The Effects Of Treating Mind, Body And Spirit With Acupuncture And Oriental Medicine To Increase The Efficacy Of Fibromyalgia
|Posted on November 28, 2013 at 3:07 AM|
The aim of this study was to analyze the effects of treating mind, body, and spirit with acupuncture and herbal medicine to increase the efficacy of pain management for fibromyalgia syndrome (FMS).
The design of this research was to compare and contrast research articles from PubMed, the clinical experience of the author, and a research survey, which was administered to support or disprove the hypothesis that treating the mind, body and spirit with acupuncture and herbal medicine increased pain management of fibromyalgia. Outcome of statistics in survey were cross-referenced with clinical and research studies to confirm the validity of the results. The results of five clinical case studies, which consisted of females in ages from 21-55 years, were compared with the survey and research literature results in order to find the consistency and differences that proved or disproved the hypothesis.
There were 44 participants, who began the survey, although only 22 of the participants finished a significant amount of the study and only 16 completed the survey. Eighty-two of the survey participants reported themselves to be spiritual individuals, 87% were interested in taking part in an acupuncture and herbal medicine clinical trial. After treatment with acupuncture, each patient initiated a life style change. A high percentage of participants claimed that acupuncture affected them spiritually, mentally and it was the most effective treatment for pain management. Herbal medicine had lower results than the results for acupuncture.
cost effective, health care, fibromyalgia, psychological effects, acupuncture, psychosomatic, spirituality, religion, depression, herbal medicine, Chinese medicine, pain management, mind, body, spirit, herbal medicine, acupuncture, medical cost.
Fibromyalgia was first recorded in 1904. There are clear descriptions of individuals with what we now call fibromyalgia going back centuries in medical literature. Sir William Gowers was the first to coin the term “fibrositis”, “which was considered a form of muscular rheumatism caused by inflammation of fibrous tissue overlying muscles.
The term “psychogenic rheumatism” was also used for a diagnosis for fibromyalgia in that era, although not as prevalent as “fibrositis” (Smith, Harris & Clauw, 2011). Presently Fibromyalgia is still listed under departments of medicine, of psychiatric and rheumatism; both being valid in that both are interrelated. “Fibromyalgia syndrome is defined by chronic widespread pain and hypersensitivity to pressure at specific points. Other key symptoms are fatigue and sleep disturbances. Most patients report a wide range of additional somatic and psychological symptoms. There is no gold standard for the clinical diagnosis of Fibromyalgia syndrome.” (Hauser, et al., 2011). There is a high expenditure of time and money diagnosing and treating fibromyalgia patients with low percentage of success. The treatments are not effective and may result in drug addiction. There are many side effects associated with the drugs prescribed for the diverse and numerous symptoms associated with fibromyalgia. Fibromyalgia is treated with Nsaids, and antidepressants.
Although, some doctors are recommending acupuncture to their patients as an alternative treatment, acupuncture is not considered to be the gold standard of treatment. In this author’s clinical experience, all patient treatment was focused on mind, body, and spirit, which has resulted in a success in managing pain and depression associated with fibromyalgia. In addition the patients had a change in their personal relationships and lifestyle, after undergoing treatment. The previous pre-proposal for a clinical trial study was not feasible for the following reasons of lack of monetary funds, lack of academic resources to obtain an IRB, and a lack of participants. In addition, a set of parameters of evaluation for spirit needed to be set to assess spirit. Most studies done on religion and spirituality were done by survey. Designing a survey to ask the pertinent questions that were related to the research would allow for the data necessary to prove the hypothesis and serve the dual purpose of finding the participants needed for an actual clinical trial. The complexity of psychological and somatic symptoms of fibromyalgia supports the hypothesis that treating mind, body, and spirit with acupuncture and herbal medicine increases the efficacy in pain management of fibromyalgia.
A survey was administered online. The results of the online survey were compared with the clinical data from five females age range 21-57 that either were diagnosed with fibromyalgia or had the symptoms of fibromyalgia without a diagnosis, which were treated with acupuncture protocols. The findings to these two experimental groups were cross-referenced with research literature using keywords: cost effective, health care, fibromyalgia, psychological effects, acupuncture, psychosomatic, spirituality, religion, depression, herbal medicine, Chinese medicine, pain management, mind, body, spirit, herbal medicine, acupuncture, medical cost.
