PURPOSE: Fibromyalgia syndrome (FMS) is a chronic disorder characterized by widespread pain, fatigue, and reduced quality of life. Although acupuncture is commonly used for symptom management, evidence regarding its efficacy remains inconsistent. This systematic review and meta-analysis aimed to evaluate the short- and long-term effects of acupuncture on core symptoms of FMS.
METHODS: Following PRISMA guidelines, we systematically searched PubMed, Embase, CENTRAL, and ClinicalTrials.gov for randomized controlled trials (RCTs) through February 24, 2025. Eligible trials compared acupuncture versus conventional treatment, with or without sham acupuncture, in adults with FMS. Study quality was assessed using Cochrane RoB 2.0. Data were synthesized with random-effects models in Stata 18.0, and subgroup analyses explored effects of gender, treatment frequency, and acupuncture type.
RESULTS: Seventeen RCTs comprising 773 participants were included. Meta-analysis demonstrated that acupuncture significantly improved pain (SMD = -0.72, 95% CI: -1.02 to -0.41, P < 0.01, I2 = 70.86%) and stiffness (SMD = -0.72, 95% CI: -1.10 to -0.34, P < 0.01, I2 = 48.71%) in the short term, with these benefits remaining statistically significant during long-term follow-up. However, benefits in quality of life, mental health, work ability, anxiety, depression, and energy were observed only in the short term. No significant overall improvements were found in physical function or fatigue. Subgroup analysis indicated that high-session-frequency acupuncture was associated with better physical function, while acupuncture with electrical stimulation provided additional benefits in reducing fatigue and number of tender points (NTP).
CONCLUSION: Acupuncture is an effective treatment for key FMS symptoms, particularly pain and stiffness. Therapeutic effects are influenced by treatment frequency and acupuncture type. Further high-quality trials are needed to optimize treatment protocols and sustain long-term benefits.
| Discipline Area | Score |
|---|---|
| Rehab Clinician (OT/PT) |  |
| Physician |  |
Physician rater
Most benefits beyond pain and stiffness diminished after 8 weeks. Limitations included small sample sizes, evidence of publication bias, and the sensitivity analyses showed instability in fatigue and stiffness outcomes. Further research is required on optimal protocols and maintenance strategies.
Physician rater
Acupuncture is most effective in FMS as an adjunct within multimodal rehabilitation, because it significantly reduces pain and stiffness in both the short and long term. However, higher-frequency sessions (= 2x/week) are necessary for functional gains; electroacupuncture offers additional benefits for fatigue and tender points. Psychological improvements (such as anxiety and depression) are temporary, emphasizing that acupuncture cannot replace behavioral interventions.
Rehab Clinician (OT/PT) rater
Useful paper but the outcomes are influenced by high heterogeneity between trials, which may have impacted short- and especially long-term outcomes of acupuncture in patients with fibromyalgia syndrome.
Rehab Clinician (OT/PT) rater
This is a well-structured and methodologically sound review following PRISMA guidelines, with appropriate use of Cochrane RoB 2.0 to assess study quality. The findings are clinically relevant for managing fibromyalgia syndrome, particularly demonstrating consistent benefits in pain and stiffness. However, moderate-to-high heterogeneity and relatively small pooled sample size limit the strength and generalizability of the conclusions. The lack of sustained improvements in fatigue and physical function is an important limitation. Overall, the study reinforces existing evidence supporting acupuncture as a useful adjunct in FMS management.
, McMaster University