Post-COVID-19 syndrome — also called long COVID — is defined by the World Health Organization as the persistence or appearance of symptoms three months after acute SARS-CoV-2 infection, with a minimum duration of two months and without other diagnostic explanation. It is estimated that at least 10% of infected patients develop persistent manifestations — especially fatigue, dyspnea, sleep alterations, diffuse musculoskeletal pain, palpitations, brain fog, and anxiety — configuring a public health problem of large magnitude. With the advance of the 2020s, medical acupuncture has been investigated as an adjuvant intervention for this multisystemic condition, with systematic reviews published between 2023 and 2024 gathering a growing body of clinical trials.
What the 2023–2024 Meta-Analyses Showed
Systematic reviews published in journals such as Frontiers in Medicine, Complementary Therapies in Medicine, and Journal of Integrative Medicine grouped randomized clinical trials conducted predominantly in China, South Korea, and Europe between 2021 and 2024. Interventions evaluated included manual acupuncture, electroacupuncture, moxibustion, and auricular acupuncture, always as adjuvant therapy to standard post-COVID rehabilitation care. The most consistent primary outcomes were: reduction of fatigue (assessed by scales such as FAS, FSS, and FACIT-F), improvement of sleep quality (PSQI, ISI), and decrease in residual respiratory symptoms (mMRC scale and submaximal functional capacity).
POOLED EFFECT SIZES (LAM ET AL. 2024, FRONT NEUROL — 110 RCTS OF ACUPUNCTURE ON SYMPTOMS SHARED WITH LONG COVID)
Mechanistic Plausibility
The neurophysiologic rationale for the use of acupuncture in long COVID is aligned with the mechanisms already described for post-viral fatigue and for nociplastic pain: modulation of autonomic tone (with increased vagal activity and reduced sympathetic activity), attenuation of circulating inflammatory markers — including IL-6, TNF-α, and CRP — and regulation of central circuits linked to perception of effort and interoception. In neuroimaging studies, stimulation of points such as ST36 and PC6 is associated with modulation of the salience network and the insular cortex, areas implicated in the perception of fatigue and dyspnea.
Limitations and Gaps
The available literature still presents important limitations: predominance of studies of Chinese origin, heterogeneity in protocols of points, sessions, and treatment duration, frequent use of unblinded active controls (standard care), and samples of moderate size. Pragmatic multicenter trials with patient-centered outcomes and long-term follow-up (≥ 12 months) are lacking, as are comparative studies with other evidence-based interventions for long COVID — such as progressive rehabilitation, cognitive-behavioral therapy, and guided pacing.
POST-COVID SYNDROME — MULTIDISCIPLINARY APPROACH BY SYMPTOM
| SYMPTOM | PILLARS | ADJUVANTS INCLUDING ACUPUNCTURE |
|---|---|---|
| Persistent fatigue | Guided pacing, gradual return-to-activity | Acupuncture, sleep management, nutritional support |
| Dyspnea | Progressive cardiopulmonary rehabilitation | Acupuncture, breathing techniques |
| Sleep disturbances | Sleep hygiene, CBT for insomnia | Acupuncture, melatonin selectively |
| Brain fog | Cognitive rehabilitation, stress management | Mild gradual aerobic activity |
| Diffuse chronic pain | Multimodal management, physical therapy | Acupuncture, cognitive-behavioral approaches |
| Dysautonomia/POTS | Hydration, salt, compression, propranolol/ivabradine | Guided cardiovascular training |
Guided pacing
Avoid boom-bust; gradual progression respecting patient limits.
Adjuvant to rehabilitation
Acupuncture as a complement to progressive cardiopulmonary rehabilitation.
Multidisciplinary coordination
Physician + physical therapist + nutritionist + mental health support.
The accumulation of evidence on acupuncture for long COVID accompanies a broader trend: the integration of evidence-based non-pharmacologic therapies into the management protocols of chronic and post-viral conditions. Ongoing pragmatic trials, with larger samples and extended follow-up, are expected to refine the positioning of this modality in the care algorithms for patients with persistent sequelae of SARS-CoV-2 infection.
Fonte Original
Frontiers in Neurology(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).
Learn More about this Topic
Related educational articles
Fibromyalgia: Why It Hurts Everywhere — and What Works
Understand fibromyalgia — a syndrome of chronic widespread pain, its central mechanisms, diagnosis, and multidisciplinary therapeutic approaches.
Chronic Fatigue: Recognize, Diagnose, and Treat
Understand myalgic encephalomyelitis / chronic fatigue syndrome (ME/CFS) — a complex neuroimmunological condition, its mechanisms, diagnosis, and therapeutic approaches.
Primary Insomnia: Why You Cannot Sleep — and How to Treat It
Understand chronic insomnia — the most prevalent sleep disorder, its neurobiologic mechanisms, diagnosis, and evidence-based treatments.