Fibromiyaljili Kadınlarda Akupunkturun Ağrı, Yaşam Kalitesi ve Depresyon Üzerine Etkisi

Öz

Amaç: Fibromiyalji Sendromu (FMS) kronik yaygın kas iskelet sistemi ağrısı ile karakterize; yorgunluk,

depresyon, uyku bozukluğu, anksiyete gibi semptomların sıklıkla eşlik ettiği multisistemik bir

hastalıktır. Bu çalışmanın amacı FMS’li kadınlarda akupunkturun standart tedaviye ek olarak ağrı

düzeyi, yaşam kalitesi ve depresyon üzerine etkisini araştırmaktı.

Materyal ve Metot: Prospektif kontrollü çalışmaya, 18‐65 yaş aralığında ACR kriterlerine göre FMS

tanısı alan (55 kadın; ortalama yaş 40,65 yıl; ortalama hastalık süresi 2,69/yıl), 55 kadın hasta dahil

edildi. Hastalar akupunktur grubu ve kontrol grubu olarak ikiye ayrıldı. Her iki grup da halihazırda

kullandıkları medikal tedaviye devam ettiler. Akupunktur grubuna kullandıkları tedaviye ek olarak

haftada 1 seans, 20 dk süre ile 10 hafta akupunktur tedavisi uygulandı (toplam 10 seans). Her iki grubun

tedavi öncesi ve sonrası ağrı şiddeti VAS (Vizüel Analog Skala), depresyon düzeyi Beck Depresyon

Ölçeği (BDÖ), yaşam kalitesi ise Fibromiyalji Etki Anketi (FEA) ile değerlendirilerek kaydedildi.

Bulgular: Sonuç ölçütlerinde zamanla ortaya çıkan farkın gruplar arası karşılaştırmasında VAS, FEA ve

hassas nokta sayısı değerlendirmelerinde akupunktur grubunda görülen iyileşme kontrol grubuna göre

daha yüksek saptanmıştır (sırasıyla p=0,001, p=0,017, p=0,016). BDÖ’de zamanla ortaya çıkan değişim her

iki grup arasında anlamlı fark göstermedi (p=0.076).

Sonuç: Çalışma akupunkturun FMS’li kadınlarda ağrı, hassas nokta sayısı ve yaşam kalitesi üzerine

olumlu sonuçları olduğunu göstermiştir. Akupunktur, ilaç tedavisine ek olarak FMS semptomlarını

azaltmaya katkı sağlamak için FMS tedavisinde tercih edilebilir.

Anahtar Kelimeler

• Fibromiyalji sendromu,akupunktur,ağrı,günlük yaşam aktivitesi

The Effect of Acupuncture on Pain, Quality of Life and Depression in Women with Fibromyalgia

Abstract

Objectives: Fibromyalgia Syndrome (FMS) is a multisystem disease characterized by chronic diffused musculoskeletal pain, accompanied by symptoms such as fatigue, depression, sleep disorder, and anxiety. The aim of the study is to evaluate the effect of acupuncture on pain, depression and quality of life in women with FMS in addition to the standard treatment.
Materials and Methods: 55 women patients aging between 18-65 years and diagnosed as having FMS according to ACR criteria (55 female; mean age 40.65/years, mean disease duration 2.69/ years) were included in this prospective controlled study. The patients were assigned to either acupuncture or control group. Both groups continued their ongoing medical treatment. The acupuncture group received acupuncture treatment 1 session/week, each session lasted 20 minutes for 10 weeks in addition to their current medical treatment (a total of 10 sessions). The outcome measures were pain intensity with Visual Analogic Scale (VAS), quality of life with Fibromyalgia Impact Questionnaire (FIQ), depression level with Beck Depression scale (BDI) at baseline and after the treatment.
Results: Comparison of the difference over time between the groups revealed that improvement in VAS, FIQ and count of tender points was significantly higher in the acupuncture group compared to the control group (p=0.001, p=0.017, p=0.016, respectively). The difference in BDI over time did not show any significant difference between the groups (p=0.076).
Conclusion: The study showed that acupuncture had positive results on pain, quality of life and tender points in women with FMS. In addition to medical treatment, acupuncture may be preferred to contribute for decreasing FMS symptoms.