Materials and Methods
The design of this research is to compare and contrast research articles from PubMed, the author’s clinical experience through case studies of past fibromyalgia patients whom had a diagnosis from a medical doctor and patients who displayed symptoms of fibromyalgia and depression but did not have a diagnosis of fibromyalgia from a medical doctor. Each patient was given acupuncture treatment starting with the upper back spiritual Shu points (needle towards the spine), balance method and invigorate blood protocol LI 4 (He gu), 11 (Qu chi), ST36 (Zu san li), Sp 6 (San yin jiao), 10 (Xue hai) in addition the following acupoints were used to calm the mind, Yintang, shishengcong, Du 20 (Bai hui), 24 (Shen ting), St8 (Tou wei), GB8 (Shuai gu).
Each patient listened to a meditation tape titled
Release, Fear, Anger and Anxiety
by John Daniels, for a total of 60 minutes. Every Patient was given two 30 session, prone and supine in one treatment.
In addition, a survey was created to analyze the current populace of fibromyalgia patients and the current trends of medicine and the experience of the patients, in reference to mind, body, and spirit. The participants were given the option to leave information if they were interested in being part of a future clinical trial. The survey questions were created for each area of the study, mind, body, spirit and qualifying questions. The spirit component of the study was defined with questions inquiring about fulfillment, connection and/or a higher power. These words are linked to discussions and verbalizations of past patients and the public at large. An online survey was created, advertised and administered for fibromyalgia participant who have been diagnosed by a medical doctor previous to the survey. The survey was advertised on Facebook, corporate website,
craigslist, LinkedIn, online local newspapers, emails to all contacts educational, personal, and professional, as well as word of mouth. PubMed is a gold standard source of research information and literature of clinical studies already executed. PubMed literature was researched using key words: cost effective, health care, fibromyalgia, psychological effects, acupuncture, psychosomatic, spirituality, religion, depression, herbal medicine, Chinese medicine, pain management, mind, body, spirit, herbal medicine, acupuncture, medical cost.
Epidemiology and Impact
The patient is treated with a battery of medications and exercise to combat their symptoms. The result of such treatment may lead to a drug addiction problem, which can further acerbate the patient’s symptoms. The cost of the exams and medications contribute to the increase medical cost in fibromyalgia patients’ management. A study from 2001 to 2004 that consisted of 87 patients, found that in comparison of regular medical cost there was a $7985 difference between those who incurred regular medical cost in comparison to those with the medical complication of fibromyalgia.
‘There was no significant change in direct costs after participation in a brief fibromyalgia treatment program. Those with increased symptom severity averaged $2034 higher direct medical cost during the four-year period" (Thompson et al., 2011). There are no laboratory tests available for diagnosing fibromyalgia. In
The Practice of Chinese Medicine: The Treatment of Disease with Acupuncture and Chinese Herbs
by Giovanni Maciocia states: “Doctors rely on patient histories, self-reported symptoms, a physical examination, and an accurate manual tender point examination. Proper implementation of the examination determines the presence of multiple tender points at characteristic locations. The estimated time that it takes is an average of five years for a fibromyalgia patient to get an accurate diagnosis” (Maciocia, 2008, p. 1093). In Chinese medicine, there are two main pathologies of fibromyalgia listed full and empty conditions. The main full conditions listed are:
The main empty conditions are:
Spleen qi or spleen yang deficiency
Spleen and kidney yang deficiency
Liver blood deficiency
Liver and kidney yin deficiency
In actual clinical practice, fibromyalgia may possibly present itself in a combination of full and empty patterns; for example liver qi stagnation with spleen deficiency, liver blood deficiency, and phlegm accumulation (Maciocia 2008, p. 1092).
