Evoked Pressure Pain Sensitivity Is Associated with Differential Analgesic Response to Verum and Sham Acupuncture in Fibromyalgia.
OBJECTIVE
Fibromyalgia is a chronic pain condition with few effective treatments. Many fibromyalgia patients seek acupuncture for analgesia; however, its efficacy is limited and not fully understood. This may be due to heterogeneous pathologies among participants in acupuncture clinical trials. We hypothesized that pressure pain tenderness would differentially classify treatment response to verum and sham acupuncture in fibromyalgia patients.


METHODS
Baseline pressure pain sensitivity at the thumbnail at baseline was used in linear mixed models as a modifier of differential treatment response to sham versus verum acupuncture. Similarly, needle-induced sensation was also analyzed to determine its differential effect of treatment on clinical pain.


METHODS
A cohort of 114 fibromyalgia patients received baseline pressure pain testing and were randomized to either verum (N = 59) or sham (N = 55) acupuncture. Participants received treatments from once a week to three times a week, increasing in three-week blocks for a total of 18 treatments. Clinical pain was measured on a 101-point visual analog scale, and needle sensation was measured by questionnaire throughout the trial.


RESULTS
Participants who had higher pain pressure thresholds had greater reduction in clinical pain following verum acupuncture while participants who had lower pain pressure thresholds showed better analgesic response to sham acupuncture. Moreover, patients with lower pressure pain thresholds had exacerbated clinical pain following verum acupuncture. Similar relationships were observed for sensitivity to acupuncture needling.


CONCLUSIONS
These findings suggest that acupuncture efficacy in fibromyalgia may be underestimated and a more personalized treatment for fibromyalgia may also be possible.
Departments of Anesthesiology.
Noah A
NA
Zucker
Biostatistics, University of Michigan, Ann Arbor, Michigan.
Alex
A
Tsodikov
School of Nursing and Department of Anesthesiology and Perioperative Medicine, Oregon Health Sciences University, Portland, Oregon.
Scott D
SD
Mist
Department of Radiology, Massachusetts General Hospital, Martinos Center for Biomedical Imaging, Charlestown, Massachusetts, USA.
Stephen
S
Cina
Department of Radiology, Massachusetts General Hospital, Martinos Center for Biomedical Imaging, Charlestown, Massachusetts, USA.
Vitaly
V
Napadow
Departments of Anesthesiology.
Richard E
RE
Harris
D015667:Acupuncture Analgesia; D000328:Adult; D000368:Aged; D005260:Female; D005356:Fibromyalgia / Q000628:therapy*; D006801:Humans; D008297:Male; D008875:Middle Aged; D059408:Pain Management / Q000379:methods*; D010147:Pain Measurement; D017288:Pain Threshold / Q000502:physiology*; D055815:Young Adult
Fibromyalgia; Needling Sensation; Pressure Pain Threshold; Quantitative Sensory Testing;  Acupuncture