Literature on
Complementary and Alternative Medicines
(CAM)
Assefi NP, Sherman KJ, Jacobsen C, Goldberg J, Smith WR,
Buchwald D. A randomized clinical trial of acupuncture compared
with sham acupuncture in fibromyalgia. Ann Intern Med 2005;
143(1):10-19.
Abstract: BACKGROUND: Fibromyalgia is a common chronic pain
condition for which patients frequently use acupuncture.
OBJECTIVE: To determine whether acupuncture relieves pain in
fibromyalgia. DESIGN: Randomized, sham-controlled trial in which
participants, data collection staff, and data analysts were
blinded to treatment group. SETTING: Private acupuncture offices
in the greater Seattle, Washington, metropolitan area. PATIENTS:
100 adults with fibromyalgia. INTERVENTION: Twice-weekly
treatment for 12 weeks with an acupuncture program that was
specifically designed to treat fibromyalgia, or 1 of 3 sham
acupuncture treatments: acupuncture for an unrelated condition,
needle insertion at nonacupoint locations, or noninsertive
simulated acupuncture. MEASUREMENTS: The primary outcome was
subjective pain as measured by a 10-cm visual analogue scale
ranging from 0 (no pain) to 10 (worst pain ever). Measurements
were obtained at baseline; 1, 4, 8, and 12 weeks of treatment;
and 3 and 6 months after completion of treatment. Participant
blinding and adverse effects were ascertained by self-report.
The primary outcomes were evaluated by pooling the 3
sham-control groups and comparing them with the group that
received acupuncture to treat fibromyalgia. RESULTS: The mean
subjective pain rating among patients who received acupuncture
for fibromyalgia did not differ from that in the pooled sham
acupuncture group (mean between-group difference, 0.5 cm [95%
CI, -0.3 cm to 1.2 cm]). Participant blinding was adequate
throughout the trial, and no serious adverse effects were noted.
LIMITATIONS: A prescription of acupuncture at fixed points may
differ from acupuncture administered in clinical settings, in
which therapy is individualized and often combined with herbal
supplementation and other adjunctive measures. A usual-care
comparison group was not studied. CONCLUSION: Acupuncture was no
better than sham acupuncture at relieving pain in fibromyalgia
Barbour
C. Use of complementary and alternative treatments by
individuals with fibromyalgia syndrome. J Am Acad Nurse Pract
2000; 12(8):311-316.
Abstract: Although muscle pain is the primary complaint of
patients with fibromyalgia, there are myriad associated symptoms
that cause them to seek healthcare. Some individuals try
alternative treatments when conventional medicine does not
provide symptom relief. A questionnaire was developed to collect
information regarding complementary treatments and their
effectiveness. Sixty individuals visited the researcher's web
page and completed and submitted an online questionnaire on
fibromyalgia. Literature, heat, walking, vitamins, and massage
were the interventions tried most frequently. Literature,
aromatherapy, support groups, heat, and massage were rated the
most effective
Berman
BM, Ezzo J, Hadhazy V, Swyers JP. Is acupuncture effective in
the treatment of fibromyalgia? J Fam Pract 1999; 48(3):213-218.
Abstract: BACKGROUND: 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 quasi-randomized controlled trials, or cohort
studies of patients with FMS who were treated with acupuncture.
Methodologic 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
methodologic 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 FMS-related 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.
CONCLUSIONS: 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 trials are
needed to provide more robust data on effectiveness
Breuer GS, Orbach H, Elkayam O, Berkun Y, Paran D, Mates M et
al.
Perceived efficacy among patients of various methods of
complementary alternative medicine for rheumatologic diseases.
Clin Exp Rheumatol 2005; 23(5):693-696.
