Acupuncture efficacy for fibromyalgia in the framework of predictive, preventive, and personalized medicine: results of a pragmatic open-label study

Abstract

Background. Acupuncture is an effective therapy in chronic pain that can be recommended in patients with fibromyalgia (FM). However, the symptomatological expressiveness of FM is very wide, and to date, there is no ideal patient who is a suitable candidate for acupuncture therapy. In a high-prevalence disease such as FM, in the absence of well-codified treatment patterns, being able to apply the rationale of predictive, preventive and personalized medicine (PPPM/3PM) is crucial to avoid unnecessary expense and burden on patients. The aim of this study, in the context of PPPM/3PM, is to identify the predictive factors of failure to acupuncture in order to identify the ideal FM patient to be directed to such treatment. Methods. FM patients with severe symptoms refractory to standard drug therapy underwent eight weekly acupuncture sessions. Significant improvement, defined as a reduction of at least 30% of the Revised Fibromyalgia Impact Questionnaire (FIQR), was assessed at the end of the eight weeks (T1) of treatment and three months after the end of treatment (T2). Univariate analysis was conducted to identify predictors of significant improvement at T1 and T2. Variables, which resulted significantly associated with clinical improvement at univariate analysis, were included in multivariate models. Results. Analyses were conducted on 77 patients (9 males, 11.7%). At T1, significant improvement in FIQR was recorded in 34 out of 77 patients (44.2%). At T2, significant improvement in FIQR persisted in 16 out of 77 patients (20.8%). In multivariate analysis, predictive variables of treatment failure were tender point count (odds ratio [OR] = 0.49, 95% confidence interval [95% CI]: 0.28–0.86, p = 0.01) and pain magnification (OR = 0.68, 95% CI: 0.47–0.99, p = 0.04) assessed with Pain Catastrophizing Scale, at T1. At T2, the only predictive variable of treatment failure was concomitant duloxetine use (OR = 0.21, 95% CI: 0.05–0.95, p = 0.04). Conclusion. The novelties of this study are in the context of PPPM/3PM in terms of a predictive approach, through the identification of clinical characteristics of unfavorable response to acupuncture. By evaluating these variables, it is possible to implement a targeted and cost-effective tertiary prevention and plan personalized medical service in patients with FM.