of fibromyalgia? (Structured abstract)
3. Acupuncture for fibromyalgia: a systematic review of randomized clinical trials
(Provisional record) - citée en pub med
Clinical evidence:
rien
Pub Med:
1. Acupuncture for fibromyalgia—a systematic review of randomized clinical trials
2. A randomized controlled trial of acupuncture added to usual treatment for
fibromyalgia
3. Improvement in fibromyalgia symptoms with acupuncture: results of a randomized
controlled trial
RÉSULTATS
1) Acupuncture for fibromyalgia, A systematic review of randomized clinical trials,
Rheumatology 2007 46(5):801-804; doi:10.1093/ Rheumatology / kel406
Electronic literature searches were conducted to locate all RCTs of acupuncture for
fibromyalgia. Five RCTs met the inclusion criteria.
Overall, the evidence for acupuncture in the treatment of fibromyalgia is mixed. Three
RCTs are positive, i.e. implying acupuncture is effective [8, 9, 11] including two that are
amongst the more rigorous studies [8, 9]. The effects were, however, mostly short-lived,
small and therefore of debatable value to patients. Two RCTs are negative, i.e. they fail
to show effectiveness [8, 10, 12]. One negative trial [10] was large and well-designed,
addressing some of the deficiencies in the previous trial by Delzue et al. [8] (in particular,
potentially inadequate blinding). There was no significant difference in average Jadad
score between the positive and the negative RCTs. The three positive trials all used EA
either exclusively [11] or in combination with manual stimulation [9]. The two negative
trials [8, 9] used only manual acupuncture.
In conclusion, the notion that acupuncture is an effective adjunctive, symptomatic
treatment for fibromyalgia is not supported by unanimous results from RCTs. The
existing evidence is mixed and further rigorous studies seem warranted
2) Complementary and alternative medicine in fibromyalgia and related syndromes,
Laura C. Holdcraft* PhD Department of Psychiatry and Behavioural Sciences,
Harborview Medical Center, University of Washington
School of Medicine, Box 359797, 325 Ninth Ave, Seattle, WA 98104-2499, USA Nassim
Assefi MD Department of Medicine and OB/GYN, Harborview Medical Center, University
of Washington School of Medicine, 325 Ninth Ave, Seattle, WA 98104-2499, USA
Dedra Buchwald MD Department of Medicine, Harborview Medical Center, University of
Washington School of Medicine, 325 Ninth Ave, Seattle, WA 98104-2499, USA
Acupuncture has become one of the most widely used and accepted forms of CAM. It
involves stimulation of well-defined acupoints throughout the body using a variety of
methods, most traditionally through the insertion of thin metal needles. Further
stimulation can be provided by a variety of modalities such as pressure, friction,
electrical and magnetic forces, suction and heat. Although all of the eight studies that
were identified have shown that acupuncture has beneficial effects on FMS symptoms,
the majorities are inadequately controlled, non-RCTs (see Ref. 14). Nonetheless, two
elegant RCTs substantiate the findings of the smaller studies.15,16
First, among 70 FMS patients engaged in a 3-week RCT of electro acupuncture,
subjects’ pain threshold improved by 70% in the active intervention group and only 4%
in the sham acupuncture group.15 In fact, seven of the eight outcome measures (pain
threshold, number of analgesics used in last week, subjective and regional pain, sleep,
morning stiffness, and patient- and physician-rated improvement) showed significant
improvement from baseline with treatment; no changes in any of these parameters were
encountered in the control patients.
Furthermore, for five of the eight outcomes, significant differences were noted between
the treated and untreated groups.
In a second study, 60 patients were randomized to weekly acupuncture, weekly sham
acupuncture, or usual care for 16 weeks. 16 All the patients also received 25 mg of
Amitryptyline at bedtime. Measures of pain and depression differed significantly between
the acupuncture and the two control groups; no improvement occurred in the sham
acupuncture and usual care groups. Adverse events included unpleasantness of needle
insertion and increase in symptoms in the first study among 16% of subjects; no adverse
events occurred in the second study.
Although compelling, these two RCTs have several limitations. First, there is
considerable controversy regarding the equivalence of electroacupuncture and
conventional acupuncture. Some practitioners believe that the former provides primarily
short-term analgesia and the latter affords longer-term pain relief.
Second, measures for assessing whether patients were actually blinded were not used
in either study.
Third, the first study did not include functional or psychological measures, and the
second did not use objective measures such as colorimetric or blinded clinical 674 L. C.
Holdcraft, N. Assefi and D. Buchwald.
Assessments:
Finally, long-term follow-up of patients was not a part of either study.
Extended follow-up is crucial in studies of FMS because it is a chronic illness with
symptoms that wax and wane over time and the analgesic effects of acupuncture may
be transient, especially with brief treatment protocols (i.e. 4 weeks or less).
Taken together, these small but high-quality studies provide strong evidence (level A)
that acupuncture should be considered as a treatment for FMS. However, specific
recommendations such as the type of acupuncture to use, duration and frequency of
treatment, and the degree of acupoint stimulation await illumination by future studies.
