Written by Karen Pilkington, Edzard Ernst and the CAM-Cancer Consortium.
Updated December 16, 2015

Acupuncture for fatigue

Does it work?

Several feasibility studies ascertained that acupuncture-trials for cancer fatigue were feasible and that the subject was worthy of further investigation.10-12

Systematic reviews

Five systematic reviews of trials of acupuncture for cancer-related fatigue have presented mixed conclusions.13-17 While the methods used differed, a similar set of clinical trials were selected for these reviews and this included a number of pilot trials. The only meta-analysis that has been conducted showed no significant difference between acupuncture and sham acupuncture, or between acupuncture and no treatment or wait-list control or between acupuncture and acupressure or self-acupuncture.14 The only significant difference was between acupuncture plus education intervention versus usual care. There is a suggestion of a possible benefit from using acupuncture as an adjuvant therapy but, because of lack of blinding, it is not possible to confirm this. It has also been suggested that the dose used in trials was suboptimal and the heterogeneity of the interventions added to the lack of conclusive evidence.

Narrative reviews

Several non-systematic reviews of acupuncture for cancer-related fatigue are available and tend to arrive at cautious conclusions stating that “acupuncture may help”18 or that “insufficient data exist”.19

Randomised controlled trials

In addition to the RCTs included in the systematic reviews, two further trials have been conducted. One of these assessed the effectiveness of electroacupuncture for fatigue related to aromatase inhibitor-related arthralgia.20 Electroacupuncture was compared with sham acupuncture and a wait list control group and effects on fatigue, sleep and psychological distress measured.  Electroacupuncture appeared the most effective treatment but acupuncture was individualised to address a range of symptoms and it is difficult to separate the effects on each of these interlinked outcomes. Thus, the results can be considered preliminary and indicative of a possible benefit only.

A second trial investigated the effects of acupressure on fatigue during chemotherapy in lung cancer patients.21 Acupressure with and without essential oils was tested against sham acupressure at non-acupoints, all treatments being provided daily for 5 months. Changes in fatigue were not significantly different between the acupressure and sham groups.

Citation Karen Pilkington, Edzard Ernst, CAM-Cancer Consortium. Acupuncture for fatigue [online document]. http://ws.cam-cancer.org/The-Summaries/Mind-body-interventions/Acupuncture-for-fatigue. December 16, 2015.