The fact that there is no gold standard to diagnose fibromyalgia, leads to the skepticism of the very existence of the disease. “Fibromyalgia is a diagnosis of exclusion, meaning a “name” given to a collection of symptoms. Fibromyalgia is not universally accepted as a diagnosis. Patients value a name to explain symptoms previously dismissed or attributed simply to psychological or social problems” (Kumar & Clark 2005, p. 1282). “Sometimes patients are inappropriately labeled as ‘heart sink’ (pit in stomach feeling) patients. “ One of the biggest frustrations for patients is the fact that most laboratory tests are normal, and the fear the doctor will believe it is ‘all in their mind’.” (Kumar & Clark, 2005, p.1282). “As for treatment, a sympathetic approach is appropriate; with reassurance for the patient that fibromyalgia often improves and is not inevitably disabling” (Kumar & Clark, 2005 p.1282). The clinical manifestations of fibromyalgia are characterized by the presence of multiple tender points and constellation of symptoms, which are common in western and eastern medicine. Although there may be different terminology used these are the common symptoms:
Numbness or tingling sensations in the hands and feet (paresthesia)
Difficulty concentrating and poor memory
Restless leg syndrome
Painful menstrual periods
Headaches and facial pain
The clinical manifestations of fibromyalgia that are listed above reference several symptoms of mental and emotional characteristics (Maciocia, 2008, p.1092). Depression, a psychological manifestation that, was listed in the symptoms as far back as 1904. In 2011 a study of the temperament and character profile of patients with fibromyalgia was done. The study reference that, the etiology of FMS is unknown, but is possibly multifactorial. The article lists: “Genetic factors, environmental factors, central pain processing systems, and also psychological factors play an important role in the development of FM” (Gencay-Can & Can, 2011). There is no study or clinical cases that have proven any connection of genetic factors contributing to a patient developing fibromyalgia. The results of the survey showed that there was a traumatic event that occurred before the patient demonstrated symptoms of FMS, which would further support a study done on the personality traits of FMS patients. In 2011, a research study consisting of 42 females was conducted, which concluded, “Personality profiles such as negativistic thought and poor coping skills is part of the psycho-pathogenesis. A resolution of personality style may contribute to the understanding of etiological process that underlie FM and is also used for individualized treatment planning” (Gencay-Can & Can, 2011).
The common personality traits for fibromyalgia are:
Maladaptive response to loss
A traumatic event can result in depression, which is consistent with the FMS patient experience. Depression may be a result of feelings of anger, low self-esteem, frustrated, sad, which eventually leads to more severe symptoms of apathy, sleep disturbances, changes in appetite, fatigue, and loss of interest in previously enjoyable activities. Treatment with antidepressant drugs such as; Prozac, Zoloft, Elavil, and Wellbutrin, to name some of the drugs used in treatment of fibromyalgia.
Alternative medicine modalities are being used with more frequency in the treatment of fibromyalgia as it is done with depression, with the prescribing of physical exercise such as yoga, tai chi and meditation to help move the body and increase hormonal levels that elevate the mood. Another aspect is the religious/spiritual component of pain management.
A study was conducted on chronic pain and fatigue, with association to religion and spirituality. A survey was conducted; by the Canadian Community Health: which, consisted, of 37,000 individuals in age range of 15 years or older from 2002 to 2008. The research discusses the importance of religion and spirituality in management of chronic pain and fatigue.
The loss of hope that leads to lack of spiritual fulfillment and there are studies that have focused on this aspect of fibromyalgia and its importance on resolving fibromyalgia symptoms. Patients who are religious and spiritual were more likely to have better psychological well-being and use positive coping strategies. An individual’s spirituality and/or religion may be important in coping with the overall management of chronic pain and fatigue (Baetz & Bowen, 2008).
In a study on Acupuncture is has been shown that there was some improvement in symptoms of fibromyalgia. “Acupuncture was well tolerated with minimal adverse effects. Symptoms of fibromyalgia improved in the acupuncture group to a greater extent than in the control group. Specific symptoms that showed the most improvements included fatigue and anxiety.” (Martin, Sletten, Williams & Berger, 2006 p.757). The improvement was both clinically and statistically significant. “Therefore, acupuncture may have a role in the symptomatic treatment of patients with fibromyalgia” (Martin et al, pg. 757). In reference to gender, FMS appears to affect more women than men at a ratio of at least 88% some studies suggest more. There is one study that resulted in the difference in gender to be 50/50 with equal amount of men and women. There are no studies that found a difference in the clinical picture of FMS. “There are studies, which show that more females than males are affected” (Hauser, et al., 2011).
