Chronic fatigue syndrome

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).

References

Afari N, Buchwald D. Chronic fatigue syndrome: a review. Am J Psychiatry 2003;160:221-36.
Cairns R, Hotopf M. A systematic review describing the prognosis of chronic fatigue syndrome. Occup Med (Oxford)2005;55:20-31.
Gur A. Oktayoglu P. Central nervous system abnormalities in fibromyalgia and chronic fatigue syndrome: New concepts in treatment. Current Pharmaceutical Design 2008; 14: 1274-94.
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.
What to do about medically unexplained symptoms. DTB2001; 39: 5-8.
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 Medicine2003; 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).