Is additional acupuncture plus usual care effective in reducing fatigue among patients with chronic fatigue syndrome and idiopathic chronic fatigue?
Date of publication of randomized controlled trial: July 2015
Design
Randomized controlled trial (RCT).
Participants
150 adults (age range: 19 to 65 years, male %: 34.7%) with mchronic fatigue syndrome (CFS) and idiopathic chronic fatigue (ICF) presenting major symptoms of continuous or recurrent fatigue due to unknown causes lasting for at least 6 months.
Intervention
Intervention 1: Manual acupuncture was performed. Acupoints for acupuncture treatment were GV20, bilateral GB20, bilateral BL11, BL13, BL15, BL18, BL20 and BL23. Duration of treatment lasted for 15 minutes. The treatment course consisted 10 sessions and was given 2 to 3 times per week for a duration of 4 weeks;
Intervention 2: Sa-am acupuncture, a traditional Korean acupuncture method, was performed. Acupoints selected for treatment were LU8, SP3, HT8, BL15 and CV6. All needles were retained for 15 min after being twirled nine times (at LU8, SP3, and HT8) or six times (at BL15 and CV6). The treatment course consisted 10 sessions and was given 2 to 3 times per week for a duration of 4 weeks.
Comparator
Comparison 1: Manual acupuncture plus usual care versus usual care alone;
Comparison 2: Sa-am acupuncture plus usual care versus usual care alone.
Major Outcomes
Outcome 1: Change in fatigue score measured by Fatigue Severity Scale (FSS) from baseline to 5 weeks;
Outcome 2: Change in stress score measured by a short form of the Stress Response Inventory (SRI) from baseline to week 5;
Outcome 3: : Change in stress score measured by a short form of the Stress Response Inventory (SRI) from baseline to week 13;
Outcome 4: Change in intensity of fatigue measured by Numeric Rating Scale (NRS) from baseline to week 5.
Settings
The authors did not state whether the trial was conducted in inpatient or outpatient settings.
Comparison    Manual acupuncture plus usual care versus usual care alone
Main Results
Compared with usual care alone, manual acupuncture plus usual care significantly reduced FSS score (least squares mean difference (LSMD): -0.43, 95% CI: -0.81 to -0.05), SRI score at week 5 (LSMD: -6.01, 95% CI: -11.58 to -0.44) and NRS score (LSMD: -0.92, 95% CI: -1.45 to -0.40) in CFS and ICF patients.
Comparison 1: Manual acupuncture plus usual care versus usual care alone
Outcomes (units) No. of studies (Total number of participants) Mean (SD) / No. of participants Heterogeneity test (I2) LSMD (95% CI) p value Overall quality of evidence*
Intervention Comparator
1 (NA) 1(99) Week 5: 3.38(1.01)/ 49 Week 5: 4.47(1.18)/50 Not applicable as there is only 1 trial -0.43 (-0.81 to -0.05) 0.023 Moderate
2 (NA) 1(99) Week 5: 42.21(14.18)/ 49 Week 5: 56.47(18.03) /50 Not applicable as there is only 1 trial -6.01 (-11.58 to -0.44) 0.032 Moderate
4 (NA) 1(99) Week 5: 4.42(1.98)/ 49 Week 5: 6.53 (1.36) /50 Not applicable as there is only 1 trial -0.92 (-1.45 to -0.40) <0.001 Moderate
Keys: SD= standard deviation; LSMD: least squares mean difference; CI: confidence interval.
Comparison    Sa-am acupuncture plus usual care versus usual care alone.
Main Results
Compared with usual care alone, Sa-am acupuncture plus usual care significantly lowered SRI score among CFS and ICF patients at week 5 (LSMD: -9.33, 95% CI: -14.72 to -3.95)and week 13 (LSMD: -10.80, 95% CI: -16.49 to -5.12). Besides, Sa-am acupuncture plus usual care showed significant reduction in NRS score (LSMD: -0.90, 95% CI: -1.42 to -0.39).
Comparison 2: Sa-am acupuncture plus usual care versus usual care alone
Outcomes No. of studies (Total number of participants) Mean (SD) / No. of participants Heterogeneity test (I2) LSMD (95% CI) p value Overall quality of evidence*
Intervention Comparator
2 (NA) 1(101) Week 5: 42.10(13.66)/ 51 Week 5: 56.47(18.03) /50 Not applicable as there is only 1 trial -9.33 (-14.72 to -3.95) <0.001 Moderate
3 (NA) 1(101) Week 13: 39.81(13.55)/ 49 Week 5: 57.41(20.46) /50 Not applicable as there is only 1 trial -10.80 (-16.49 to -5.12) <0.001 Moderate
4 (NA) 1(101) Week 5: 4.52(1.70)/ 51 Week 5: 6.53 (1.36) /50 Not applicable as there is only 1 trial -0.90 (-1.42 to -0.39) <0.001 Moderate
Keys: SD= standard deviation; LSMD: least squares mean difference; CI: confidence interval.
