How Acupuncture Improves Fatigue

When you’re chronically fatigued, if your practitioner tells you that standing on your head and drinking water 5x per day will increase your energy, you just might be willing to try it.

Have you gotten to the point where you’re willing to try anything to improve your fatigue levels?

This can be a dangerous place to be in your healing journey. It leaves you vulnerable to being taken advantage of by less-than-honest practitioners (yes, unfortunately, they do exist).

Alternative medicine therapies like acupuncture are commonly sought out (often in desperation) to improve fatigue levels. But before you go rushing out to book an acupuncture appointment, allow me a moment to present you with the current research on acupuncture’s efficacy in the treatment of chronic fatigue syndrome. It might not be what you think!

Is acupuncture an effective treatment modality for chronic fatigue syndrome?

Acupuncture involves the insertion of fine needles into your skin/muscle tissue. Being an acupuncturist myself, I know a thing or two about this type of treatment. Personally, I have had positive results in using acupuncture in the treatment of chronic fatigue. But I don’t want to rely on just my experience. I want to share with you what the research suggests.

In my research, I found two meta-analyses of acupuncture used for the treatment of chronic fatigue. To clarify, a meta-analysis is a study that reviews multiple individual studies and combines the results of all into a detailed conclusion. As far as research goes,  meta-analyses are as good as it gets. They are thought to hold more weight than an individual study because they include more participants across many different types of trials.

At first blush, research suggests that acupuncture is indeed quite effective at treating chronic fatigue. (1, 2, 3, 4, 5) Each of these fives studies suggested that acupuncture improved fatigue levels more than placebo and/or western medical treatment.

Sounds pretty good, right?

But there’s an inherent problem with a number of the studies. The efficacy of treatment was based on a before and after fatigue questionnaire. Sometimes, the questionnaire was done immediately after treatment.

I don’t know about you, but after lying on a table at any practitioner’s office, I generally feel more relaxed. Acupuncture/massage/chiropractic/etc. appointments are a welcome break to the busy-ness of our lives. You should feel better after an appointment. Often, the clinic environment itself is tranquil and relaxing. It’s not surprising that participants felt an improvement in their fatigue immediately after treatment – they were able to rest and relax for roughly 60 minutes. But I don’t think this is evidence that acupuncture itself improves chronic fatigue.

Other studies were structured better, doing the follow-up questionnaire after a course of treatments. The studies would run for a couple of months with 2-3 acupuncture appointments each week for the duration of the study. Patients would fill out a fatigue assessment before and after the course of therapy. In general, patients felt that their energy improved after a course of acupuncture treatments.

I think it’s safe to conclude that acupuncture will (likely) improve your energy levels. But none of these studies did long-term follow-ups. I personally want to see if acupuncture is able to keep one’s energy levels elevated a year (or more) after treatment. If so, it suggests that acupuncture treatments are addressing a root cause of the fatigue and not just the symptoms associated with it.

Right now, I think it’s a safe and logical conclusion that acupuncture can improve your energy over the short term. But there’s no evidence to suggest acupuncture will cure chronic fatigue.

How does acupuncture improve fatigue?

How acupuncture works have been the topic of many different studies. Initially, it was thought that acupuncture worked because of the placebo effect. Testing methods improved and researchers were able to show how acupuncture had a quantifiable impact on the immune system. You could measure the changes in your blood before and after treatment. Acupuncture was not a placebo after all!

In the context of chronic fatigue, inflammation is commonly thought to be strongly associated with the illness. CFS patients seem to have an overwhelming increase in inflammatory cytokines. (6) Cytokines are so accurate at predicting fatigue that the severity of your fatigue can be accurately assessed simply by looking at the levels of inflammatory markers. Higher levels of inflammatory markers result in higher levels of fatigue. (7, 8)

Some of the common cytokines associated with chronic fatigue include:

• Interleukin 6 (IL-6)
• Interferon-gamma (IFN-γ)
• Tumor necrosis factor alpha (TNF-α)

Each of these above cytokines has been shown to be elevated in CFS. Thus, it would make good sense to have a treatment focused on lowering these markers. Lower levels of inflammation results in lower levels of fatigue.

