OBJECTIVE: Acupuncture has demonstrated efficacy as a treatment for fibromyalgia; however, predictors of short- and long-term analgesic response in this population are not well understood. METHODS: This manuscript describes a secondary analysis of a single-center, blinded, sham-controlled, randomized longitudinal acupuncture clinical trial in fibromyalgia. Baseline characterization included pressure pain threshold and pain interference, while residualized change in pain intensity from baseline to follow-up served as the primary outcome measure. Participants were randomized into groups that received verum (n = 36) or sham (n = 29) acupuncture treatment over a 12-week period (18 treatments) and were followed for 37 weeks from the initiation of treatment. RESULTS: Lower pressure pain thresholds at baseline were associated with greater analgesia only in the sham treatment group immediately following treatment, while those with higher pressure pain thresholds had greater analgesia with verum treatment (B = -13.43, P = 0.001). Additionally, greater perceived impact of pain at baseline was predictive of greater short-term analgesia irrespective of treatment. Pressure pain threshold was not found to be predictive of long-term differential treatment response (B = -1.71, P = 0.66). There was a significant difference in the relationship between perceived impact of pain at baseline and subsequent long-term analgesia between groups where those with greater perceived impact of pain displayed improved long-term analgesia for verum acupuncture compared to the sham group (B = -11.37, P = 0.004). CONCLUSION Our results support the use of a self-reported pain outcome in predicting long-term analgesia following acupuncture in fibromyalgia. Please cite this article as: Murphy AE, Arewasikporn A, Taylor-Swanson L, Williams DA, Harris RE. Pressure pain threshold and perceived impact of pain differentially predict short-term and long-term pain reduction following acupuncture in fibromyalgia. J Integr Med. 2025; 23(2): 152-158.
Adult ; Female ; Humans ; Male ; Middle Aged ; Acupuncture Therapy ; Fibromyalgia/therapy* ; Pain Management/methods* ; Pain Measurement/statistics & numerical data* ; Pain Threshold/physiology* ; Pressure ; Treatment Outcome ; Longitudinal Studies

The fibromyalgia syndrome (FMS) could be approached by various treatments modalities including education, aerobic exercise, cognitive behavioral therapy, tricyclic antidepressants, serotonin norepinephrine reuptake inhibitors, pregabalin, and so on. If other treatments fail, opioids including morphine should be considered. In this case report, we describe the case of a 44-year-old woman who was diagnosed with FMS three years ago, and suffered from severe intractable pain, side effects from other drugs, and opioid tolerance. Administration of morphine via an implantable drug delivery system resulted in significant improvement in the patient's pain intensity, fibromyalgia impact questionnaire score, and sleep disturbance. Our case demonstrates that an implantable drug delivery system with morphine can be a potential treatment option for refractory fibromyalgia patients.
Adult ; Analgesics, Opioid ; Antidepressive Agents, Tricyclic ; Cognitive Therapy ; Drug Delivery Systems* ; Education ; Exercise ; Female ; Fibromyalgia* ; Humans ; Injections, Spinal ; Morphine* ; Norepinephrine ; Pain, Intractable ; Pregabalin ; Serotonin

OBJECTIVETo observe the clinical efficacy on fibromyalgia syndrome treated with acupuncture at the acupoints selected from the affected meridians based on the location differentiation and the heavy moxibustion at painful points by the randomized controlled trial with medication.

METHODSThirty-two patients of fibromyalgia were randomized into an acupuncture-moxihustion group and a medication group, 16 cases in each one. In the acupuncture-moxibustion group, acupuncture at the acupoints selected from the affected meridians based on the location differentiation and the heavy moxibustion at painful points were applied, once every two days, three times a week, for 4 weeks totally. In the medication group, tramadol sustained release tablets and amitriptyline were prescribed for oral administration, once a day, for 4 weeks. The follow-up visit was conducted for 4 weeks in the two groups. Before and after treatment and in follow-up visit, the revised version of the fibromyalgia impact questionnaire (FIQR) and visual analogue scale (VAS) were adopted for assessment and comparison of the efficacy between the two groups.