There are several studies on the effect of acupuncture in pain management and insomnia. There also some studies on psychological disorders and the effectiveness of acupuncture.
The effect of acupuncture and herbal medicine can have on the mind, body and spirit of an individual is the goal of the study. There are not enough research studies or clinical cases, from professional experience to test the hypothesis of herbal medicine’s impact on fibromyalgia symptoms. The online survey data is the only reference of the validity of herbal medicine’s ability to affect the mind, body, spirit to increase the effectiveness of pain management in fibromyalgia. Research literature on the subject of herbal medicine’s effectiveness of pain management through affecting mind, body and spirit was not found to exist at this present date. Furthermore there was no clinical case to reference to test this part of the hypothesis.
Dragon Rises, Red Bird Flies: Psychology & Chinese Medicine
by Hammer & Kaptchuk (1990) explains the natural energy functions of the human organism as a key to mental, emotional, and spiritual health. The book defines personality types in the five elemental principles and how they relate to the disease process. “Some of the consequences of Liver Organ system disharmony, according to Chinese Medicine, are mental irritation, depression, and anger, causing a diminishing of the “free-going’ of the Qi in the Liver and the Qi in other vulnerable parts of the body” (Hammer & Kaptchuk 1990, p.65).
Liver organ system disharmony is the resultant diagnosis for emotional issues of mental irritation, depression and anger, which manifests as pain. The emotional and spiritual body affects the physical body, by which the same principle would dictate that treating the emotional and spiritual body resulted in a resolution of said disorder or imbalance which cause the pain or health issue. There are several books on Acupuncture and psychological medical practice, for example:
Chinese Medical Psychiatry
by Flaws & Lake (2010). And another notable reference
Five Elements Constitutional Acupuncture
by Hicks, Hicks & Mole (2004). Five Element theories are based on treating the emotional body to treat the physical body through acupuncture. In a five element treatment session the practitioner will focus on treating the emotional and spiritual body to bring the spirit in balance and allow the body to follow that healing process. “Chronic physical symptoms are seen as being the manifestation of the illness, (biao), which stems from the root (ben). The root usually lies in the mind or spirit.” (Hicks, Hicks & Mole 2004, p.13)
In clinical practice, this author has treated patients with fibromyalgia and fibromyalgia like symptoms in patients with depression, using a combination of different treatment theories, five element, esoteric, balance method, upper back Shu points, and the ghost points. In each case there is an emotional/ spiritual change in each patient and an elevation in their mood, which resulted in a reduction of their insomnia, lack of appetite, and pain symptoms a that were experienced as part of their illness.
Case 1: 59 year old female, had chronic pain abdominal pain, migraine headaches, back pain, paresthesia, IBS, and depression for 5 years. Patient on anti-depressive medication and still has alternate “mellow/anxious” episodes. The patient was treated with acupuncture for two sessions of treatment consisting of a front and back session of acupuncture. The esoteric points to open heart and stop sweating were used in a prone position with a second session in the supine position of the balance method.
Patient reported 100% improvement in pain and depression. The improvement was experienced without medication regiment after acupuncture session. Patient stated she felt more connected and could feel the energy of the acupuncture during the sessions.
Case 2: 30 year old female, had chronic pain and depression after a break up with boyfriend, patient has additional emotional issues of panic attacks, and constant feeling of anxiousness, insomnia, whole body pain, 8/10. Patient denies being diagnosed with fibromyalgia but has the same number and pain points. Patient reported mood 6/10 very but sad. Treated patient with upper spiritual Shu points and balance method after first session patient reported a 30% improvement of pain. After second session patient reported 3% improvement but pain was reduced to soreness.