Enter acupuncture. Acupuncture treatments have been shown to lower these inflammatory cytokines. (9) Improved levels of inflammation results in improved energy.

The question that remains is “for how long are the inflammatory processes suppressed?”. If acupuncture improves inflammation for a few hours or days, then it’s not a viable long-term solution. But if the effects of acupuncture can last for months, then I believe it to be a viable co-treatment option for chronic fatigue. We need more research to identify just how long acupuncture treatments exert a beneficial effect on the fatigued body.

Is your acupuncturist helping your fatigue?

In the research trials that have been done on chronic fatigue, specific acupuncture points were chosen to identify exactly what sort of effect they had on inflammation/fatigue. I suggest your acupuncturist follow the acupoint recommendations shown to be effective in the research; not to choose points based on his/her experience.

I make this recommendation because these trials have shown specific acupuncture points have beneficial effects on inflammation within your body. We just don’t know the effects of other acupuncture points on inflammation. In the interest of improving your energy, stick to what we know. Below, I list the acupuncture points that have been found to improve fatigue and inflammation levels:

• Back shu points
  • One study used only these points for treatment and found that they significantly improved fatigue levels and the mental health of participants. (9)
  • These are acupoints that run along the paraspinal (erector spinae) muscles of your back.
  • They should be needled at the vertebrae of T3, T5, T9, T11, and L2.
  • Treatment should be 2x/week for roughly 30 minutes per appointment.
• Other acupoint combinations
  • The following acupuncture points have been shown to lower inflammatory markers in your blood (thus improving fatigue levels). Bring a copy of this list to your acupuncture appointment, your practitioner should be familiar with each of these points. (10)
    • Guanyuan (CV 4),
    • Shenshu (BL 23),
    • Pishu (BL 20),
    • Zusanli (ST 36),
    • Qihai (CV 6)
• Moxibustion
  • Moxibustion is a therapy commonly used in Traditional Chinese Medicine that involves burning mugwort on specific acupuncture points.
  • Whether or not moxibustion is an effective therapy remains undecided. Most of the studies done on moxibustion have reached unclear conclusions. (11)
  • One study on acupuncture and moxibustion used in the treatment of chronic fatigue syndrome found that the combination improved natural killer (NK) cells and improved the abilities of T-lymphocytes. (12)
    • This study did not differentiate moxibustion vs acupuncture. So it is unclear whether the results were due to acupuncture, moxibustion, or the combination.

This list is not meant to be exhaustive. But it does offer an insight into which acupuncture points are best suited for treating fatigue. But how often do you need to receive these treatments in order to experience a benefit?

How often should you get acupuncture to improve fatigue levels?

It’s unlikely that you’re going to be able to measure inflammatory markers before and after acupuncture treatments. Therefore, it’s best to rely on the treatment frequency outlined in the research. Depending on the trial, participants were receiving acupuncture treatments anywhere from two to six times per week. Treatment duration was generally thirty minutes or less.

The majority of acupuncture treatments in North America are structured in one-hour time blocks. I recommend you discuss altering treatment duration with your practitioner. Opt for less treatment time (30 minutes is plenty) and a higher frequency of treatment. I don’t think it’s realistic for anyone’s schedule to permit six visits in a week. Two or three treatments each week should be sufficient. If you notice no improvement in your fatigue levels (and your schedule permits) try adding a fourth treatment to your weekly routine.

Should you get acupuncture?

Acupuncture treatments have been shown to be incredibly safe. At worst, you may end up with a small bruise. With such little downside, I would most certainly recommend you try a series of acupuncture sessions.

Worst case scenario, your fatigue levels don’t improve and you’re no worse off than before starting treatment. Best case scenario, your fatigue levels improve dramatically and remain that way for some time.

More research is needed to identify whether acupuncture can decrease inflammation over the long-term. If it can, I think it should be considered a regular part of treatment for chronic fatigue syndrome. If acupuncture only improves inflammation for a short period of time, I think it should be used as an adjunct to functional medicine. Acupuncture can help improve fatigue-related symptoms while functional medicine looks to correct the root cause.

 

Ok, there you have it. Acupuncture is a safe and potentially very effective means in which to improve fatigue levels.

 

Now, I want to hear from you!

What has acupuncture done to your energy levels?

 

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