Pain Treatment of Fibromyalgia by Acupuncture
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Pain Treatment of Fibromyalgia by Acupuncture

Abstract The lack of objective parameters makes the
measurement of pain and the efficacy of pain treatment in
patients with chronic pain very difficult. We performed acupuncture
therapy in fibromyalgia patients and established
a combination of methods to objectify pain measurement
before and after therapy. The parameters corresponded to
patients’ self-report. Twenty-nine fibromyalgia patients as
defined by ACR-criteria (25 women, 4 men) with a mean
age of 48.2±2.0 years and a mean disease duration of
6.1±1.0 years participated in the study. Pain levels and positive
tender points were assessed using the visual analogue
scale (VAS, i.e., range 0–100 mm) and dolorimetry. Serotonin
and substance P levels in serum and the serotonin concentration
in platelets were measured concomitantly. During
acupuncture therapy no analgesic medication was allowed.
The VAS scores decreased from 64.0±3.4 mm before
therapy to 34.5±4.3 mm after therapy (P<0.001). Dolorimetry
revealed a decreased number of tender points after
therapy from 16.0±0.6 to 11.8±1.0, P<0.01. Serotonin
levels decreased from 715.8±225.8 μg/1012 platelets
to 352.4±47.9 μg/1012 platelets (P<0.01), whereas the
serum concentration increased from 134.0±14.3 ng/ml
to 171.2±14.6 ng/ml (P<0.01). Substance P levels in
serum increased from 43.4±3.5 pg/ml to 66.9±8.8 pg/ml
(P<0.01). Acupuncture treatment of patients with fibromyalgia
was associated with decreased pain levels and
fewer positive tender points as measured by VAS and dolorimetry.
This was accompanied by decreased serotonin
concentration in platelets and an increase of serotonin and
substance P levels in serum. These results suggest that
acupuncture therapy is associated with changes in the concentrations
of pain-modulating substances in serum. The
preliminary results are objective parameters for acupuncture
efficacy in patients with fibromyalgia.
Key words Fibromyalgia · Serotonin · Substance P ·
Pain · Acupuncture · Therapy
Fibromyalgia is characterised by widespread pain [1]. In
addition to the phenomenon of pain [1–4], researchers have
shown pathological changes in pain-modulating substances
in fibromyalgia patients [5–8]. Acupuncture therapy
effectively reduces pain in fibromyalgia patients as
previously shown [9]. The relationship between pain reduction
and changes in pain-modulating substances in
serum after acupuncture, however, is currently unknown.
The aims of this study are to examine whether pain reduction
after acupuncture treatment is concomitantly related
to changes in serotonin and substance P levels and to
make the efficacy of acupuncture treatment more objective.
Twenty-nine fibromyalgia patients (25 women, 4 men)
with a mean age of 48.2±2.0 years and mean duration of
symptoms of 6.1±1.0 years were treated with acupuncture
over 6 weeks (6 single treatments, once per week) according
to an individually adapted therapy strategy following
acupuncture rules [9]. The population did not show any alcohol
or nicotine abuse in their history. No pain medication
was allowed during the study. The following parameters
were investigated to characterise the effect of the treatment:
– Patients reported their pain levels before and after acupuncture
treatment using the 100 mm visual analogue
scale (VAS) (0 mm = no pain; 100 mm = most intensive
– Dolorimetry with a commercial dolorimeter (markasub,
Basel, Switzerland) of 24 tender points as recommended
by Lautenschläger et al. [10]
Received: 15 May 1997
H. Sprott · S. Franke · H. Kluge · G. Hein
Pain treatment of fibromyalgia by acupuncture
Rheumatol Int (1998) 18: 35–36 © Springer-Verlag 1998
Dr. H. Sprott (½) · S. Franke · G. Hein
Department of Internal Medicine IV, Friedrich Schiller University,
D-07740 Jena, Germany
Tel.: +3641-939-157
Fax: +3641-939-269,
H. Kluge
Department of Neurology, Friedrich Schiller University,
Jena, Germany
– Measurement of platelet serotonin by fluorescent complex
formation between serotonin and o-phthaldialdehyde
– Measurement of serum serotonin by a commercial competitive
ELISA (Amicyl-Test, IBL, Hamburg, Germany)
– Measurement of the serum substance P concentration in
serum after purification of the specimens on C-18-RPcolumns
(Sep-Pak Plus C 18 columns, Millipore Waters,
Eschborn, Germany) by an ELISA system (Cayman
Chemical Company Ann Arbor MI, USA)
Statistical analyses were performed by SPSS for
WINDOWS. Means and S.E.M. are reported. The Wilcoxon
rank sum test was used.