Abstract: OBJECTIVE: The purpose of this cross-sectional survey
was to obtain and analyze data on self-perceived efficacy of
different types of complementary alternative medicine (CAM) by
patients with various rheumatologic conditions. METHODS:
Patients followed in rheumatology outpatient clinics were
screened for the use of CAM. Patients reporting the use of CAM
were asked to participate in face-to-face structured interviews,
specifying the various CAM types they used, and grading their
subjective impression of efficacy of each CAM type on a scale of
1-10. RESULTS: 350 consecutive patients were screened and 148
reported using CAM. In general, homeopathy and acupuncture were
the most commonly used CAM types (44% and 41% of the CAM users,
respectively). The mean number of different CAM methods used by
a CAM user was 1.9 +/- 1.1. Patients with fibromyalgia used
significantly more CAM methods (2.7 +/- 1.4, p = 0.005). On
patients' self-perceived efficacy scale of 1-10, the mean score
of the whole group was 5.3 +/- 3.2. Acupuncture and homeopathy
achieved significantly higher self-perceived efficacy scores in
CAM users with spondylo-arthropathies and osteoarthritis,
respectively, when compared to some of the other disease groups.
Satisfaction was lowest among CAM users with rheumatoid
arthritis, vasculitis and connective tissue diseases.
CONCLUSION: In general, CAM users were less than moderately
satisfied with self-perceived-efficacy of CAM therapies. However
efficacy of specific CAM methods differed significantly among
patients in different disease groups
Crofford
LJ, Appleton BE. Complementary and alternative therapies for
fibromyalgia. Curr Rheumatol Rep 2001; 3(2):147-156
Abstract: Fibromyalgia (FM) is a syndrome of chronic widespread
musculoskeletal pain that is accompanied by sleep disturbance
and fatigue. Clinical treatment usually includes lifestyle
modifications and pharmacologic interventions meant to relieve
pain, improve sleep quality, and treat mood disorders. These
therapies are often ineffective or have been shown in clinical
studies to have only short-term effectiveness. Pharmacologic
treatments have considerable side effects. Patients may have
difficulty complying with exercise-based treatments. Thus,
patients seek alternative therapeutic approaches and physicians
are routinely asked for advice about these treatments. This
article reviews nontraditional treatment alternatives, from use
of nutritional and herbal supplements to acupuncture and
mind-body therapy. Little is known about efficacy and tolerance
of complementary and alternative therapies in FM and other
chronic musculoskeletal pain syndromes. Most studies on these
treatments have been performed for osteoarthritis, rheumatoid
arthritis, or focal musculoskeletal conditions. Clinical trials
are scarce; the quality of these trials is often criticized
because of small study population size, lack of appropriate
control interventions, poor compliance, or short duration of
follow-up. However, because of widespread and growing use of
alternative medicine, especially by persons with chronic
illnesses, it is essential to review efficacy and adverse
effects of complementary and alternative therapies
Ernst E.
Musculoskeletal conditions and complementary/alternative
medicine. Best Pract Res Clin Rheumatol 2004; 18(4):539-556.
Abstract: Complementary/alternative medicine (CAM) is immensely
popular for musculoskeletal conditions. It is, therefore,
essential to define CAM's value for such indications. This
chapter summarises the trial data for or against CAM as a
symptomatic treatment for back pain, fibromyalgia, neck pain,
osteoarthritis and rheumatoid arthritis. Collectively the
evidence demonstrates that some CAM modalities show significant
promise, e.g. acupuncture, diets, herbal medicine, homoeopathy,
massage, supplements. None of the treatments in question is
totally devoid of risks. By and large the data are not
compelling, not least due to their paucity and methodological
limitations. It is, therefore, concluded that our research
efforts must be directed towards defining which form of CAM
generates more good than harm for which condition
Harris
RE, Tian X, Williams DA, Tian TX, Cupps TR, Petzke F et al.
Treatment of fibromyalgia with formula acupuncture:
investigation of needle placement, needle stimulation, and
treatment frequency. J Altern Complement Med 2005;
11(4):663-671.
Abstract: Objectives: The objective of this study was to
investigate whether typical acupuncture methods such as needle
placement, needle stimulation, and treatment frequency were
important factors in fibromyalgia symptom improvement.
