PO:29:131 | Early effect of auricular acupuncture on pain modulation in patients with fibromyalgia: findings from a real-life experience

Benedetta Bianchi¹, Edoardo Cipolletta¹, Sonia Farah¹, Fausto Salaffi¹, Marco Di Carlo¹ | ¹Clinica Reumatologica, Università Politecnica delle Marche, ospedale Carlo Urbani Jesi, Ancona, Italy

Background. Acupuncture has a millennia-long history in the treatment of musculoskeletal pain, , showing satisfactory outcomes in the menagement of chronic pain syndromes (1). The use of microsystem-based techniques, such as auricular acupuncture, remains an underexplored area in fibromyalgia (FM). Currently, at the Rheumatology Unit of the Università Politecnica delle Marche, auricular acupuncture is offered as an outpatient treatment for patients with FM. Objectives. To evaluate the 24-hour efficacy of semi-permanent needles ear application in reducing musculoskeletal pain in FM patients and to identify predictors of early response.

Methods. The acupuncture treatment cycle is offered to patients with moderate disease severity, defined as a revised Fibromyalgia Impact Questionnaire (FIQR) score >40, despite optimal pharmacological therapy. At baseline, a clinical and clinimetric evaluation was performed, investigating pain, disease severity, depression, anxiety, and catastrophizing. Pain symptoms were reassessed 24 hours after the first session of application of semi-permanent needles using the Numerical Rating Scale for current pain (NRS-now) and the Widespread Pain Index (WPI). A reduction of 2 points on the NRS-now was considered a significant improvement. The difference between baseline and 24-hour values for NRS-now and WPI was assessed using the Wilcoxon signed-rank test. In addition, a linear regression analysis was performed to identify predictors of early response.

Results. A total of 84 patients were enrolled (79 women and 5 men), with a median age of 57 years (IQR 49.8-64), a median baseline FIQR of 62.2 (IQR 50.2-78.7), a median baseline WPI of 10 (IQR 7.5-13.0) and a median baseline NRS-now of 7 (IQR 5-8). At 24 hours after needles application, a significant reduction in pain symptoms was observed, both in terms of current pain and widespread pain (NRS-now decreased to 6 [IQR 5-8], p = 0.004; WPI decreased to 7 [IQR 4-10], p <0.001) (Table 1). A significant improvement was recorded in 29 (34.5%) of the 84 patients studied. Linear regression analysis identified baseline NRS-now (p <0.001) as the only significant predictor of response, with higher baseline scores associated with greater improvements (Table 2).

Conclusions. Auricular acupuncture may represent a rapidly effective technique for managing pain in patients with FM. The presence of severe pain at the moment of needles application seems to be a predictive variable of early effectiveness. The therapeutic effect of a cycle of auricular acupuncture sessions rather than a single application and the persistance of treatment-related benefits remain subjects for further investigation. Reference: (1) Di Carlo M, Beci G, Salaffi F. Acupuncture for Fibromyalgia: An Open-Label Pragmatic Study on Effects on Disease Severity, Neuropathic Pain Features, and Pain Catastrophizing. Evid Based Complement Alternat Med. 2020 Feb 25;2020:9869250.