The session patient reported 25% improvement of leg pain shoulders no long tender and improvement of 10%. In addition the patient reported emotionally she improved. Patient reported a whole body pain reduction of 10%. Initially patient had constipation as is usually with depressed patients by the fourth treatment patient reported bowel movement 2x’s day with improved mood. Patient reported a connectedness during acupuncture treatment
Case 3: 21 year old female diagnosed with fibromyalgia, has severe headaches and painful periods, patient in a dysfunctional relationship with boyfriend. Patient is the sole source of income for couple in the relationship. Patients was treated with the Upper back Shu points and invigorate blood and qi points St36 (Zu San Li), LI4 (He Gu), 11 (Qu Chi), Sp6 (San yin jiao), 10 (Xue hai), Liv3 (Tai chong) and dispel phlegm and damp points Sp 9 (Yin ling quan), ST 40 (Feng long), for dysmenorraghia Ren 3 (Zhong qi),6 (Qi hai), K3 (Tai xi), and UB23 (Shen Shu). After 3 sessions patient broke off relationship with boyfriend. Patient reported a 70% improvement of symptoms. Patient reported a reduction in pain, insomnia and more verbal in communication of thoughts and feelings.
In addition patient reported an improvement of menstrual cycle pain. After 7 sessions of treatment patient returned to boyfriend and stopped treatment. Patient states that her pain has returned although not as much as previously. Patient returned after one year to treatment after violent break up with boyfriend in which patient reported a 90% improvement in symptoms. Patient reported a connectedness during the acupuncture treatment session and stated although she didn’t like needles she loved the way they make her feel.
Case 4: 57-year-old female diagnosed previously with fibromyalgia, treated in the clinic for depression, constipation, and leg numbness. In addition, patient diagnosed with hyperthyroidism. Presently shows no physical signs consistent with previous diagnosis. Patient treated for 9 sessions using the upper back Shu points, five elements, esoteric, Japanese hara method, balance method, Chinese herbal medicine, and electric stimulation for the numbness. The patient reported the least amount of improvement to be 50% with an average of 70% improvement over the course of acupuncture treatment sessions. The last treatment patient reported 100% improvement. Patient reported mood to 6/10. Patient no longer needs cane and able to walk unassisted. There was initial improvement in her constipation that became dry and hard. Patient reported feeling calm, grounded and connected.
Each of the patients in the cases reported immediately after treatment a feeling of being connected and their mood feeling lighter as well as a reduction in pain symptoms. In addition each patient experienced a change in their relationships and interaction with other people in a more beneficial way. Note that during each acupuncture session a meditation or meditative music tape was played and each patient was given quartz crystals on their torso to assist in meditation. All patients were given points to reduce anxiety, Yintang, was a consistent point used, other points used were ST8 (Tou Wei), GB8 (Shuai gu), Du 24(shen ting), Shishengcong, Du 20 (bai hui), although these are the group of points used for this sole purpose not all were used in each case.
A survey was designed with consideration to the different aspects of this study. It was important to have a consistent measured source to evaluate the validity of other studies. Pain and depression scales were analyzed and referenced in creating the questions to have a consistent replicable study. “Hamilton depression”, Patient Health Questionnaire(PHQ8, PHQ9), and Wang’s pain scale are the gold standard sources referenced. Below is the diagram for the study and the mechanism the study took the participants into in getting the results desired. The questions were made up of several different categories to comprise all of the study aspects and results to make a factual conclusion. There was also an option for a participant to leave information to be considered for an actual clinical trial for further research on the subject.
Survey Question Analysis
The following is an objective categorical characterization of questions asked.
Treating questions (#T), Qualifying Questions (#Q), Relationship Questions (#R) into each category of the study.
There were 44 participants who began the survey, although only 22 of the participants finished a significant amount of the study and only 16 completed the survey. The participants consisted of 88 % women, which is consistent with both survey and clinical research study results. The average level of interference of daily life skills is a five on a scale 0-10, which was the same for the level of depression. The average participant had frequent pain all day.
The significant part of the results was the key component of spiritual connection or relating to oneself as spiritual. There were a high percentage of participants who claimed to be spiritual not religious. Although both deal with an aspect of spirituality the latter has a more traditional component with set boundaries and taboos.