3) Targino RA, Imamura M, Kaziyama HH, Souza LP, Hsing WT, Furlan AD,
Imamura ST, Azevedo Neto RS.
A randomized controlled trial of acupuncture added to usual treatment for fibromyalgia J
Rehabil Med. 2008 Jul;40(7):582-8.Departamento de Patología, Avenida Doctor Arnaldo
455, Sao Paulo, Brazil. [email protected]
OBJECTIVE:
To evaluate the effectiveness of acupuncture for fibromyalgia.
METHODS:
Fifty-eight women with fibromyalgia were allocated randomly to receive either
acupuncture together with tricyclic antidepressants and exercise (n=34), or tricyclic
antidepressants and exercise only (n=24). Patients rated their pain on a visual analogue
scale. A blinded assessor evaluated both the mean pressure pain threshold value over
all 18 fibromyalgia points and quality of life using SF-36.
RESULTS:
At the end of 20 sessions, patients who received acupuncture were significantly better
than the control group in all measures of pain and in 5 of the SF-36 subscales. After 6
months, the acupuncture group was significantly better than the control group in
numbers of tender points, mean pressure pain threshold at the 18 tender points and 3
subscales of SF-36. After one year, the acupuncture group showed significance in one
subscale of the SF-36; at 2 years there were no significant differences in any outcome
measures.
CONCLUSION:
Addition of acupuncture to usual treatments for fibromyalgia may be beneficial for pain
and quality of life for 3 months after the end of treatment. Future research is needed to
evaluate the specific effects of acupuncture for fibromyalgia.
4) Improvement in fibromyalgia symptoms with acupuncture: results of a randomized
controlled trial
Department of Anaesthesiology, Mayo Clinic College of Medicine, 200 First St SW,
Rochester, MN 55905, USA. [email protected]
(Cette étude est inclue dans le systemic review citée plus haut).
CONCLUSION:
This study paradigm allows for controlled and blinded clinical trials of acupuncture. We
found that acupuncture significantly improved symptoms of fibromyalgia. Symptomatic
improvement was not restricted to pain relief and was most significant for fatigue and
anxiety.
5) Is acupuncture effective in the treatment of fibromyalgia? (Structured abstract)
Centre for Reviews and Dissemination Database of Abstracts of Reviews of Effects
2008 Issue 4 Copyright © 2008 University of York. Published by John Wiley & Sons,
Ltd. Original article: Berman B M,Ezzo J,Hadhazy V,Swyers J P.Is acupuncture
effective in the treatment of fibromyalgia? Journal of Family Practice.1999;48(3):213218. Links
BACKGROUN:
We conducted this study to assess the effectiveness of acupuncture
in the treatment of fibromyalgia syndrome (FMS), report any adverse effects, and
generate hypotheses for future investigation.
METHODS:
We searched MEDLINE, EMBASE, Manual Therapy Information
System, the Cochrane registry, the University of Maryland Complementary and
Alternative Medicine in Pain, the Centralized Information Service for Complementary
Medicine, and the National Institutes of Health Office of Alternative Medicine databases for the key words "acupuncture" and "fibromyalgia." Conference abstracts, citation
lists, and letters supplemented the search. We selected all randomized or quasirandomized controlled trials, or cohort studies of patients with FMS who were treated
with acupuncture. Methodological quality, sample characteristics, type of acupuncture
treatment, and outcomes were extracted. Statistical pooling was not performed because
of the differences in control groups.
RESULTS
Seven studies (3 randomized controlled trials and 4 cohort studies)
were included; only one was of high methodological quality. The high-quality study
suggests that real acupuncture is more effective than sham acupuncture for relieving
pain, increasing pain thresholds, improving global ratings, and reducing morning
stiffness of FMS, but the duration of benefit following the acupuncture treatment series is
not known. Some patients report no benefit, and a few report an exacerbation of FMSrelated pain. Lower-quality studies were consistent with these findings. Booster doses of
acupuncture to maintain benefit once regular treatments have stopped have been
described anecdotally but not investigated in controlled trials.
CONCLUSION
The limited amount of high-quality evidence suggests that real
acupuncture is more effective than sham acupuncture for improving symptoms of
patients with FMS. However, because this conclusion is based on a single high-quality
study, further high-quality randomized.
CONCLUSION
3 études pertinentes récentes mais avec des résultats contradictoires. La première
étude (systemic review) incluant 5 études dont 3 démontrant que l'acupuncture est
efficace versus 2 démontrant le contraire. Deuxième indique une amélioration a/n
douleur avec acupuncture mais à court terme (3 mois). L'amélioration peut être aussi à
cause des suivis rapprochés pour les acupunctures. Cette étude n’a pas été conclue à
double insu, il n’y avait pas de traitement placebo adéquat. Donc, il n'est pas vraiment
clair que nos patients atteints de fibromyalgie profiteront ou non de l'acupuncture. De
plus, ce traitement n'est toujours pas couvert par les assurances. Nous aurons besoin
d’un peu plus d'evidence avant de conseiller nos patients de se diriger vers
l'acupuncture.