Design/settings/subjects: A single-site, single-blind,
randomized trial of 114 participants diagnosed with fibromyalgia
for at least 1 year was performed. Intervention: Participants
were randomized to one of four treatment groups: (1) T/S needles
placed in traditional sites with manual needle stimulation (n =
29): (2) T/0 traditional needle location without stimulation (n
= 30); (3) N/S needles inserted in nontraditional locations that
were not thought to be acupuncture sites, with stimulation (n =
28); and (4) N/0 nontraditional needle location without
stimulation (n = 2 7). All groups received treatment once
weekly, followed by twice weekly, and finally three times
weekly, for a total of 18 treatments. Each increase in frequency
was separated by a 2-week washout period. Outcome measures: Pain
was assessed by a numerical rating scale, fatigue by the
Multi-dimensional Fatigue Inventory, and physical function by
the Short Form-36. Results: Overall pain improvement was noted
with 25%-35% of subjects having a clinically significant
decrease in pain; however this was not dependent upon "correct"
needle stimulation (t = 1.03; p = 0.307) or location (t = 0.76;
p = 0.450). An overall dose effect of treatment was observed,
with three sessions weekly providing more analgesia than
sessions once weekly (t = 2.10; p = 0.039). Among treatment
responders, improvements in pain, fatigue, and physical function
were highly codependent (all p </= 0.002). Conclusions: Although
needle insertion led to analgesia and improvement in other
somatic symptoms, correct needle location and stimulation were
not crucial
Holdcraft
LC, Assefi N, Buchwald D. Complementary and alternative medicine
in fibromyalgia and related syndromes. Best Pract Res Clin
Rheumatol 2003; 17(4):667-683.
Abstract: Complementary and alternative medicine (CAM) has
gained increasing popularity, particularly among individuals
with fibromyalgia syndrome (FMS) for which traditional medicine
has generally been ineffective. A systematic review of
randomized controlled trials (RCTs) and non-RCTs on CAM studies
for FMS was conducted to evaluate the empirical evidence for
their effectiveness. Few RCTs achieved high scores on the
CONSORT, a standardized evaluation of the quality of methodology
reporting. Acupuncture, some herbal and nutritional supplements
(magnesium, SAMe) and massage therapy have the best evidence for
effectiveness with FMS. Other CAM therapies have either been
evaluated in only one RCT with positive results (Chlorella,
biofeedback, relaxation), in multiple RCTs with mixed results
(magnet therapies), or have positive results from studies with
methodological flaws (homeopathy, botanical oils, balneotherapy,
anthocyanidins, dietary modifications). Lastly, other CAM
therapies have neither well-designed studies nor positive
results and are not currently recommended for FMS treatment
(chiropractic care)
Lind BK,
Lafferty WE, Tyree PT, Diehr PK, Grembowski DE. Use of
complementary and alternative medicine providers by fibromyalgia
patients under insurance coverage. Arthritis Rheum 2007;
57(1):71-76.
Abstract: OBJECTIVE: To quantify how visits and expenditures
differ between insured patients with fibromyalgia syndrome (FMS)
who visit complementary and alternative medicine (CAM) providers
compared with patients with FMS who do not. Patients with FMS
were also compared with an age- and sex-matched comparison group
without FMS. METHODS: Calendar year 2002 claims data from 2
large insurers in Washington state were analyzed for provider
type (CAM versus conventional), patient comorbid medical
conditions, number of visits, and expenditures. RESULTS: Use of
CAM by patients with FMS was 2.5 times higher than in the
comparison group without FMS (56% versus 21%). Patients with FMS
who used CAM had more health care visits than patients with FMS
not using CAM (34 versus 23; P < 0.001); however, CAM users had
similar expenditures to nonusers among patients with FMS ($4,638
versus $4,728; not significant), because expenditure per CAM
visit is lower than expenditure per conventional visit. Patients
with FMS who used CAM also had heavier overall disease burdens
than those not using CAM. CONCLUSION: With insurance coverage, a
majority of patients with FMS will visit CAM providers. The
sickest patients use more CAM, leading to an increased number of
health care visits. However, CAM use is not associated with
higher overall expenditures. Until a cure for FMS is found, CAM
providers may offer an economic alternative for patients with
FMS seeking symptomatic relief
Martin
DP, Sletten CD, Williams BA, Berger IH. Improvement in
fibromyalgia symptoms with acupuncture: results of a randomized
controlled trial. Mayo Clin Proc 2006; 81(6):749-757.