RESULTSAfter treatment and in follow-up visit, FIQR score and VAS score were improved apparently as compared with those before treatment in the two groups (all P<0. 05). At the end of treatment, the differences were not significant statistically between the two groups (all P>0. 05). But the differences were significant in follow-up visit (all P<0. 05). The scores in the acupuncture-moxibustion group were improved persistently, but those in the medication group were rebound.

CONCLUSIONThe acupuncture at the acupoints selected from the affected meridians based on the location differentiation and the heavy moxibustion at painful points are safe and effective in the treatment of fibromyalgia syndrome and present the better persistent effect as compared with the combined medication of tramadol sustained release tablets and amitriptyline.

Acupuncture Points ; Acupuncture Therapy ; Adult ; Female ; Fibromyalgia ; therapy ; Humans ; Male ; Meridians ; Middle Aged ; Moxibustion ; Pain Measurement ; Young Adult

BACKGROUNDFibromyalgia (FMS) is a syndrome characterized by chronic widespread musculoskeletal pain, whose etiology is not completely understood. Different therapeutic approaches have been used with inconsistent results. This observation does not invalidate the continued search for alternative treatments aimed at improving quality of life (QoL) in FMS.

OBJECTIVEThis study compared three classical traditional Chinese medicine (TCM) therapies: acupuncture (AC), electroacupuncture (EAC) and moxibustion (MX) in the management of pain and promotion of QoL in FMS patients.

DESIGN, SETTING, PARTICIPANTS AND INTERVENTIONSA preliminary, group-assigned, comparative study enrolled 30 women, mean age (46.90±9.24) years (range 20-60 years), who met the 1990 American College of Rheumatology criteria for FMS diagnosis and a pain-pressure threshold (PPT) < 4 kg/cm(2). The study was conducted in a teaching tertiary-care medical institution from May 2010 through April 2012. AC, EAC and MX were delivered for 30 min, once a week, for 8 weeks, bilaterally at Neiguan (PC6), Hegu (LI4), Yanglingquan (GB34), Sanyinjiao (SP6) and Taichong (LR3) acupoints.

MAIN OUTCOME MEASURESEach week, immediately before treatment and after treatment, subjects were tested for PPTs, Wong-Baker Faces Pain Scale (WBFPS; for pain intensity) and Medical Outcomes Study 36-item Short Form Health Survey (SF-36: for QoL).

RESULTSThere was no significant improvement in pain or reduction of tender points in any of the groups studied, at the end of the 8th session. Significant improvement of QoL was perceived in vitality (after AC treatment) and in mental health (after EAC and MX treatments).

CONCLUSIONTCM therapies (AC, EAC and MX) promoted an improvement in the QoL in two areas (vitality and mental health) in FMS women. Further large-scale clinical trials are required to confirm this effect.

Acupuncture Therapy ; Adult ; Complementary Therapies ; Female ; Fibromyalgia ; psychology ; therapy ; Humans ; Medicine, Chinese Traditional ; Middle Aged ; Moxibustion ; Quality of Life

Fibromyalgia syndrome after comprehensive treatment of breast cancer is rare and seldom reported. Here we present a case of a 50-year-old female patient,who was admitted to the hospital because of generalized fibromyalgia for 3 months and brain metastasis after the right breast carcinoma surgery for 1 month, and the clinical diagnosis was brain metastasis from breast carcinoma combined with fibromyalgia syndrome. The fibromyalgia were relieved with proper symptomatic treatment but the patient eventually died of tumor progression.
Brain Neoplasms ; mortality ; secondary ; Breast Neoplasms ; complications ; mortality ; therapy ; Carcinoma ; mortality ; therapy ; Female ; Fibromyalgia ; diagnosis ; etiology ; therapy ; Humans ; Middle Aged

BACKGROUNDFibromyalgia is a syndrome characterized by chronic pain, fatigue, depression, and sleep disturbances. Its primary cause is unclear. Several studies have reported decreased intracellular magnesium levels in patients with fibromyalgia and have found negative correlation between magnesium levels and fibromyalgia symptoms.

OBJECTIVETo gather preliminary data on whether transdermal magnesium can improve quality of life for women who have fibromyalgia.