Comparison    Manual acupuncture plus usual care versus usual care alone
Main Results
Compared with usual care alone, manual acupuncture plus usual care significantly reduced FSS score (least squares mean difference (LSMD): -0.43, 95% CI: -0.81 to -0.05), SRI score at week 5 (LSMD: -6.01, 95% CI: -11.58 to -0.44) and NRS score (LSMD: -0.92, 95% CI: -1.45 to -0.40) in CFS and ICF patients.
Comparison 1: Manual acupuncture plus usual care versus usual care alone
Outcomes (units) 1 (NA) 2 (NA) 4 (NA)
No. of studies (Total number of participants) 1(99) 1(99) 1(99)
Mean (SD) / No. of participants Intervention Week 5: 3.38(1.01)/ 49 Week 5: 42.21(14.18)/ 49 Week 5: 4.42(1.98)/ 49
Comparator Week 5: 4.47(1.18)/50 Week 5: 56.47(18.03) /50 Week 5: 6.53 (1.36) /50
LSMD (95% CI) -0.43 (-0.81 to -0.05) -6.01 (-11.58 to -0.44) -0.92 (-1.45 to -0.40)
p value 0.023 0.032 <0.001
Overall quality of evidence* Moderate Moderate Moderate
Keys: SD= standard deviation; LSMD: least squares mean difference; CI: confidence interval.
Comparison    Sa-am acupuncture plus usual care versus usual care alone.
Main Results
Compared with usual care alone, Sa-am acupuncture plus usual care significantly lowered SRI score among CFS and ICF patients at week 5 (LSMD: -9.33, 95% CI: -14.72 to -3.95)and week 13 (LSMD: -10.80, 95% CI: -16.49 to -5.12). Besides, Sa-am acupuncture plus usual care showed significant reduction in NRS score (LSMD: -0.90, 95% CI: -1.42 to -0.39).
Comparison 2: Sa-am acupuncture plus usual care versus usual care alone
Outcomes 2 (NA) 3 (NA) 4 (NA)
No. of studies (Total number of participants) 1(101) 1(101) 1(101)
Mean (SD) / No. of participants Intervention Week 5: 42.10(13.66)/ 51 Week 13: 39.81(13.55)/ 49 Week 5: 4.52(1.70)/ 51
Comparator Week 5: 56.47(18.03) /50 Week 5: 57.41(20.46) /50 Week 5: 6.53 (1.36) /50
LSMD (95% CI) -9.33 (-14.72 to -3.95) -10.80 (-16.49 to -5.12) -0.90 (-1.42 to -0.39)
p value <0.001 <0.001 <0.001
Overall quality of evidence* Moderate Moderate Moderate
Keys: SD= standard deviation; LSMD: least squares mean difference; CI: confidence interval.
Conclusion
Benefits
This study demonstrated that among CFS and ICF patients, manual acupuncture plus usual care group significantly improved fatigue as measured by FSS. Adding body acupuncture or Sa-am acupuncture to usual care provided significant stress relief and reduction in fatigue intensity as measured by NRS. For all outcomes, the overall quality of evidence is moderate. Further research is fairly likely to have an important impact on our confidence in this estimate of effect.
Harms
A total of ten adverse events were reported by 10 participants, including two adverse events which were not related to acupuncture. Two out of the remaining eight adverse events were considered to be possibly associated with acupuncture and the symptom severity was mild. Participants who reported adverse events improved during the research period and they continued to participate in the study.
Link to Original Article
https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4515016/
The synopsis is based on the following article:
Kim JE, Seo BK, Choi JB, Kim HJ, Kim TH, Lee MH, et al. Acupuncture for chronic fatigue syndrome and idiopathic chronic fatigue: a multicenter, nonblinded, randomized controlled trial. Trials. 2015 Jul 26;16(1):1.


* Interpretation of quality assessment results:
• Very low: Further research is most likely to have an important impact on our confidence in this estimate of effect.
• Low: Further research is likely to have an important impact on our confidence in this estimate of effect.
• Moderate: Further research is fairly likely to have an important impact on our confidence in this estimate of effect.
• High: Further research is unlikely to have an important impact on our confidence in this estimate of effect.
• Very high: Further research is most unlikely to have an important impact on our confidence in this estimate of effect.

Details of assessment method can be found at Chung VC, Wu XY, Ziea ET, Ng BF, Wong SY, Wu JC. Assessing internal validity of clinical evidence on effectiveness of CHinese and integrative medicine: Proposed framework for a CHinese and Integrative Medicine Evidence RAting System (CHIMERAS). European Journal of Integrative Medicine. 2015 Aug 31;7(4):332-41.