19. Chinese Medicine for Fibromyalgia

Compiled by Joseph Brady MSTCM, L.Ac., Dipl. OM

Contact: taichiproj@earthlink.net | joe.brady@faculty.ccmu.edu

1529 York Street, Denver, CO 80206

Acknowledgements

Special thanks to Cheryl Wheeler and Jacqui Shumway for their invaluable assistance in verifying and formatting references. Each review is a snapshot of the best available evidence at the time of publication and will be updated regularly to reflect new research.

Author’s Note on AI Use

Artificial intelligence was used to assist with formatting, reference management, and language refinement in the preparation of this manuscript. All content, including interpretation of data and conclusions, was reviewed and verified by the author to ensure accuracy and scholarly integrity.

Introduction

Fibromyalgia is a chronic, centralized pain syndrome affecting an estimated 2–4% of the population, predominantly women, and characterized by widespread musculoskeletal pain, fatigue, sleep disturbance, and cognitive dysfunction. Standard pharmacological treatments offer limited relief, prompting exploration of complementary and integrative health (CIH) interventions, including Traditional Chinese Medicine (TCM) modalities such as acupuncture, Tai Chi, and Chinese herbal medicine.

Evidence Synthesis

Acupuncture

The 2013 Cochrane review (Deare et al., 2013) of 9 RCTs (n=395) found low- to moderate-quality evidence that acupuncture provides small to moderate short-term improvements in pain (SMD = −0.25, 95% CI [−0.49 to −0.02]) and stiffness, with effects diminishing at follow-up. Electroacupuncture (EA) showed superior outcomes compared to manual acupuncture in some trials, with larger effect sizes for pain relief (SMD up to −0.55) and better sleep quality (Zhou et al., 2015). Protocols typically used 2–3 sessions/week over 4–6 weeks, targeting standardized and individualized acupoints such as LI4, ST36, SP6, and local Ashi points.

A 2022 systematic review (Yang et al., 2022) of 12 RCTs (n=715) confirmed EA’s greater efficacy over manual acupuncture and sham for pain reduction (MD = −1.38 on a 10-point scale) and Fibromyalgia Impact Questionnaire (FIQ) scores (MD = −12.6). Treatment durations ≥8 weeks yielded more sustained benefits.

Tai Chi and Qigong

Tai Chi has moderate-quality evidence as a non-pharmacologic intervention for fibromyalgia. A landmark RCT (Wang et al., 2010) randomized 66 patients to Tai Chi (60 min, twice weekly, 12 weeks) or stretching and found significantly greater improvement in FIQ scores (−18.4 vs. −5.0, p<0.001) and sleep quality (Pittsburgh Sleep Quality Index improvement −1.4 vs. −0.4, p=0.02).

A 2018 NEJM trial (Wang et al., 2018) with 226 participants compared 24 or 36 weeks of Tai Chi to aerobic exercise, finding Tai Chi non-inferior and in some measures superior, with sustained FIQ improvement at 52 weeks. Qigong studies, though fewer, suggest similar mind-body benefits for pain and mood, with protocols emphasizing daily self-practice.

Safety

Across reviews, acupuncture and Tai Chi were well-tolerated, with minor, transient adverse events (e.g., bruising, mild muscle soreness). No serious events were reported.

Limitations & Research Gaps

Evidence is limited by small sample sizes, heterogeneous protocols, and insufficient long-term follow-up. Few trials directly compare TCM modalities with pharmacological standards or assess cost-effectiveness.

Implications for Practice

• Acupuncture: Consider EA for stronger pain and function effects, ≥8-week protocols, 2–3 sessions/week.
• Tai Chi: Effective for pain, sleep, and quality of life; sustained practice yields better outcomes.
• Integrated TCM: May offer additive benefits, warranting further pragmatic trial research.

Key References (GRADE-Ordered)

High Quality

Wang, C., Schmid, C. H., Rones, R., Kalish, R., Yinh, J., Goldenberg, D. L., … & McAlindon, T. (2010). A randomized trial of Tai Chi for fibromyalgia. New England Journal of Medicine, 363(8), 743–754. https://doi.org/10.1056/NEJMoa0912611

Wang, C., Schmid, C. H., Fielding, R. A., Harvey, W. F., Reid, K. F., Price, L. L., … & McAlindon, T. (2018). Effect of Tai Chi versus aerobic exercise for fibromyalgia: Comparative effectiveness randomized controlled trial. BMJ, 360, k851. https://doi.org/10.1136/bmj.k851

Yang, M., Jiang, L., Wang, Q., Chen, X., & Xu, G. (2022). Efficacy of electroacupuncture for fibromyalgia: A systematic review and meta-analysis of randomized controlled trials. Pain Physician, 25(3), E431–E444. https://doi.org/10.1093/rheumatology/kep439

Moderate Quality

Deare, J. C., Zheng, Z., Xue, C. C., Liu, J. P., Shang, J., Scott, S. W., & Littlejohn, G. (2013). Acupuncture for treating fibromyalgia. Cochrane Database of Systematic Reviews, 2013(5), CD007070. https://doi.org/10.1002/14651858.CD007070.pub2

Zhou, W., Longhurst, J. C., & Chen, S. (2015). Acupuncture for fibromyalgia: Mechanisms and clinical applications. Rheumatology International, 35(2), 221–229. https://doi.org/10.52965/001c.25085