Table 1. Clinical Efficacy and Safety.

Author (Year)	Groups Studied and Intervention	Results and Findings	Conclusions
Mist et al. (2018)50	Thirty women with confirmed, symptomatic fibromyalgia treated with twenty treatments of either group acupuncture or group education over 10 weeks.	Statistically significant improvements in FIQ-R and Global Fatigue Index for group acupuncture at the end of treatment and four weeks following, neither of which seen in group education.	Group acupuncture improved symptoms, pain, and fatigue. It is safe and tolerable.
Karatay et al. (2018)51	75 women with fibromyalgia randomized into real acupuncture, sham acupuncture, or simulated acupuncture therapy; treated biweekly for four weeks.	Serum serotonin levels increased with sham and real acupuncture. Substance P levels decreased in real but increased in simulated acupuncture. Real and sham acupuncture improved NTP, VAS, FIQ and BDI after treatment. These effects continued for three months. Simulated acupuncture improved NTP, VAS and BDI.	Real acupuncture therapy may be an effective therapy for fibromyalgia long-term. Substance P and serum serotonin levels offer an explanation for acupuncture’s mechanism of action.
Zhang et al. (2019)4	Meta-analysis of twelve RCTs of real vs sham acupuncture for fibromyalgia found over several research databases, including PubMed. Quality of evidence determined via GRADE tool.	Significantly better improvement in pain and quality of life with real acupuncture over sham graded low-to-moderate quality. Real acupuncture long-term effects were also greater than sham.	Acupuncture can be safely and effectively used in patients with fibromyalgia.
Kim et al. (2019)52	Meta-analysis of ten RCTs of real vs sham acupuncture in the treatment of fibromyalgia.	Real acupuncture resulted in greater improvements in pain, sleep quality, and general status than sham acupuncture. Improvements in fatigue were not seen.	Real acupuncture is greater than sham acupuncture in treating fibromyalgia symptoms, although evidence for improved fatigue was not found.
Uğurlu et al. (2017)53	50 women randomized into real or sham acupuncture groups and treated for 12 sessions over eight weeks.	Real and sham acupuncture improved VAS, VDI, FIQ at one- and two-month intervals after the first treatment. Real acupuncture improved scores greater than sham.	Acupuncture improves pain and symptoms of fibromyalgia, although the sham effect was important as well.
Assefi et al. (2005)56	100 patients with fibromyalgia randomized into fibromyalgia-specific acupuncture, acupuncture for another condition, nonacupoint needle insertion, or simulated acupuncture and treated bi-weekly for 12 weeks.	VAS scores did not differ in real acupuncture from either of the sham acupuncture groups.	Acupuncture is not better at pain reduction than sham acupuncture in fibromyalgia treatment. No adverse effects were reported.
Martin et al. (2006)58	50 patients with fibromyalgia randomized into real acupuncture or simulated.	Significant improvements in FIQ with real acupuncture compared to simulated with the largest discrepancy at a one-month follow-up. Fatigue and anxiety were most improved, and activity and physical function were unchanged.	Acupuncture improves fibromyalgia symptomatology with the greatest improvements in fatigue and anxiety.
Yüksel et al. (2019)59	42 fibromyalgia patients and 21 healthy volunteers were randomized into acupuncture or TENS application groups. EEG recordings were obtained before and after treatment.	Decreased pain and increased inhibitor activity found on EEG posttreatment reported for both acupuncture and TENS.	TENS and acupuncture are beneficial in fibromyalgia treatment.
Di Carlo et al. (2020)62	8 weeks of weekly acupuncture treatment in 96 fibromyalgia patients unresponsive to optimal drug therapy as determined by baseline FIQ-R, PDQ, and PHQ15 scores	85.4% of patients improved in FIQ-R, with 40.6% showing clinically significant improvement. 14.6 decreased in FIQ-R. Neuropathic-like features and somatic symptoms were significantly improved as measured by PDQ and PHQ15, respectively.	Acupuncture is an effective treatment in high-severity fibromyalgia unresponsive to other forms of therapy.
Lannuccelli et al. (2017)65	30 fibromyalgia patients and 20 healthy subjects received acupuncture therapy with before and after levels of serum neuropeptide Y.	Baseline neuropeptide Y was higher in controls than fibromyalgia patients. NYP levels were significantly reduced after treatment, along with a reduction in pain and tender point count.	Acupuncture contains analgesic properties, and NYP plays a role in this pain control.
Rico-Villademoros et al. (2020)66	Spanish cross-sectional study spanning two years measured treatment satisfaction with pharmacological and non-pharmacological treatments of fibromyalgia. Measured via 10-point numerical rating scale (NRS).	The most commonly reported non-pharmacologic treatments were physical exercise and diet. The most common drugs prescribed were tramadol and benzodiazepines. The highest satisfaction reported with acupuncture and poor satisfaction reported with pharmacologic treatments.	Several therapies lack adequate study, including acupuncture, thus insufficient evidence to support the superiority of acupuncture over other treatment modalities.