Background The use of acupuncture is related to patients' expectations, and the therapeutic interaction effect remains a topic of debate in the literature. Accordingly, it is still unclear whether acupuncture can generate positive clinical effects in patients with fibromyalgia (FM). Objective To determine the effectiveness of acupuncture versus placebo for clinical outcomes and determine the overall effect not attributed to specific effects in patients with FM. Design Umbrella review of systematic reviews (SRs) and meta-analyses. Data sources and methods An electronic search was performed in MEDLINE (via PubMed), Web of Science, CENTRAL, EMBASE, LILACS, CINAHL, PEDro, and SPORTDiscus databases from inception until December 2023. We selected studies with a clinical diagnosis of FM and that analyzed the effectiveness of acupuncture compared with a placebo. Pain intensity, functional status, fatigue, sleep quality, and depression symptoms were assessed. Effect sizes were calculated as the mean difference (MD) or standard mean difference (SMD). The quality of intervention reporting was assessed using the Grading of Recommendations Assessment, Development, and Evaluation approach. Results Eleven SRs with 8399 participants were included. Compared with placebo, acupuncture was associated with reductions in pain intensity (MD = -1.13 cm, 95% CI -2.09 to -0.17, p < 0.001), physical function (SMD = -0.63, 95% CI -1.67 to 0.41, p = 0.06), sleep quality (SMD = -0.25, 95% CI -1.39 to 0.88, p = 0.06), and fatigue (SMD = 0.20, 95% CI = 0.17 to 0.22, p < 0.001). The proportion not attributable to specific effects (PCE) of acupuncture was 58% for pain intensity (PCE = 0.58, 95% CI 0.45 to 0.71), 57% for physical function (PCE = 0.57, 95% CI -0.07 to 1.20), and 69% for fatigue (PCE = 0.69, 95% CI 0.18 to 1.21). Conclusion Acupuncture showed a statistically significant difference in decreased pain intensity and fatigue in women with FM. However, the certainty of evidence was low to very low; its effects are not clinically important, and more than 50% of the overall treatment effects were not attributed to the specific effects of acupuncture. PROSPERO registration number CRD42023487315.

中文翻译：

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针灸与安慰剂对纤维肌痛临床状态和潜在特异性影响的影响：11 项荟萃分析的总体综述。


背景 针灸的使用与患者的期望有关，治疗相互作用的效果仍然是文献中争论的话题。因此，目前尚不清楚针灸是否可以对纤维肌痛（FM）患者产生积极的临床效果。目的 确定针灸与安慰剂对临床结果的有效性，并确定 FM 患者的总体效果（不归因于特定效果）。设计系统评价 (SR) 和荟萃分析的总体评价。数据来源和方法 从建立到 2023 年 12 月，在 MEDLINE（通过 PubMed）、Web of Science、CENTRAL、EMBASE、LILACS、CINAHL、PEDro 和 SPORTDiscus 数据库中进行了电子检索。我们选择了 FM 临床诊断的研究，并且分析了针灸与安慰剂相比的有效性。评估疼痛强度、功能状态、疲劳、睡眠质量和抑郁症状。效应大小计算为平均差（MD）或标准平均差（SMD）。使用建议评估、制定和评价分级方法对干预报告的质量进行了评估。结果 纳入 11 个 SR，共 8399 名参与者。与安慰剂相比，针灸与疼痛强度（MD = -1.13 cm，95% CI -2.09 至 -0.17，p < 0.001）、身体功能（SMD = -0.63，95% CI -1.67 至 0.41，p）的降低相关。 = 0.06）、睡眠质量（SMD = -0.25，95% CI -1.39 至 0.88，p = 0.06）和疲劳（SMD = 0.20，95% CI = 0.17 至 0.22，p < 0.001）。疼痛强度（PCE = 0.58，95% CI 0.45 至 0.71）不可归因于针灸特异性效应（PCE）的比例为 58%，身体功能（PCE = 0.57，95% CI -0.07 至 1.20）为 57%，疲劳率为 69%（PCE = 0.69，95% CI 0.18 至 1.21）。结论 针灸在降低 FM 女性疼痛强度和疲劳方面具有统计学显着差异。然而，证据的质量从低到极低；其疗效在临床上并不重要，总体治疗效果的50%以上并非归因于针灸的具体疗效。 PROSPERO 注册号 CRD42023487315。