Abstract: OBJECTIVE: To test the hypothesis that acupuncture
improves symptoms of fibromyalgia. PATIENTS AND METHODS: We
conducted a prospective, partially blinded, controlled,
randomized clinical trial of patients receiving true acupuncture
compared with a control group of patients who received simulated
acupuncture. All patients met American College of Rheumatology
criteria for fibromyalgia and had tried conservative symptomatic
treatments other than acupuncture. We measured symptoms with the
Fibromyalgia Impact Questionnaire (FIQ) and the Multidimensional
Pain Inventory at baseline, immediately after treatment, and at
1 month and 7 months after treatment. The trial was conducted
from May 28, 2002, to August 18, 2003. RESULTS: Fifty patients
participated in the study: 25 in the acupuncture group and 25 in
the control group. Total fibromyalgia symptoms, as measured by
the FIQ, were significantly improved in the acupuncture group
compared with the control group during the study period (P =
.01). The largest difference in mean FIQ total scores was
observed at 1 month (42.2 vs 34.8 in the control and acupuncture
groups, respectively; P = .007). Fatigue and anxiety were the
most significantly improved symptoms during the follow-up
period. However, activity and physical function levels did not
change. Acupuncture was well tolerated, with minimal adverse
effects. 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
Mayhew E,
Ernst E. Acupuncture for fibromyalgia--a systematic review of
randomized clinical trials. Rheumatology (Oxford) 2006; 19;.
Abstract: Objective. Acupuncture is often used and frequently
advocated for the symptomatic treatment of fibromyalgia. A
systematic review has previously demonstrated encouraging
findings. As it is now outdated, we wanted to update it.
Methods. We searched seven electronic databases for relevant
randomized clinical trials (RCTs). The data were extracted and
validated independently by both authors. As no meta-analysis
seemed possible, the results were evaluated in narrative form.
Results. Five RCTs met our inclusion criteria, all of which used
acupuncture as an adjunct to conventional treatments. Their
methodological quality was mixed and frequently low. Three RCTs
suggested positive but mostly short-lived effects and two
yielded negative results. There was no significant difference
between the quality of the negative and the positive RCTs. All
positive RCTs used electro-acupunture. Conclusion. The notion
that acupuncture is an effective symptomatic treatment for
fibromyaligia is not supported by the results from rigorous
clinical trials. On the basis of this evidence, acupuncture
cannot be recommended for fibromyalgia
Sarac AJ,
Gur A. Complementary and alternative medical therapies in
fibromyalgia. Curr Pharm Des 2006; 12(1):47-57.
Abstract: This article describes the studies that have been
performed evaluating complementary or alternative medical (CAM)
therapies for efficacy and some adverse events fibromyalgia
(FM). There is no permanent cure for FM; therefore, adequate
symptom control should be goal of treatment. Clinicians can
choose from a variety of pharmacologic and nonpharmacologic
modalities. Unfortunately, controlled studies of most current
treatments have failed to demonstrate sustained, clinically
significant responses. CAM has gained increasing popularity,
particularly among individuals with FM for which traditional
medicine has generally been ineffective. Some herbal and
nutritional supplements (magnesium, S- adenosylmethionine) and
massage therapy have the best evidence for effectiveness with
FM. Other CAM therapies such as chlorella, biofeedback,
relaxation have either been evaluated in only one randomised
controlled trials (RCT) with positive results, in multiple RCTs
with mixed results (magnet therapies) or have positive results
from studies with methodological flaws (homeopathy, botanical
oils, balneotherapy, anthocyanidins and dietary modifications).
Another CAM therapy such as chiropractic care has neither
well-designed studies nor positive results and is not currently
recommended for FM treatment. Once CAM therapies have been
better evaluated for safety and long-term efficacy in randomised,
placebo-controlled trials, they may prove to be beneficial in
treatments for FM. It would then be important to assess studies
assessing cost-benefit analyses comparing conventional therapies
and CAM
Singh BB,
Wu WS, Hwang SH, Khorsan R, Der-Martirosian C, Vinjamury SP et
al. Effectiveness of acupuncture in the treatment of
fibromyalgia. Altern Ther Health Med 2006; 12(2):34-41.