References

  1. BAcC (British Acupuncture Council) website. Ten Top Things to Know. Available at www.acupuncture.org.uk. Accessed 17th April 2015.
  2. Filshie, J., Cummings, M. Western medical acupuncture. In: Ernst, E., White, A.  (Eds). Acupuncture: A Scientific Appraisal. 1999. Butterworth-Heinemann, Oxford. pp 31-59.
  3. White A; Editorial Board of Acupuncture in Medicine. Western medical acupuncture: a definition. Acupunct Med. 2009 27(1):33-5.
  4. White A, Ernst E. Introduction. In: Ernst, E., White, A. (Eds). Acupuncture: A Scientific Appraisal. 1999. Butterworth-Heinemann, Oxford. pp1-10.
  5. Birch S, Kaptchuk T. History, nature and current practice of acupuncture: an East Asian perspective. In: Ernst, E., White, A.  (Eds). Acupuncture: A Scientific Appraisal. 1999. Butterworth-Heinemann, Oxford. pp 11-30.
  6. Ahn AC, Colbert AP, Anderson BJ, Martinsen OG, Hammerschlag R, Cina S, Wayne PM, Langevin HM. Electrical properties of acupuncture points and meridians: a systematic review. Bioelectromagnetics. 2008 29(4):245-56.
  7. Zhao ZQ. Neural mechanism underlying acupuncture analgesia. Prog Neurobiol 2008; 84(4):355-375.
  8. Molassiotis A, Browall M, Milovics L, Panteli V, Patiraki E, Fernandez-Ortega P. Complementary and alternative medicine use in patients with gynecological cancers in Europe. Int J Gynecol Cancer. 2006 16 Suppl 1:219-24.
  9. Molassiotis A, Fernadez-Ortega P, Pud D, Ozden G, Scott JA, Panteli V, Margulies A, Browall M, Magri M, Selvekerova S, Madsen E, Milovics L, Bruyns I, Gudmundsdottir G, Hummerston S, Ahmad AM, Platin N, Kearney N, Patiraki E. Use of complementary and alternative medicine in cancer patients: a European survey. Ann Oncol. 2005 16(4):655-63.
  10. Vickers A, Straus DJ, Fearon B et al. Acupuncture for postchemotherapy fatigue: a phase II study. J Clin Oncol 2004; 22: 1731-5.
  11. Mao JJ, Styles T, Cheville A et al. Acupuncture for nonpalliative radiation therapy-related fatigue: feasibility study. J Soc Integr Oncol 2009;7: 52-8.
  12. Johnston MF, Hays RD, Subramanian SK et al. Patient education integrated with acupuncture for relief of cancer-related fatigue randomized controlled feasibility study. BMC Complement Altern Med 2011; 25 Jun: 49.
  13. Grant, S. J., C. A. Smith, N. de Silva and C. Su. Defining the Quality of Acupuncture: The Case of Acupuncture for Cancer-Related Fatigue. Integr Cancer Ther 2015 14(3): 258-270.
  14. He, X. R., Q. Wang and P. P. Li. Acupuncture and moxibustion for cancer-related fatigue: a systematic review and meta-analysis. Asian Pac J Cancer Prev 2013 14(5): 3067-3074.
  15. Ling, W. M., L. Y. Lui, W. K. So and K. Chan. Effects of acupuncture and acupressure on cancer-related fatigue: a systematic review. Oncol Nurs Forum 2014 41(6): 581-592.
  16. Posadzki, P., T. W. Moon, T. Y. Choi, T. Y. Park, M. S. Lee and E. Ernst. Acupuncture for cancer-related fatigue: a systematic review of randomized clinical trials. Support Care Cancer 2013 21(7): 2067-2073.
  17. Zeng, Y., T. Luo, J. Finnegan-John and A. S. Cheng. Meta-Analysis of Randomized Controlled Trials of Acupuncture for Cancer-Related Fatigue. Integr Cancer Ther 2013 13(3): 193-200.
  18. Deng G, Vickers A, Simon Yeung K et al. Acupuncture: integration into cancer care. J Soc Integr Oncol 2006; Spring 4: 86-92.
  19. Sood A, Barton DL, Bauer BA et al. A critical review of complementary therapies for cancer-related fatigue. Integr Cancer Ther 2007; 6: 8-13.
  20. Mao, J. J., J. T. Farrar, D. Bruner, J. Zee, M. Bowman, C. Seluzicki, A. DeMichele and S. X. Xie. Electroacupuncture for fatigue, sleep, and psychological distress in breast cancer patients with aromatase inhibitor-related arthralgia: a randomized trial. Cancer 2014 120(23): 3744-3751.
  21. Tang, W. R., W. J. Chen, C. T. Yu, Y. C. Chang, C. M. Chen, C. H. Wang and S. H. Yang. Effects of acupressure on fatigue of lung cancer patients undergoing chemotherapy: an experimental pilot study. Complement Ther Med 2014 22(4): 581-591.
  22. White A, Hayhoe S, Ernst E. Survey of Adverse Events Following Acupuncture Acupunct Med. 1997; 15:67-70.
  23. Witt CM, Pach D, Brinkhaus B, Wruck K, Tag B, Mank S, Willich SN. Safety of acupuncture: results of a prospective observational study with 229,230 patients and introduction of a medical information and consent form. Forsch Komplementmed. 2009 Apr;16(2):91-7. doi: 10.1159/000209315. Epub 2009 Apr 9.
  24. White A. A cumulative review of the range and incidence of significant adverse events associated with acupuncture. Acupunct Med. 2004; 22(3):122-123.
  25. Ernst E. Deaths after acupuncture: a systematic review. Int J Risk Safety 2010; 22(3):131-136.
  26. BMAS (British Medical Acupuncture Society). Code of Practice & Complaints Procedure. Version 9 December 2009. Accessed 21st July 2015.