DESIGN, SETTING, PARTICIPANTS AND INTERVENTIONSThis is a patient questionnaires and survey in a fibromyalgia clinic at a tertiary medical center. Forty female patients with the diagnosis of fibromyalgia were enrolled. Each participant was provided a spray bottle containing a transdermal magnesium chloride solution and asked to apply 4 sprays per limb twice daily for 4 weeks. Participants were asked to complete the Revised Fibromyalgia Impact Questionnaire, SF-36v2 Health Survey, and a quality-of-life analog scale at baseline, week 2, and week 4.

MAIN OUTCOME MEASUREQuestionnaire and survey scores, evaluated through intent-to-treat and per-protocol analyses.

RESULTSTwenty-four patients completed the study (mean [SD] age, 57.2 [7.6] years; white, 95%; mean body mass index, 31.3 kg/m2). With intention-to-treat analysis, Revised Fibromyalgia Impact Questionnaire subscale and total scores were significantly improved at week 2 and week 4 (total score, P=0.001). Per-protocol analysis results were similar: all subscales of the Revised Fibromyalgia Impact Questionnaire were significantly improved at week 2 and week 4 (total score, P=0.001).

CONCLUSIONThis pilot study suggests that transdermal magnesium chloride applied on upper and lower limbs may be beneficial to patients with fibromyalgia.

TRIAL REGISTRATIONClinicalTrials.gov.ldentifier NCT01968772.

Administration, Cutaneous ; Aged ; Feasibility Studies ; Female ; Fibromyalgia ; drug therapy ; psychology ; Humans ; Magnesium Chloride ; administration & dosage ; adverse effects ; Middle Aged ; Pilot Projects ; Quality of Life

Fibromyalgia is a chronic pain syndrome of unknown etiology that is characterized by diffuse musculoskeletal pain, fatigue, sleep disturbance, memory disturbance, and exaggerated tenderness over particular paired locations. Fibromyalgia is found in 2% to 4% of the general population and more common in women, with symptoms usually appearing between 20 and 55 years of age. The diagnostic criteria for fibromyalgia syndrome established in 1990 by the American College of Rheumatology (ACR), includes widespread pain for at least 3 months and point tenderness upon the application of a 4 kg weight at 11 or more of the 18 characteristic tender points. The 2010 ACR preliminary diagnostic criteria have been developed, which are strongly correlated with the 1990 ACR criteria and provide an alternative approach to diagnosis. Patients with fibromyalgia syndrome have lower pain thresholds and experience an altered temporal summation to pain stimuli. The sensitization of pain perception occurs in the dorsal horn of patients with fibromyalgia. However, it is unknown whether sensitization is due to increased pain fiber facilitation, or decreased inhibition. Pregabalin is approved by the United States Food and Drug Administration for the management of fibromyalgia patients. Tricyclic antidepressants, cardiovascular exercise, cognitive behavioral therapy and patient education are also effective in reducing the pain experienced by fibromyalgia patients. This article provides an overview of fibromyalgia syndrome, which is currently thought to be partly responsible for chronic diffuse pain.
Animals ; Antidepressive Agents, Tricyclic ; Chronic Pain ; Cognitive Therapy ; Fatigue ; Female ; Fibromyalgia ; gamma-Aminobutyric Acid ; Horns ; Humans ; Memory ; Musculoskeletal Pain ; Pain Perception ; Pain Threshold ; Patient Education as Topic ; Rheumatology ; United States Food and Drug Administration ; Pregabalin

OBJECTIVETo evaluate the clinical effect of combination of acupuncture, cupping and medicine for treatment of fibromyalgia syndrome.

METHODSBy using multi-central randomized controlled method, 186 cases were randomly divided into an acupuncture combined with cupping and western medicine group (group A), an acupuncture combined with cupping group (group B) and a western medicine group (group C) and treated continuously for 4 weeks. The treatment of acupuncture combined with cupping was produced by acupuncture at five mental points and moving cupping on the Hechelu of the back, once evrey other day, thrice each week, and the western medicine therapy by oral administration of Amitriptyline, once each day. The scores of McGill Pain Questionnaire (MPQ), the amount of tenderness point and the time of producing effect were compared and the therapeutic effects were assessed with the Hamilton Depression Scale (HAMD).

