Acupuncture-related therapies significantly reduce overall, physical, and mental fatigue in chronic fatigue syndrome patientsAcupuncture may help reduce physical and mental fatigue in CFS

ObjectiveTo systematically review the available evidence on acupuncture-related therapies for chronic fatigue syndrome (CFS), with cautious interpretation due to the limited number and heterogeneity of studies.MethodsPubMed, Embase, Web of Science, and Cochrane Library were systematically searched for randomized controlled trials (RCTs) on acupuncture-related therapies for CFS from database inception to April 1, 2026. Two researchers independently performed literature screening, data extraction, and risk of bias assessment. The methodological quality of the included studies was evaluated using the Cochrane RoB 2 tool for RCTs. Meta-analysis was conducted using R software. Continuous outcomes were expressed as standardized mean difference (SMD) with 95% confidence interval (CI), and binary outcomes as risk ratio (RR) with 95% CI. Primary outcomes included overall fatigue, physical fatigue, mental fatigue, total response rate, and incidence of adverse events.ResultsA total of 8 RCTs involving 715 patients were included. Risk of bias assessment showed that one study had a high overall risk of bias, and seven studies raised “some concerns.” Meta-analysis results indicated that acupuncture-related therapies were superior to control interventions in improving overall fatigue, with a statistically significant difference (SMD = −1.31, 95% CI: −2.16 to −0.47, p = 0.002), although heterogeneity was high (I2 = 91.7%). They were also superior to controls in improving physical fatigue (SMD = −0.52, 95% CI: −0.88 to −0.16, p = 0.0048; I2 = 63.8%) and mental fatigue (SMD = −0.59, 95% CI: −0.93 to −0.26, p = 0.0006; I2 = 56.5%). The total response rate was higher in the intervention group than in the control group, with a statistically significant difference (RR = 1.22, 95% CI: 1.07 to 1.40, p = 0.004; I2 = 0.0%). Safety analysis showed no statistically significant difference in the risk of adverse events between the intervention and control groups (RR = 2.26, 95% CI: 0.76 to 6.76, p = 0.144; I2 = 0.0%).ConclusionCurrent limited evidence indicates that acupuncture-related therapies may have some beneficial effects on overall, physical, and mental fatigue in patients with CFS, and may increase response rates; however, these findings should be interpreted cautiously due to small sample sizes, moderate risk of bias, and heterogeneity among studies. No explicit safety hazards have been confirmed. And further validation by more high-quality RCTs is needed.Systematic review registrationThis systematic review protocol was preregistered on the Open Science Framework (OSF) (https://osf.io. Registration DOI: 10.17605/OSF.IO/KJ67M).