Acupuncture in the treatment of fibromyalgia: An updated review of clinical evidence

Introduction: Fibromyalgia (FM) is a chronic syndrome characterized by widespread musculoskeletal pain, fatigue, sleep disturbances, and cognitive impairment. Acupuncture has been widely used as a complementary therapy; however, the magnitude of its clinical effect remains a matter of debate. Objective: To synthesize the available scientific evidence regarding the efficacy and safety of acupuncture in the treatment of fibromyalgia by analyzing randomized controlled trials (RCTs), systematic reviews, and recent clinical guidelines. Methods: A systematized narrative review was conducted through searches in the PubMed/MEDLINE, Cochrane Library, and Google Scholar databases, covering publications up to September 2025. RCTs, systematic reviews, and meta-analyses evaluating manual acupuncture or electroacupuncture in adult patients diagnosed with fibromyalgia according to the American College of Rheumatology criteria were included. Data on acupuncture protocols, comparators, clinical outcomes, and adverse events were extracted. Results: A total of 23 RCTs and 11 systematic reviews/meta-analyses were identified, encompassing more than 8,400 participants from 15 countries. Acupuncture demonstrated a significant reduction in pain, as well as improvements in quality of life and emotional symptoms compared with usual care or sham acupuncture, although the clinical effect size was small to moderate. Studies such as those by Vas et al. and Karatay et al. reported sustained benefits and suggested neurochemical mechanisms, including increased serotonin levels and reduced substance P. Adverse events were rare and mild. International guidelines, such as the EULAR 2016/17 recommendations, consider acupuncture an optional intervention, whereas recent Chinese guidelines assign a strong recommendation. Conclusion: Acupuncture is a safe and effective adjunctive intervention in the management of fibromyalgia, particularly for pain relief and improvement of overall well-being, and should be integrated into multimodal treatment strategies.