Did ‘the Princess on the Pea— Suffer from Fibromyalgia Syndrome?

Lundeberg, Thomas; Lund, Irène

doi:10.1136/aim.25.4.184

Cited by 8 publications

(3 citation statements)

References 157 publications

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“…132 We have previously questioned conclusions based on so called randomised controlled trials using sham procedures such as 'placebo needles', superficial needling or needling outside the affected area. [133][134][135][136][137] Despite claims of being inert there is now strong evidence suggesting that this is not the case but additional modulatory systems seem to be affected when using acupuncture. Taken together it appears that a major effect of acupuncture, superficial needling and 'sham acupuncture' may be attributed to deactivation of function in limbic structures resulting in reduced affective components of pain.…”

Section: Irritable Bowel Syndrome (Ibs)mentioning

confidence: 99%

Is it All about Sex? Acupuncture for the Treatment of Pain from a Biological and Gender Perspective

Lund

Lundeberg

2008

Acupunct Med

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Pain is a unique personal experience showing variability where gender and sex related effects might contribute. The mechanisms underlying the differences between women and men are currently unknown but are likely to be complex and involving interactions between biological, sociocultural and psychological aspects. In women, painful experimental stimuli are generally reported to produce a greater intensity of pain than in men. Clinical pain is often reported with higher severity and frequency, longer duration, and present in a greater number of body regions in women than in men. Women are also more likely to experience a number of painful conditions such as fibromyalgia, temporomandibular dysfunction, migraine, rheumatoid arthritis and irritable bowel syndrome. With regard to biological factors, quantitative as well as qualitative differences in the endogenous pain inhibitory systems have been implicated, as well as an influence of gonadal hormones. Psychosocial factors like sex role beliefs, pain coping strategies, and pain related expectancies may also contribute to the differences. Being exposed to repeated painful visceral events (eg menses, labour) during life may contribute to an increased sensitivity to, and greater prevalence of, pain among women. When assessing the outcome of pharmacological and non-pharmacological therapies in pain treatment, the factors of gender and sex should be taken into account as the response to an intervention may differ. Preferably, treatment recommendations should be based on studies using both women and men as the norm. Due to variability in results, findings from animal studies and experiments in healthy subjects should be interpreted with care.

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Section: Irritable Bowel Syndrome (Ibs)mentioning

confidence: 99%

Is it All about Sex? Acupuncture for the Treatment of Pain from a Biological and Gender Perspective

Lund

Lundeberg

2008

Acupunct Med

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“…Some conditions, eg migraine or fibromyalgia, probably require several mechanisms to be activated if treatment is to be effective; 22 and some conditions, again including fibromyalgia, may require a different dose according to the degree to which the nervous system is sensitised in a particular patient. 23 The effect of needling will vary at different sites in the body, and, for simplicity, we shall not consider the site of stimulation in this paper. 24 Due to the properties of the nervous system, there are likely to be 'threshold' effects so that the relationship between dose and response is not linear.…”

Section: -10mentioning

confidence: 99%

Defining an Adequate Dose of Acupuncture Using a Neurophysiological Approach – a Narrative Review of the Literature

et al. 2008

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Many different styles of acupuncture practice exist, and lack of agreement on the optimal acupuncture treatment for any particular condition may mean that some patients do not receive the best treatment. This uncertainty also makes the negative results of sham controlled trials difficult to interpret. Unless we can be sure that both adequate acupuncture and an inactive sham were used in a particular trial, then that trial should not be interpreted as dismissing acupuncture for that condition. Acupuncture practice clearly involves much more than needling procedures, but there is a strong argument for elucidating the role of those needling procedure first. The components of acupuncture needling procedures have been described in the STRICTA document, but it is also clear that the patient's perception of needling is relevant for the outcome of treatment. We therefore recommend the concept of ‘dose’ of acupuncture needling, which should include both the stimulus given to the patient, and certain aspects of the patient's perceptions and response that are known to be linked to the subsequent therapeutic response. We propose the following definition of dose: the physical procedures applied in each session, using one or more needles, taking account of the patient's resulting perception (sensory, affective and cognitive) and other responses (including motor). The dose may be affected by the state of the patient (eg nervous, immune and endocrine systems); different doses may be required for different conditions. The constituents of an adequate dose can be established initially by clinical opinion and subsequently by empirical evidence from experimental studies, which may be either clinical or basic research studies. Systematic reviews which do not consider the adequacy of the acupuncture treatment may have unreliable conclusions. Out of 47 recent systematic reviews, only six have applied some criteria for adequacy. Five used a rating system or conducted a subgroup analysis, and one excluded studies from the analysis altogether if they did not meet criteria for adequacy. Research into what constitutes an adequate dose of acupuncture has long been neglected and is now urgent. Clinical studies that compare the effects of different treatment protocols are probably the most reliable source of evidence, and may also demonstrate a dose-response relationship.

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“…Lundeberg and Lund 35 comment on sleep disorder in fibromyalgia and draw attention to the failure of acupuncture studies to measure quality of sleep because pain is frequently the primary outcome measure. FIQ contains one question related to sleep so does include change of this parameter within an overall assessment.…”

Section: ;32mentioning

confidence: 99%

Acupuncture in the Treatment of Fibromyalgia in Tertiary Care – a Case Series

2007

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Aims Fibromyalgia is a common cause of chronic widespread pain. The benefit of medication is often limited by its side effects, and the improvements obtained with exercise and education are inconsistent. Many patients seek acupuncture treatment, which is reported to be helpful in some cases. This study aimed to explore the acceptability and benefits of acupuncture offered in the setting of a tertiary referral clinic. Methods An open, uncontrolled observational study was conducted among patients who met the usual fibromyalgia criteria and who had a pain score of at least 30 on a 100mm Visual Analogue Scale (VAS). Patients were allowed to continue other treatments but not to introduce new ones. Acupuncture was given using a Western approach according to a protocol developed by consensus. Patients were offered eight treatments in eight weeks. Outcome measures included VA S of pain intensity and Fibromyalgia Impact Questionnaire (range 0 -100), and were taken before and after treatment, and at 14, 20 and 34 weeks from enrolment. Results Twenty four eligible patients were enrolled in a 12 month period. Baseline mean pain VA S score for these 24 patients was 74 (SD 18) and mean Fibromyalgia Impact Questionnaire score 78 (SD 12.4). Only 14 patients completed the course of treatment within about 10 weeks. Compliance was poor in the remaining patients because of difficulty attending clinic, and in two cases because of exacerbation of pain. Completion of outcome measures was variable and therefore the analysis of data is limited. Five patients scored at least 20% reduction in Fibromyalgia Impact Questionnaire score which is a clinically relevant improvement. Two of these scored at least 50% reduction. Conclusion Acupuncture appears to offer symptomatic improvement to some patients with fibromyalgia in a tertiary clinic who have failed to respond to other treatments. In view of its safety, further acupuncture research is justified in this population.

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Did ‘the Princess on the Pea— Suffer from Fibromyalgia Syndrome?

Cited by 8 publications

References 157 publications

Is it All about Sex? Acupuncture for the Treatment of Pain from a Biological and Gender Perspective

Is it All about Sex? Acupuncture for the Treatment of Pain from a Biological and Gender Perspective

Defining an Adequate Dose of Acupuncture Using a Neurophysiological Approach – a Narrative Review of the Literature

Acupuncture in the Treatment of Fibromyalgia in Tertiary Care – a Case Series

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