RESULTSThe cured and markedly effective rate was 65.0% (39/60) in the group A, which was superior to 15.9% (10/63) in the group B and 16.1% (9/56) in the group C (both P < 0.001). After treatment, the scores of MPQ and HAMD and the amount of tenderness point all decreased in the three groups, group A being significantly better than group B and group C, and the time of producing effect in the group A was more earlier than those in the group B and the group C.

CONCLUSIONThe therapeutic effect of combination of acupuncture, cupping and medicine on fibromyalgia syndrome is superior to that of the simple acupuncture combined with cupping or the simple medicine.

Acupuncture Points ; Acupuncture Therapy ; Adult ; Amitriptyline ; therapeutic use ; Antidepressive Agents, Tricyclic ; therapeutic use ; Combined Modality Therapy ; Female ; Fibromyalgia ; drug therapy ; therapy ; Humans ; Male ; Middle Aged ; Young Adult

BACKGROUND/AIMS: Acidic saline injections produce mechanical hyperresponsiveness in male Sprague-Dawley rats. We investigated the effect of milnacipran in conjunction with tramadol on the pain threshold in an acidic saline animal model of pain. METHODS: The left gastrocnemius muscle of 20 male rats was injected with 100 microL of saline at pH 4.0 under brief isoflurane anesthesia on days 0 and 5. Rats administered acidic saline injections were separated into four study subgroups. After determining the pre-drug pain threshold, rats were injected intraperitoneally with one of the following regimens; saline, milnacipran alone (60 mg/kg), milnacipran (40 mg/kg) plus tramadol (20 mg/kg), or milnacipran (40 mg/kg) plus tramadol (40 mg/kg). Paw withdrawal in response to pressure was measured at 30 min, 120 min, and 5 days after injection. Nociceptive thresholds, expressed in grams, were measured with a Dynamic Plantar Aesthesiometer (Ugo Basile, Italy) by applying increasing pressure to the right or left hind paw until the rat withdrew the paw. RESULTS: A potent antihyperalgesic effect was observed when tramadol and milnacipran were used in combination (injected paw, p=0.001; contralateral paw, p=0.012). This finding was observed only at 30 min after the combination treatment. CONCLUSIONS: We observed potentiation of the antihyperalgesic effect when milnacipran and tramadol were administered in combination in an animal model of fibromyalgia. Further research is required to determine the efficacy of various combination treatments in fibromyalgia in humans.
Analgesics, Opioid/administration & dosage/*pharmacology ; Animals ; Antidepressive Agents/administration & dosage/*pharmacology ; Behavior, Animal/drug effects ; Cyclopropanes/administration & dosage/*pharmacology ; Disease Models, Animal ; Drug Synergism ; Drug Therapy, Combination ; Fibromyalgia/chemically induced/complications/*prevention & control ; Hydrogen-Ion Concentration ; Hyperalgesia/etiology/*prevention & control ; Injections, Intraperitoneal ; Male ; Pain/etiology/*prevention & control ; Pain Measurement ; Pain Threshold/*drug effects ; Rats ; Rats, Sprague-Dawley ; Sodium Chloride ; Time Factors ; Tramadol/administration & dosage/*pharmacology

Fibromyalgia syndrome (FMS) is a chronic and debilitating musculoskeletal pain disorder of unknown aetiology with usual accompanying features of fatigue, sleep disturbances and stiffness. Its place in medical textbooks was controversial with rheumatologists holding the helm of its management for many years. Over the last decade, abnormalities have been identified at multiple levels in the peripheral, central, and sympathetic nervous systems as well as the hypothalomo-pituitary-adrenal axis stress response system. With the elucidation of these pathways of pain, FMS is known more as a central sensitivity syndrome. This led to tremendous increment in interest in both pharmacological and non-pharmacological treatment of FMS. The United States Food and Drug Administration (FDA) has also successively approved 3 drugs for the management of fibromyalgia--pregabalin, duloxetine and milnacipran. Non-pharmacological modalities showed aerobic exercise, patient education and cognitive behavioural therapy to be most effective. Overall, management of FMS requires a multi-disciplinary approach.
Fibromyalgia ; drug therapy ; etiology ; physiopathology ; Humans ; Rheumatology ; Syndrome