The subject of spirituality and religion resulted in 80% participants answered they were missing something in their life. Although only 47% reported they were searching for something in their lives, 63% reported they felt spiritually unfulfilled. There were 62% of the participants that reported that after treated with acupuncture they felt more fulfilled and connected or a spiritual experience. The key words were connected and fulfilled, which signified a measurement of a spiritual experience. The highest level of pain at onset of fibromyalgia symptoms was reported to be level eight, which was reported by 37% of the participants. Most participants were employed and had significant others who were employed. Most participants loved their job and found their career fulfilling. There were a high percentage of participants who had not reached their goals in life. In the area of fulfillment in relationships including life, personal and connection to a higher power there is a high percentage that affirmed yes.
There were follow up, questions concerning, fulfillment with relationships with significant others, family, and higher power, which resulted in a high percentage of participants reporting feeling fulfillment in all but the family relationship. Most participants reported, being independent and able to care for their partners and family. The noted difference was in the partner area about having a reliable partner who takes care of the participant 47% reported yes with the same amount reported no. The highest percentage of treatment modalities sought was acupuncture, massage and medication. Acupuncture was reported to be the highest in effectiveness in all areas for the study mind, body, spirit, and pain management.
Most drugs that were prescribed are Nsaids, anti-depressive meds, and anti-seizure meds. There were 94% of the participants who reported having had acupuncture, although only 87% reported had acupuncture specifically for fibromyalgia. Participants were evenly high at least 88% interested in participating in an acupuncture and/or Chinese herbal medicine clinical study for fibromyalgia. Acupuncture was the most effective modality to treat the various symptoms of fibromyalgia. Although twenty-three percent of the Participants reported no effect on insomnia, the same rate of 23% reported a level of four and 23% reported a level five on a scale of 1-10. Participants reported depression to be a level of five, with an absolute no effect on their appetite. The participants who reported feeling more fulfilled 62% “yes”, which was the same percentage who reported feeling more connected.
Patients who had been prescribed Chinese herbal medicine prescription were much lower at a 62% rate. Participants who were compliant with consistent administration of the herbs prescribed were 87% of the participants who reported “yes”. Herbal medicine had a lower reported effectiveness in resolving the lack of appetite, which was 38% of the participants. The participants who reported “no”, for the resolution of insomnia, which was 25% at a level five, with the equal amount of 25% for level six.
The participants who reported pain management was low to median at a 25% for level two and 25% for a level five. Participants reported Chinese herbal medicine to have been effective in depression at a level 5 rated by 38% of the group who had taken herbal medicine.
Participants scored Chinese herbal medicine low for spiritual fulfillment with 50% of the participants who reported spiritual fulfillment with herbal medicine. The participants who reported they felt connected after herbal medicine was also 50%. The statistical demographics of the participants who are participated had health insurance but only 44% had acupuncture covered by their insurance. The ages ranged from 18-75 with the larger portion of participants who earned $20,000 and less salary range, which was 40%. Most participants were students 94% and in a two person household size, although only 57% were employed. The participants who answered other for an occupation resulted in 60%
of retired individuals, and only 20% disabled and another 20% of the participants who were self-employed. There were 44% of the participants, who had earned masters as the highest education.
The literature research of fibromyalgia syndrome (FMS) through PubMed and books by various authors resulted in the discovery that there is no gold standard to diagnose FMS. FMS is not a valid disease or syndrome. FMS was originally called fibrositis, although it was not a valid disorder. The present term of fibromyalgia started in about the mid-1970s. FMS is listed under both psychological and somatic categories of medicine. The increase in cost of FMS is a result of the number of exams, doctor bills and medication cost. Although all the patient cases from clinical practice were not diagnosed with FMS each case had the same result. Most of the studies done on religion, spirituality and depression are survey studies rather than actual active clinical trials where an actual acupuncture or herbal treatment was done. After treating patients with acupuncture on points that are known to have a psychological effect, the patient reported feeling more connected and initiated changes in their lives. The survey research results demonstrated that the patient’s feelings of connection were a spiritual experienced post acupuncture treatment. The results of the survey study are in correlation with other survey studies done on the same subject.
