Introduction In recent reviews evaluating the efficacy of acupuncture in fibromyalgia syndrome (FMS) it has been concluded that acupuncture has no specific effects since the control procedure (superficial needling and/or needling away from the ‘specific’ points) has similar effects. 1-11 A prerequisite for these conclusions is that the control procedure used is inert and without specific effects. FMS is a chronic syndrome characterised by diffuse or specific muscle, joint, or bone pain, fatigue, and a wide range of other symptoms. The term fibromyalgia, coined in 1976 to more accurately describe the symptoms, originates from the Latin word fibra, meaning fibre, and the Greek words myo, meaning muscle, and algos, meaning pain. The defining symptoms of FMS are chronic, widespread pain and tenderness to light muscle touch and moderate to severe fatigue. Those affected may also experience heightened sensitivity of the skin. In patients with FMS non-noxious stimuli give rise to pain, allodynia, and noxious stimuli cause pain that lasts longer and has higher intensity than normally, hyperalgesia. FMS is also characterised by muscle ache, muscle spasms, weakness in the limbs, and ‘nerve’ pain. 12-22 ACUPUNCTURE IN MEDICINE 2007;25(3):100-106. 100 www.acupunctureinmedicine.org.uk/volindex.php Education, practice and debate Are reviews based on sham acupuncture procedures in fibromyalgia syndrome (FMS) valid? Thomas Lundeberg & Iréne Lund Abstract In recent reviews regarding the efficacy of acupuncture in fibromyalgia syndrome (FMS) it has been concluded that acupuncture has no specific effect since the control procedure (superficial needling and/or needling away from ‘specific’ points) had similar effects. These conclusions may be questioned since superficial needling and/or needling away from specific trigger points is not inert. Also, manual acupuncture or mild electroacupuncture (EA) may not be sufficient to activate the endogenous pain inhibiting system. Patients with FMS suffer from allodynia, fatigue and muscle ache, which is partly explained by peripheral and central sensitisation. Sensitisation results in augmented and altered stimulus responses whereby light stimulation of the skin has as strong an effect as regular needling on the pain inhibitory system in FMS. Central sensitisation in FMS is also associated with expanded receptive fields of central neurons resulting in a larger topographic distribution of the pain. This would suggest that control procedures using needling away from the ‘specific site’ might have as strong an effect as needling within the most painful area. Also, repeated nociceptive input from muscles (as obtained by de qi) results in expansion of receptive fields which in turn may result in activation of descending pain inhibition outside the stimulated myotome. Sensitisation to pain, such as in FMS, may also be related to abnormalities in descending efferent pathways. As there is likely to be an imbalance between excitatory and inhibitory systems in FMS, stronger stimulation may therefore be needed to activate the descending pain inhibitory system. In studies using mild manual acupuncture or weak EA stimulation optimal pain inhibition may therefore not have been obtained. When conducting studies on acupuncture, the clinical condition or syndrome needs to be taken into account and the control procedure designed accordingly. Keywords Acupuncture, fibromyalgia syndrome, pain, placebo, sensitisation, sham control. Thomas Lundeberg, senior consultant Rehabilitation Medicine University Clinic Danderyds Hospital Stockholm, Sweden Iréne Lund lecturer registered physiotherapist Department of Physiology and Pharmacology Karolinska Institutet Stockholm, Sweden Correspondence: Thomas Lundeberg thomas.lundeberg@ds.se on 23 July 2018 by guest. Protected by copyright. http://aim.bmj.com/ Acupunct Med: first published as 10.1136/aim.25.3.100 on 1 January 2007. Downloaded from