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Visual Analogue Scale (VAS) for Pain (this research study of Fibromyalgia patients would have used a similar scale.)

# Visual Analogue Scale (VAS) for Pain (this research study of Fibromyalgia patients would have used a similar scale.)

Visual Analogue Scale (VAS) for Pain. Tthis research study of Fibromyalgia patients used VAS scales to measure pain, sleep, fatigue, stiffness, anxiety and depression.)

New Research: A new study suggests acupuncture treatment is effective to relieve pain for Fibromyalgia (FM) patients.

The researchers noted that many fibromyalgia patients (91%) use Complementary and Alternative Medicine (CAM) to treat fibromyalgia symptoms and the disease. Acupuncture is one of the most commonly used CAMs. They note that the research on the effectiveness of acupuncture on Fibromyalgia has yielded mixed results. The researchers sought to show the effectiveness of acupuncture by comparing acupuncture against standard medication as the control condition.

Study participants were divided into two groups:

  1. One group received 10 acupuncture treatments for FM over 10 weeks.
  2. The other group received no acupuncture treatments for the first 5 weeks and then received 5 treatments over the following 5 weeks.

The take home messages, Part I

  • Acupuncture may be effective to relieve pain for Fibromyalgia patients.
  • Acupuncture may be effective to improve Quality of Life for FM patients (as measured via  the Fibromyalgia Impact Questionnaire–FIQ).
  • The decrease in pain and improvement of quality of life is seen when comparing acupuncture treatment to no acupuncture treatment.
  • The difference between acupuncture treatment and no acupuncture treatment (“active control”) is statistically significant.

Follow along below for further insights. And get an honest discussion about what this study does not show (you might be surprised.)

The Japanese researchers have released a preliminary abstract of their study in the Journal of Chinese Medicine. More details culled from the provisional PDF of the complete article:

Research Study Breakdown

The cause of Fibromyalgia (FM) is unknown. It is characterized by chronic widespread musculoskeltal pain with defined tender points. Fibromyalgia symptoms including stiffness, numbness and tingling, nerve pain, fatigue, sleep disturbance and functional impairment. Depression, anxiety, headaches, bowel function problems, and cognitive difficulties are other symptoms associated with Fibromyalgia.

Who were the research subjects?

16 patients (13 women and 3 men; age range 25-63 years)

All study participants had

  1. been diagnosed with Fibromyalgia (FM);
  2. FM for at least one year;
  3. widespread pain for at least 6 months;
  4. normal neurological examination findings of nerve function (including deep tendon reflexes, voluntary muscle action and sensory function;
  5. failed to respond to medications prescribed by FM specialists.

What treatment did they recieve?

Randomly classified into two groups:

  1. 8 to Group A
  2. 8 to Group B
Acupuncture Sessions First 5 Weeks Second 5 Weeks
Group A no sessions (control) 5 sessions, weekly
Group B 5 sessions, weekly 5 sessions, weekly

Groups A received a clinical exam once or twice a week during the control period (first 5 weeks). Group A took standard medications/treatment for the first 5 weeks.

What kind of acupunture?

  • Electroacupuncture (15 min)
  • Trigger point acupuncture (15 min)

were used to treat the patients, for total treatment sessions of 30 minutes.

What was tested?

  • Pain intensity–quantified with a 10cm visual analogue scale (VAS)
  • Pain Disability–Quality of life–measured by Fibromyalgia impact questionnaire (FIQ) on physical function, work, wellbeing.

FIQ includes VAS for pain, sleep, fatigue, stiffness, anxiety and depression.

Higher scores are more negative.

See image above for an example of a VAS.

When was the testing done?

The VAS and FIQ measures were completed by the patients immediately before each treatment.

Measures were  analyzed three times:

  1. Pre–immediately before the first treatment
  2. Middle–after five weeks of treatment
  3. Post–after ten weeks of treatment.

What were the results?

