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VBCR - April 2017, Vol 6, No 1
Anne Rowe

Fibromyalgia is a syndrome that affects the muscles and soft tissue and is characterized by widespread chronic pain and other symptoms, including headache, sleep difficulties, fatigue, muscle pain, and mood disorders that can significantly affect the patient’s quality of life. Recent evidence has shown that some patients with fibromyalgia are at increased risk for serious comorbidities, such as heart disease. According to data from the 2012 US National Health Interview Survey, myocardial infarction occurred more than twice as frequently in individuals who were diagnosed with fibromyalgia than in those who did not have the disorder.1 Furthermore, in a recent population-based cohort study of Taiwanese patients, those with fibromyalgia were at a 47% increased risk for coronary heart disease (CHD) after adjusting for age, sex, vocation, monthly earnings, and comorbid conditions.2

First Study to Examine Efficacy of Acupuncture in Preventing CHD

Although treatment with FDA-approved agents for fibromyalgia, such as pregabalin, duloxetine, and milnaci­pran, may be beneficial for some patients, experts recommend a combination of pharmacologic and non­pharmacologic strategies to manage fibromyalgia-related symptoms.

Acupuncture is one nonpharmacologic intervention that is often used to relieve pain and improve physical function; according to a recently published retrospective analysis of 158,425 adult Taiwanese patients, this ancient form of therapy may also decrease the risk for CHD in patients with fibromyalgia.3

“To our knowledge, our present nationwide population-based study is the first to reveal that acupuncture decreases the risk of CHD in patients with fibromyalgia,” wrote Mei-Yao Wu, PhD, Research Center for Traditional Chinese Medicine, China Medical University Hospital, Taiwan, and colleagues. Dr Wu and colleagues used data from the Taiwanese National Health Insurance Research Database to perform a propensity score–matched study of patients diagnosed with fibromyalgia between 2000 and 2010. Patients were categorized into 2 cohorts—those who received acupuncture and those who did not—with a total of 58,899 patients in each cohort. The investigators used a Cox regression model to compare the hazard ratio (HR) of acupuncture versus no acupuncture after adjusting for age, sex, comorbidities, and medication use.

Common Comorbidities with Fibromyalgia

Baseline characteristics in both cohorts of patients were comparable in terms of sex, age, comorbidities, drugs administered, alcoholism (or alcohol-related disorders), tobacco use, and obesity. Both groups had more women than men, and the most common age group was 40 to 59 years. The most common comorbidity was hypertension, which was observed in >20% of patients; followed by hyperlipidemia in 17% of patients; anxiety in 11%; diabetes in 10.6%; strokein 6.9%; depression in 4.9%; and congestive heart failure in 1% of the patients.

The mean time between fibromyalgia diagnosis and initial acupuncture session was approximately 919 days, and patients underwent an average of 7.45 acupuncture sessions. The majority (85%) of patients had manual acupuncture, 3.6% had electroacupuncture, and approximately 10.7% had both types of therapy.

The most common reason that patients in the study chose to undergo acupuncture was for the treatment of musculoskeletal and connective tissue issues. Additional disease categories in the acupuncture cohort included injury, and nervous, digestive, respiratory, circulatory, and genitourinary system disorders.

Beneficial Effects of Acupuncture on Risk for CHD

At the time of follow-up, 4389 patients in the acupuncture cohort and 8133 patients in the nonacupuncture group had CHD (adjusted HR, 0.43; 95% confidence interval, 0.41-0.45). The ability of acupuncture to reduce the risk for CHD was observed in both men and women in the study. The type of medications patients were taking (ie, oral steroids, nonsteroidal anti-inflammatory drugs, or statins) did not reduce the benefit of acupuncture therapy. The investigators noted that although certain factors increased the risk for CHD in patients with fibromyalgia, including older age and the presence of comorbidities, a significantly lower cumulative incidence of CHD was seen in patients who had acupuncture compared with those who did not.

“As a popular treatment for fibromyalgia, acupuncture has been performed on patients with fibromyalgia in several clinical trials. However, the outcome evaluation was previously always focused on pain score, sleep quality, and QOL [quality of life]. In our study, we found that the beneficial effects of acupuncture on developing CHD in patients with fibromyalgia were independent of sex, age, comorbidities and anti-inflammatory drugs included in our data,” Dr Wu and colleagues wrote.

The investigators listed potential reasons for the reduction in CHD rates in patients who undergo acupuncture, including that insomnia is associated with fibromyalgia and CHD, and acupuncture has been shown to improve the quality of sleep.

Acupuncture also has the potential to reduce depression and inflammation, both of which have been shown to increase the risk for CHD. In addition, acupuncture may have the potential to alter certain central nervous system functions related to cardiac function, although further study into this mechanism of action is warranted.

References

  1. Walitt B, Nahin RL, Katz RS, et al. The prevalence and characteristics of fibromyalgia in the 2012 National Health Interview Survey. PLoS One. 2015;10:e0138024.
  2. Su CH, Chen JH, Lan JL, et al. Increased risk of coronary heart disease in patients with primary fibromyalgia and those with concomitant comorbidity: a Taiwanese population-based cohort study. PLoS One. 2015;10:e0137137.
  3. Wu MY, Huang MC, Chiang JH, et al. Acupuncture decreased the risk of coronary heart disease in patients with fibromyalgia in Taiwan: a nationwide matched cohort study. Arthritis Res Ther. 2017;19:37.
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