Keywords

• Fibromyalgia syndrome,acupuncture,pain,quality of life

Kaynakça

1. 1. Hauser W, Zimmer C, Felde E, Kollner V. What are the key symptoms of fibromyalgia syndrome? Results of a survey of the German Fibromyalgia Association. Schmerz 2008;22:176-83.
2. 2. Chandran A, Schaefer C, Ryan K, Baik R, McNett M, Zlateva G. The comparative economic burden of mild, moderate, and severe fibromyalgia: results from a retrospective chart review and cross-sectional survey of working-age U.S. adults. J Manag Care Pharm 2012;18:415-26.
3. 3. Weigent DA, Bradley LA, Blalock JE, Alarcon GS. Current concepts in the pathophysiology of abnormal pain perception in fibromyalgia. Am J Med Sci 1998;315:405-12.
4. 4. Cetin N. Factors affecting the quality of life in patients with fibromyalgia. Turk J Rheumatol 2009;24:77-81.
5. 5. Beck AT, Ward CH, Mendelson M, Mock J, Erbaugh J. An inventory for measuring depression. Arch of Gen Psychiatry 1961;4:561-71.
6. 6. Hisli N. Beck Depresyon Ölçeği’nin bir Türk örnekleminde geçerlilik ve güvenilirliği. Psikoloji Dergisi 1988;6:118-22.
7. 7. Burckhardt CS, Clark Sr, Bennet RM. The fibromiyalgia impact questionnaire: development and validation. J Rheumatol 1991;18:728-33.
8. 8. Sarmer S, Ergin S, Yavuzer G. The validity and realibility of the Turkish version of the Fibromyalgia impact questionnaire. Rheumatol Int 2000;20:9-12.

9. 9. Cabyoglu TM, Ergene N, Tan U. The mechanism of acupuncture and clinical application. Int J Neurosci 2006;116 :115–25.
10. 10.Targino RA, Imamura M, Kaziyama HH, et al. A randomized controlled trial of acupuncture added to usual treatment for fibromyalgia. J Rehabil Med 2008;40:582-8.
11. 11. Vas J, Modesto M, Aguilar I, Santos-Rey K, Benítez-Parejo N, Rivas-Ruiz F. Effects of acupuncture on patients with fibromyalgia: study protocol of a multicentre randomized controlled trial. Trials 2011;28;12-59.
12. 12. Assefi NP, Sherman KJ, Jacobsen C, Goldberg J, Smith WR, Buchwald D. A randomized clinical trial of acupuncture compared with sham acupuncture in fibromyalgia. Ann Intern Med 2005;143:10–9.
13. 13. Marques AP, Ferreira EA, Matsutani LA, Pereira CA, Assumpcao A. Quantifying pain threshold and quality of life of fibromyalgia patients. Clin Rheumatol 2005;24:266-71.
14. 14. Hudson JI, Arnold LM, Bradley LA et al.What makes patients with fibromyalgia feel better? Correlations between Patient Global Impression of Improvement and changes in clinical symptoms and function: a pooled analysis of 4 randomised placebo- controlled trials of duloxetine. J Rheumatol 2009;36:2517–22.
15. 15. Martin DP, Sletten CD, Williams BA, Berger IH. Improvement in fibromyalgia symptoms with acupuncture: results of a randomized controlled trial. Mayo Clin Proc 2006;81:749-57.
16. 16. Uğurlu FG, Sezer N, Aktekin L, Fidan F, Tok F, Akkuş S. The effects of acupuncture versus sham acupuncture in the treatment of fibromyalgia: a randomized controlled clinical trial. Acta Reumatol Port 2017;42:32-37.
17. 17. Fietta P, Fietta P, Manganelli P. Fibromyalgia and psychiatric disorders. Acta Biomed. 2007;78:88-95.
18. 18. Chan YY, Lo WY, Yang SN, Chen YH, Lin JG. The benefit of combined acupuncture and antidepressant medication for depression: A systematic review and meta-analysis. J Affect Disord 2015;1;176:106-17.
19. 19. Deare JC, Zheng Z, Xue CC, Liu JP, Shang J, Scott SW, Littlejohn G. Acupuncture for treating fibromyalgia. Cochrane Database Syst Rev 2013;31;CD007070.