Electroacupuncture in fibromyalgia.

Electroacupuncture in fibromyalgiaED1TOR,-Several important issues arise from Christophe Deluze and colleagues' paper on electroacupuncture in fibromyalgia.'The use of electroacupuncture rather than ordinary acupuncture in this study is questionable.To treat musculoskeletal pain, manual manipulation of the needles is all that many experienced physicians consider to be necessary.2Indeed, excessive stimulation of the needles may exacerbate the symptoms.This and the unpleasantness of needle insertion (suggesting poor needling technique) led to an unusually high drop out rate in both the group given electroacu- puncture (17%) and the controls (15%) in the study.The authors also seem uncertain about the rationale for selecting acupuncture points; they say that they used "four common acupuncture points," but it is unclear exactly which points these were.The authors claim that "traditional acupuncture points" were used, and the hand point does seem to correspond to the Chinese acupuncture point Hegu (L14).The leg point, however, corresponds only approximately to the Chinese acupuncture point Zusanli (ST36), the location given being inaccurate.This point should be located by using a system of proportional measurement, which allows for differences in the size of patients.The correct distance below the inferior border of the patella is not 5 cm but 3 cun, which corresponds to the width of the patient's four fingers.Needle insertion into the tender points was avoided in this study.In treating myofascial pain, however, the best results are generally considered to be obtained by inserting the needles into the points of maximum tenderness, though electrical stimulation is usually unnecessary.Lastly, the points used in the control group cannot be regarded as suitable: electrical stimula- tion of needles only 2 cm from the real points is unlikely to be without some effect.The true efficacy of acupuncture may have been under- estimated, and further studies of higher quality are needed.