Acupuncture for fibromyalgia syndrome: an overview of systematic reviews and meta-analyses

Numerous systematic reviews (SRs) and meta-analyses (MAs) have investigated the clinical effectiveness of acupuncture therapy (AT) for fibromyalgia syndrome (FMS); however, the quality and consistency of the evidence remain unclear. This study aimed to evaluate the methodological quality and strength of evidence in published SRs and MAs on the efficacy and safety of AT for FMS.

A comprehensive literature search was conducted in 11 databases up to May 2025. Two reviewers independently selected studies, extracted data, and assessed methodological quality using A MeaSurement Tool to Assess systematic Reviews-2 (AMSTAR-2), reporting quality via Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) 2020 and certainty of evidence with Grading of Recommendations Assessment, Development, and Evaluation (GRADE).

Thirteen SRs and MAs were included. According to AMSTAR-2, only one SR and MA was rated high quality, three were moderate, and eight were low or critically low, respectively. Following the PRISMA guidelines, five SRs demonstrated compliance >85%. No high-quality evidence with GRADE assessment was found. The overall quality of evidence in the included SRs ranged from "very low" to "moderate." AT was found to be superior to sham AT or standard pharmacological therapies (SPT) in treating FMS and pain. Evidence from 10 SRs (collectively reporting on 63 outcomes) indicated that AT provided superior pain relief than sham AT or SPT. AT was more effective than sham AT (Visual Analog Scale; mean difference [MD] -1.04 [-1.70, -0.38], p = 0.002) and SPT (MD -1.77 [-2.10, -1.44], p < 0.00001) in reducing pain. It also showed significantly better long-term pain relief (standard mean difference [SMD] 0.40 [-0.77, -0.03], p = 0.03), lower Fibromyalgia Impact Questionnaire scores (SMD -0.69 [-0.91, -0.47], p < 0.00001), reduced fatigue (SMD -0.03 [-0.42, 0.35], p = 0.87), reduced number of tender points (SMD -2.38 [-3.40, -1.37], p < 0.00001), and increased pain pressure threshold (SMD 0.31 [0.02, 0.61], p = 0.04). No adverse effects attributed to AT were reported.

The current SRs and MAs provide low-quality evidence for the effectiveness of AT in treating FMS. Robust and well-designed studies using standardized methods are needed to provide more reliable and convincing evidence.

https://www.crd.york.ac.uk/PROSPERO/view/CRD42024536968, Identifier CRD42024536968.