All parameters measured before and after acupuncture
therapy are shown in Table 1. As shown, there was a statistically
significant decrease in the number of pathological
tender points and in patients’ VAS scores. There was
also a significant decrease in platelet serotonin, an increase
in the serum serotonin concentration, and a significant increase
in the substance P level.
The significant pain reduction shown in the VAS and as
assessed by dolorimetry suggest that acupuncture is a satisfactory
adjuvant pain treatment in patients with fibromyalgia.
The aim of the current study was to examine
the concentrations of the so-called pain-modulating substances
such as serotonin and substance P which are low
in the serum of fibromyalgia patients [8] before and after
acupuncture treatment. The results show that there is an
increase to levels observed in healthy individuals [12] after
acupuncture treatment. The platelet serotonin concentration
decreases, corresponding to a double increase of the
free serum serotonin based on a mean number of 210 platelets/
ml plasma. This suggests that the normalisation of the
serum serotonin level is due to a mobilisation of platelet
serotonin. These findings suggest that acupuncture is associated
with a change in serotonin and substance P in
serum in patients with fibromyalgia. In addition we observed
reductions in the number of pathological tender
points and decreased VAS scores corresponding to
patients’ own reports of pain reduction. There is a need for
further randomised and controlled studies to confirm these
preliminary results.
1. Wolfe F, Smythe HA, Yunus MB, Bennett RM, Bombardier C,
Goldenberg DL, Tugwell P, Campbell SM, Abeles M, Clark P,
Fam AG, Farber SJ, Fiechtner JJ, Franklin CM, Gatter RA,
Hamaty D, Lessard L, Lichtbroun AS, Masi AT, McCain GA,
Reynolds WJ, Romano TJ, Russell IJ, Sheon RP (1990) The
American College of Rheumatology 1990 criteria for the classification
of fibromyalgia. Report of the Multicenter Criteria
Committee. Arthritis Rheum 33:160–172
2. Müller W, Lautenschläger J (1990) Die generalisierte Tendomyopathie
(GTM) I: Klinik, Verlauf und Differentialdiagnose.
Z Rheumatol 49:11–21
3. Müller W, Lautenschläger J (1990) Die generalisierte Tendomyopathie
(GTM) II: Pathogenese und Therapie. Z Rheumatol
4. Brückle W, Müller W (1991) Schmerzverlauf und -topographie
gei generalisierten Tendomyopathien. Z Rheumatol 50 [Suppl 1]:
5. Russell IJ, Orr MD, Littman B, Vipraio GA, Alboukrek D, Michalek
JE, Lopez Y, MacKillip F (1994) Elevated cerebrospinal
fluid levels of substance P in patients with the fibromyalgia syndrome.
Arthritis Rheum 37:1593–1601
6. Sprott H, Kluge H, Franke S, Hein G (1995) Altered serotoninlevels
in patients with fibromyalgia. J Musculoske Pain 3
[Suppl 1]:65
7. Sprott H, Franke S, Grohmann G, Kluge H, Hein G (1995) Pathologische
Befunde bei Patienten mit generalisierter Tendomyopathie
(Fibromyalgie). Z Rheumatol 54:342
8. Stratz T, Schochat T, Farber L, Schweiger C, Müller W (1995)
Are there subgroups in Fibromyalgia? J Musculoske Pain 3
[Suppl 1]:15
9. Sprott H (1998) Efficiency of acupuncture in patients with fibromyalgia.
Clin Bull Myofascial Therapy 3 (in press)
10. Lautenschläger J, Brückle W, Müller W (1991) Untersuchungen
über druckschmerzhafte Punkte bei Patienten mit generalisierter
Tendomyopathie. In: Müller W (ed) Generalisierte Tendomyopathie
(Fibromyalgie). Steinkopff, Darmstadt, p 105
11. Bailly D, Vignau J, Lauth B, Racadat N, Benscart R, Servant D,
Parquet PJ (1990) Platelet serotonin decrease in alcoholic patients.
Acta Psychiatr Scand 81:68–72
12. Stratz T, Schochat T, Hrycaj P, Schweiger C, Mennet P, Färber
L, Müller W (1995) The blockade of 5-HT3-receptors in fibromyalgia
– a new therapy concept? J Musculoske Pain 3
[Suppl 1]:64
Table 1 All evaluated parameters before and after acupuncture
treatment (means±SEM are given)
Before therapy After therapy Significance
VAS (mm) 64.0±3.4 34.5±4.3 P<0.001
Tender points (n) 16.0±0.6 11.8±1.0 P<0.01
Serotonin 715.8±225.8 352.4±47.9 P<0.01
(μg/1012 platelets)
Serotonin in serum 134.0±14.3 171.2±14.6 P<0.01
Substance P in serum 43.4±3.5 66.9±8.8 P<0.01

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