At the fifth week (Middle)

  • pain intensity (U=25.0; P=0.022) in group B decreased and
  • Quality of Life (QoL) (U=24.5; P=0.026) improved in group B

when compared to group A.

The difference between acupuncture treatment and no acupuncture treatment (“active control”) at the 5th week was statistically significant.

At the start; at the end (Pre and Post)

There was no significant difference between Group A and Group B at the start and end other study.

Both Group A and Group B had decreased VAS and FIQ scores at the end of the study in comparison to the start of the study.

Conclusion: The Take Home Messages, Part II

The study’s authors conclude: “The present study suggests that acupuncture treatment is effective to relieve pain for FM patients in terms of [Quality of Life] and FIQ.”

Some further insights. And honesty about what this study does and does not show.

  • Acupuncture is effective at reducing pain and improving quality of life for fibromyalgia patients.
  • Note that at the end of the study, there was no statistical significance between Group A and Group B’s pain and Quality of Life scores. This would suggest that the 5 treatments gave a result statistically similar to 10 treatments.
  • Thus, it seems that acupuncture vs. no acupuncture is what makes the difference. Put another way, the number of treatments did NOT matter when it came to acupuncture’s effectiveness.

What does this mean for you?

One might interpret this all to mean that 5 acupuncture treatments is just as good as 10 treatment sessions. Taken literally or even to the extreme (as the media is apt to do) one might decide that if 5 is just as good as 10, what’s to stop 3 being just as good as 5? Heck, I might as well just have ONE acupuncture treatment and call it a day.

This is a danger of reading too much into one single study.

Yes, this study supports the idea that acupuncture might be effective pain relief and improve quality of life for FM.

Possibly, this study supports the idea that 5 treatments might be just as good as 10.

But more research is needed to corroborate (or support) or refute (contradict) this study’s conclusions. Only if other researchers can replicate the results, or get similar data and conclusions can we build a body of research that supports the idea that acupuncture and other Complementary and Alternative Medicine (CAM) can be effective, or even better treatment. [One goal of this blog seeks to make research into Complementary and Alternative Medicine such as acupuncture, yoga, ayurveda and even research on exercise more accessible.] This is critical research, especially considering the level of chronic illness and soaring healthcare costs associated with caring for humanity. Health care reform only accelerates the need for effective, cost-effective, humane care.

Share your thoughts, questions, and comments below. Do you have experience with acupuncture as an effective treatment for fibromyalgia? for pain? How have other complementary or alternative medicines improved your quality of life?

References and further reading

  • Itoh K, Kitakoji H. Effects of acupuncture to treat fibromyalgia: A preliminary randomised controlled trial. Chin Med. 2010 Mar 23;5(1):11. [Epub ahead of print] PubMed PMID: 20331844.
  • Abstract on the Journal of Chinese Medicine website. Includes link to the preliminary PDF report. If you are brave and love statistics, look at the graphs at the end.  http://www.cmjournal.org/content/5/1/11
  • Full Abstract:

Effects of acupuncture to treat fibromyalgia: A preliminary randomised controlled trial.

Itoh K, Kitakoji H.

ABSTRACT: BACKGROUND: Acupuncture is often used to treat fibromyalgia (FM), but it remains unclear whether acupuncture is effective. This study aims to evaluate the effects of acupuncture on pain and quality of life (QoL) in FM patients. METHODS: Sixteen patients (13 women and 3 men aged 25-63 years) suffering from FM were randomised into two groups: group A (n=8) received five acupuncture treatments after the fifth week and group B received ten acupuncture treatments. Outcome measures used in this study were pain intensity (visual analogue scale, VAS) and the fibromyalgia impact questionnaire (FIQ). RESULTS: After the fifth week, pain intensity (U=25.0; P=0.022) in group B decreased and QoL (U=24.5; P=0.026) improved compared to group A. CONCLUSION: The present study suggests that acupuncture treatment is effective to relieve pain for FM patients in terms of QoL and FIQ.

PMID: 20331844 [PubMed - as supplied by publisher]

 

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