Fatigue is the most prevalent and disabling symptom in multiple sclerosis (MS), affecting between 75% and 90% of patients at some point in the disease. Unlike physical-exertion fatigue, fatigue in MS has specific components: central fatigue (from demyelination of cortical and subcortical pathways), peripheral fatigue (muscular, from slowed nerve conduction), and secondary fatigue (from insomnia, chronic pain, depression, and medication side effects). The pharmacologic arsenal for MS fatigue is limited: amantadine and modafinil have modest efficacy and variable tolerability. A meta-analysis published in September 2024 in Complementary Therapies in Medicine offers the first systematic overview of acupuncture’s effect on this condition.
The study pooled 6 studies — 4 randomized clinical trials and 2 observational studies — evaluating patients with established diagnosis of MS and fatigue as primary or secondary endpoint. Measurement instruments included the Fatigue Severity Scale (FSS), the Modified Fatigue Impact Scale (MFIS), and visual analogue scales specific to fatigue. Quality of life was assessed with instruments such as the MS Impact Scale (MSIS) and the SF-36. Despite the small number of studies, the results were consistent and statistically robust.
MAIN RESULTS
Analysis of results: robust effect despite sample size
The mean difference of −0.92 on the fatigue scale indicates a clinically relevant reduction — especially considering that the FSS ranges from 1 to 7, and a change of 0.7 points is generally considered the MCID for that scale. The magnitude of the acupuncture effect exceeds the MCID, suggesting benefit perceptible by patients in daily life. The SMD of 0.91 for quality of life represents an effect of large magnitude in Cohen’s classification (large > 0.8), indicating that improvement in fatigue translates into substantial gains in daily, social, and emotional functioning.
The consistency of results across the 6 studies — which included both RCTs and observational studies in different countries — strengthens the robustness of the findings. The confidence interval for the fatigue difference (−1.36 to −0.47) does not cross zero in either bound, confirming statistical significance and suggesting that the benefit is real and not an analytic artifact.
Clinical context: MS fatigue as a treatment priority
Patient-perspective surveys consistently point to fatigue — and not spasticity or gait disturbances — as the symptom of greatest impact on the daily life of people with MS. It interferes with work, social relationships, the ability to care for family, and self-esteem. Despite this, it is frequently underestimated in neurologic consultations, which tend to focus on imaging outcomes (MRI lesions, brain atrophy) and objective neurologic findings. The absence of satisfactory pharmacologic options makes the evidence on acupuncture particularly relevant for neurologists seeking to complement symptom management.
Frequently Asked Questions
There is no evidence of interaction between acupuncture and the main immunomodulators used in MS (interferon beta, glatiramer acetate, natalizumab, ocrelizumab, siponimod). Acupuncture may be performed in parallel with conventional neurologic treatment. The medical acupuncturist should be informed of all medications in use, especially anticoagulants (which contraindicate more invasive procedures) and short-term corticosteroids (during exacerbations).
During an acute MS exacerbation — with active neurologic worsening and ongoing inflammation — it is recommended to wait for stabilization before initiating or resuming acupuncture. The acute exacerbation period is usually treated with pulse-dose corticosteroids. Acupuncture is more indicated as chronic-phase and maintenance treatment, not as an intervention for the acute exacerbation. After stabilization (2–4 weeks post-exacerbation), it can be resumed with focus on recovery of fatigue and compromised functions.
The studies in this meta-analysis used varied protocols of 4 to 12 weeks. In my practice, some MS patients report fatigue improvement after a few sessions. The included studies typically used cycles of 8–12 sessions. Maintenance sessions can be considered individually by the medical acupuncturist. Treatment consistency is fundamental — frequent interruptions reduce the cumulative effect.
Fonte Original
Complementary Therapies in Medicine(em inglês)Founded in 1989 by physicians trained at the University of São Paulo (USP) and specialized in China, CEIMEC is a Brazilian national reference in the teaching and practice of medical acupuncture. With more than 3,000 physicians trained over 35 years, it collaborates with HC-FMUSP and is recognized by the Brazilian Medical College of Acupuncture (CMBA/AMB).