Studies show the results are more conclusive for acupuncture than for herbal medicine in treating FMS and in treating the mind, body, and spirit. Acupuncture rated the most effective treatment for pain management. Massage was the second highest rated effective treatment. The unexpected result of the study was medication’s effectiveness rated third. More study needs to be done on herbal medicine and its effectiveness in treating mind, body and spirit, the best study would be clinical. The Participants who had health insurance was 94% but only 56% had acupuncture as a covered benefit. No insurance company covers herbal medicine that would account for the 62% of participants who had herbal medicine compared, to the 94% who had acupuncture. There was a short sightedness of this author in retrospect since during the treatment sessions of the clinical cases all were played a meditation or meditative music. Another contributing factor was the qualifying questions that would move the ineligible participants out of the survey study results. The survey was administered online internationally on the worldwide web, which made it difficult to monitor. The last contributing factor was the lack of participants who would give personal information in this type of study.
Fibromyalgia is more prominent in women than men. The cost of diagnosing and treating fibromyalgia is higher than the average single diagnosis and treatment. Which is attributed to both the diagnostic exams, with negative results, and increased number of prescription drugs that are prescribe to patients for both pain and depression. The inability to define a gold standard of diagnosis and the fact that the syndrome is an exclusion diagnosis also contributes to the increase in cost. Acupuncture treatment affected the mind, body, and spirit and increased the efficacy of pain management in FMS. Acupuncture allowed the patient to have a sense of connection. Acupuncture is an effective modality to resolve depression and pain management, and research literature supports this fact. In addition, there is research literature that supports the importance of treating the mind and spirit to effect pain management. Results of treating the mind, body and spirit with acupuncture to increase the pain management of acupuncture were proven in clinical cases, literature and the survey. After herbal treatment, 50% of the participants had a connected feeling. This is difficult to analyze without further study. There were only a sparse number of herbal medicine studies and none of which were related to the aspects that this study was researching. There were no clinical cases to compare to the survey. The survey had a low percentage of participants who had herbal treatment. More research needs to be done on herbal medicine on treating pain and depression. Herbal studies especially for formulas are challenging because of current laws resulting in the lack of approval.
Herbal studies are not allowed on humans. Clinical trial studies required to analyze herbal medicine must be performed on animals and it is not possible to analyze formulas according to government regulations. Each herb in the formula must be analyzed separately. Single herbs are not enough to resolve all of the FMS symptoms. Formulas are able to resolve a multitude of symptoms common to FMS. Further study of the effects of acupuncture should to be conducted. The clinical trial design proposed: consists of participants 18 to 75 years of age with a medical doctor diagnosis of fibromyalgia. Each participant should take the survey as a preliminary to the study. The eligible participants would be given a progress form with a measurement scale and a personal health survey to fill out before and after treatment. In addition, each patient will be required to record pain, spiritual and mental symptoms. The acupuncture treatment will consist of two sided treatment sessions using the upper back Shu spiritual points,
the balance method, invigorate blood protocols (ST36, Sp6, 10, LI4, 11, Liv3) and sedate shen and ghost points (ST8, GB8, 20, Du16, 24, Yintang). These protocols should be conducted at set intervals for a predetermined period. Patients will be treated for 3 days consecutively, for the first week, the second week and third week will be two days a week with at least one day between treatment and the weeks after that one time a week for one month, reduce to one every two week for one month. The study should allow for longer intervals between treatments for a period of 12 months or to the period, it takes to resolve all the symptoms of the syndrome. The longer intervals between treatment sessions are to measure the length of time the results remain consistent. After the twelve-month period, participants will take the initial survey again to compare the results. The herbal medicine component will be difficult but certain formulas will be selected for liver qi stagnation, spleen deficiency and dampness. Although the herbal part of the study will be difficult it is a necessary component to prove or disprove hypothesis. The survey was designed with a component to become a foundation for a clinical trial. The option to participate in a clinical study resulted in 68% of the participants who were interested and left contact information for that specific reason.
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