Abstract: CONTEXT: Fibromyalgia syndrome (FMS) is a prevalent
musculoskeletal disorder associated with pain, mood state
alteration, and disability. A structured and effective treatment
plan for palliative care has not been established. The genesis
of FMS is not clear. FMS occurs primarily in adult women.
DESIGN: Using a quasi-experimental clinical design and following
the criteria of the American College of Rheumatology (ACR), for
FMS, 21 participants completed the study. The mean age was 53.6
years. The data were collected at baseline and at 1 and 2
months. Acupuncture treatments included 17 points for FMS
symptoms, and 8 outcome measures were collected. RESULTS: The
Fibromyalgia Impact Questionnaire (FIQ) showed significant
differences at 1 and 2 months. For the SF-12, 3 subscales showed
significant differences between baseline and 2 months. Four of 6
items were significantly changed. The mean number of general
health symptoms was significantly decreased by 2 months. For the
Catastrophe Index, significant differences were found for
baseline vs 2 months. Pain threshold scores were significantly
different at end of treatment for 5 bilateral tender points.
There was significant improvement in Beck Depression items for
both 1- and 2-month periods. In a multivariate regression model,
5 covariates were included--age, number of weeks in treatment,
number of doctors treating, number of general symptoms, and
baseline FIQ score. The results indicated significant age
effect. This analysis showed that the higher the FIQ score, the
more positive the change experienced by study participants.
Number of weeks in treatment, number of doctors who treated, and
total number of general health symptoms did not have a
significant effect on outcomes. CONCLUSIONS: Significant
improvement was experienced by participants at 8 weeks of
treatment. Acupuncture treatment as delivered was effective at
reducing FMS symptoms in this outcome study
Targino
RA, Imamura M, Kaziyama HH, Souza LP, Hsing WT, Imamura ST. Pain
treatment with acupuncture for patients with fibromyalgia. Curr
Pain Headache Rep 2002; 6(5):379-383.
Abstract: Fibromyalgia is a chronic, painful musculoskeletal
syndrome of unknown etiopathogenesis. In addition to
medicamentous and physical and psychologic therapies, several
other adjunct therapies have been used as alternatives in the
attempt to obtain analgesia and decrease the symptoms that are
characteristic of this problem. This article presents a literary
review on the use of acupuncture as an adjunct or chief
treatment for patients with fibromyalgia, comparing it with an
ongoing clinical experience that has been carried out at
Hospital das Clinicas in the city of Sao Paulo. The results were
found by applying traditional acupuncture, which demonstrated
positive rates in the Visual Analogue Scale, myalgic index,
number of tender points, and improvement in quality of life
based on the SF-36 questionnaire
Wahner-Roedler DL, Elkin PL, Vincent A, Thompson JM, Oh TH,
Loehrer LL et al. Use of complementary and alternative medical
therapies by patients referred to a fibromyalgia treatment
program at a tertiary care center. Mayo Clin Proc 2005;
80(1):55-60.
Abstract: OBJECTIVE: To evaluate the frequency and pattern of
complementary and alternative medicine (CAM) use in patients
referred to a fibromyalgia treatment program at a tertiary care
center. PATIENTS AND METHODS: Patients referred to the Mayo
Fibromyalgia Treatment Program between February 2003 and July
2003 were invited on their initial visit to participate in a
survey regarding CAM use during the previous 6 months. An
85-question survey that addressed different CAM domains was
used. RESULTS: Of the 304 patients invited to participate, 289
(95%) completed the survey (263 women and 26 men). Ninety-eight
percent of the patients had used some type of CAM therapy during
the previous 6 months. The 10 most frequently used CAM
treatments were exercise for a specific medical problem (48%),
spiritual healing (prayers) (45%), massage therapy (44%),
chiropractic treatments (37%), vitamin C (35%), vitamin E (31%),
magnesium (29%), vitamin B complex (25%), green tea (24%), and
weight-loss programs (20%). CONCLUSION: CAM use is common in
patients referred to a fibromyalgia treatment program.
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