Chronic fatigue syndrome is characterised by severe, disabling fatigue, and other symptoms such as musculoskeletal pain, sleep disturbance, impaired concentration and headaches (Reid 2007).
The prevalence of chronic fatigue syndrome has been estimated to be from 0.007% to 2.8% in the general adult population, and from 0.006% to 3.0% in primary care, depending on the criteria used (Afari 2003). Chronic fatigue syndrome imposes substantial economic costs on society, mainly in terms of informal care costs and lost employment (McCrone 2003).
The cause of the syndrome remains poorly understood, but hypotheses include endocrine and immunological abnormalities, autonomic nervous system dysfunction, abnormal pain processing and certain infectious illnesses, such as Epstein-Barr virus and viral meningitis (Gur 2008, White 2001). People who have had a prior psychiatric disorder are nearly three times more likely to have chronic fatigue syndrome later in life than those who have not (Harvey 2008).
Prognosis is poor, with only around 5% of adults returning to pre-syndrome levels of functioning (Cairns 2005). Aims of treatment are to reduce levels of fatigue and associated symptoms, to increase levels of activity, and to improve quality of life. Conventional approaches include graded exercise therapy, cognitive behavioural therapy (CBT) and antidepressant drugs (DTB 2001).
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Cairns R, Hotopf M. A systematic review describing the prognosis of chronic fatigue syndrome. Occup Med (Oxford) 2005;55:20-31.
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Harvey SB et al. The relationship between prior psychiatric disorder and chronic fatigue: evidence from a national birth cohort study. Psychol Med 2008;38:933-40.
Reid S et al. Chronic fatigue syndrome. BMJ Clinical Evidence. Search date September 2007.
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White P et al. Predictions and associations of fatigue syndromes and mood disorders that occur after infectious mononucleosis. Lancet 2001;358:1946-54.
McCrone P et al. The economic cost of chronic fatigue and chronic syndrome in UK primary care. Psychological Medicine 2003; 33: 253-61.
How acupuncture can help
There are consistent positive results from observational studies (Wang 2008, Huang 2008, Guo 2007), but very few randomised controlled trials as yet (Wang 2009a, 2009b; Yiu 2007; Li 2006) (see Table overleaf). In the meantime, given the often unsatisfactory outcomes from conventional treatments, acupuncture may be a worthwhile option to consider, probably as part of a combined approach. There is evidence to support its effectiveness for some of the common symptoms – chronic pain, insomnia, depression (refer to the relevant Fact Sheets for details), but for chronic fatigue syndrome as a whole there is a need for more, and higher quality, research.
In general, acupuncture is believed to stimulate the nervous system and cause the release of neurotransmitters. Stimulation of certain acupuncture points has been shown to affect areas of the brain that are known to reduce sensitivity to pain and stress, as well as promoting relaxation and deactivating the ‘analytical’ brain, which is responsible for insomnia (Wu 1999).
Acupuncture may help to relieve symptoms of chronic fatigue syndrome such as musculoskeletal pain, headache, sleep problems, tiredness and depression by:
stimulating nerves located in muscles and other tissues, which leads to release of endorphins and other neurohumoral factors, and changes the processing of pain in the brain and spinal cord (Pomeranz 1987, Zhao 2008).
stimulating opiodergic neurons to increase the concentrations of beta-endorphin, so relieving pain (Cheng 2009).
reducing inflammation, by promoting release of vascular and immunomodulatory factors (Kavoussi 2007, Zijlstra 2003).
improving muscle stiffness and joint mobility by increasing local microcirculation (Komori 2009), which can reduce swelling and pain.
reducing insomnia through increasing nocturnal endogenous melatonin secretion (Spence 2004).
About traditional acupuncture
Acupuncture is a tried and tested system of traditional medicine, which has been used in China and other eastern cultures for thousands of years to restore, promote and maintain good health. Its benefits are now widely acknowledged all over the world, and in the past decade traditional acupuncture has begun to feature more prominently in mainstream healthcare in the UK. In conjunction with needling, the practitioner may use techniques such as moxibustion, cupping, massage or electro-acupuncture. They may also suggest dietary or lifestyle changes.
Traditional acupuncture takes a holistic approach to health and regards illness as a sign that the body is out of balance. The exact pattern and degree of imbalance is unique to each individual. The traditional acupuncturist’s skill lies in identifying the precise nature of the underlying disharmony and selecting the most effective treatment. The choice of acupuncture points will be specific to each patient’s needs. Traditional acupuncture can also be used as a preventive measure to strengthen the constitution and promote general wellbeing.
An increasing weight of evidence from Western scientific research (see overleaf) is demonstrating the effectiveness of acupuncture for treating a wide variety of conditions. From a biomedical viewpoint, acupuncture is believed to stimulate the nervous system, influencing the production of the body’s communication substances – hormones and neurotransmitters. The resulting biochemical changes activate the body’s self-regulating homeostatic systems, stimulating its natural healing abilities and promoting physical and emotional wellbeing