Acupuncture Clinical Study Of The Impact On The Quality Of Life Of Patients With Chronic Fatigue Syndrome

The dissertation is based on acupuncture treatment for Chronic Fatigue Syndrome(CFS).Firstly,with the method of documentary metrology,quality of literature home andaboard in acupuncture treatment for CFS was evaluated in recent ten years and law of thetreatment was explored;Secondly,by the help of Meta-analysis,effect of the treatment wasevaluated;And then in light of principles of randomization,control and blinding,the clinicaltrial was designed;Last but not least,by means of scale study,fields of life quality,fatigue,depression,anxiety,degree of pain as well as common symptoms in clinic were evaluated,which objectively estimated impact on acupuncture treatment for CFS patients from variousaspects.BACKGROUNDCFS was officially named by CDC of USA in 1988,which was a group of complicateddysfunction of symptom complex specialized by severe fatigue.Currently,due to unclearmechanism of CFS by western medicine,it lacks of effective treatment and specificevaluation indicator.In recent years,domestic literature all indicates positive effects onacupuncture treatment for CFS.However,quality of them varies a lot and was relatively lowin general,which is revealed in lack of high quality evidence of clinical RCT.INNOVATIONS1 In light of the new idea that quality of life(QOL)of patients should start to beemphasized in CFS-the agnogenic chronic somatopsychic disease,the conception of QOLwas drawn into the research area of acupuncture treatment for CFS,which adapted to thebio-psycho-social medical model.2 By means of scale study,the QOL of fatigue,depression,anxiety,degree of pain aswell as mental state etc.were taken as related evaluation indicators and were evaluatedbefore and after treatment,which opened a new avenue for objectively evaluating the effectof acupuncture treatment for CFS.3 In strict accordance with principles of randomization,control and blinding,the clinicaltrial was designed,which brought a practical meaning to the acupuncture treatment for CFSin current situation that was lack of clinical evidence of high quality.OBJECTIVEObjective of the trial is to observe impact and objectively evaluate the clinical effect ofacupuncture treatment in QOL of CFS patients,and to provide reliable clinical evidence ofhigh quality in aspects of treatment method and therapeutic evaluation of CFS. METHODSCase resource:All of cases were outpatients from the 1st affiliated Hospital of Tsinghua University andAcupuncture Hospital of China Academy of Chinese Medical Sciences,and they werecollected from December 2004 to December 2007.Methods of trial design:Randomization(block randomization),control(points pricked beyond meridians ascontrol)and single blinding(valuator blinding)were applied in the clinical trial.According tothe random number table and in proportion of 1:1,70 cases of CFS patients were randomlydivided into treatment and control groups.Methods of treatment:Qihai(RN6),Guanyuan(RN4),Zusanli(ST36),Sanyinjiao(SP6),Taichong(LR3),Taixi(KI3),Ganshu(BL18),Pishu(BL20),Shenshu(BL23)were selected in the treatmentgroup.After patients obtained needling sensation,twirling reinforcing manipulation wasadministrated on Zusanli(ST36),Qihai(RN6),Guanyuan(RN4),Pishu(BL20),Shenshu(BL23),while reinforcing-reducing manipulation was applied on others.In thecourse of acupuncture treatment,all of other relative treatments beyond the trial weredisused.The points selected in control group were away from meridians and about 2cmaway from the relevant acupoints used in treatment group.And after needles pricked in,sensation of needling was not acquired.Course of treatment:3 times per week,7 times as a course and 2 courses in total(14 times of treatment,6～7weeks needed),between two courses rest for 3～7 days.Standard of diagnosis and criterion of therapeutic effect:The Standard of diagnosis for CFS from CDC of USA revised in 1994 was adopted,andstrict inclusion,exclusion as well as expulsion criteria were also drawn up.In order tosynthetically evaluate impact of acupuncture treatment in QOL of CFS patients,WHOQOL-BREF,FS,SDS,SAS,VAS and method of graded point rating for clinicalsymptoms were employed as impact evaluation indicators.Statistical method:The statistical software CHISS was applied to analyze data.RESULTS1 Evaluation results of WHOQOL-BREF:(1)Scores in PHYS were significantly different in treatment group before and aftertreatment(P＜0.01),and the score after treatment was higher than that before treatment.In fields of PSYCH and SOCIL,scores rose in both groups after treatment,but differenceswere not significant.In the field of ENVIR,scores were significantly different in control groupbefore and after treatment(P＜0.05),and the score was lower after treatment than thatbefore treatment.However,scores of treatment group before and after treatment were not insignificant differences.(2)General subjective feeling of individual in QOL:After treatment,scores in bothgroups rose,but without significant differences.(3)General subjective feeling of individual in health condition:After treatment,scoresrose in both groups,and scores were significantly different in treatment group before andafter treatment(P＜0.05),while the difference was not significant in control group.(4)Total scores of the scale:Scores rose in both groups after treatment,but thedifference before and after treatment in treatment group was significant(P＜0.05).While incontrol group,it was not.2 Evaluation results of FS:After treatment,the total score of FS,scores of physical fatigue and metal fatigue allreduced with a significant difference(P＜0.01)in treatment group.While in control group,after treatment,the total score of FS,score of physical fatigue also reduced with a significantdifference(P＜0.05),but score of metal fatigue kept no significant difference before and aftertreatment.3 Evaluation results of VAS:After treatment,the score of pain reduced markedly compared with that beforetreatment with a significant difference in treatment group(P＜0.001),and also in controlgroup(P＜0.01).Percentage of pain-alleviation before and after treatment was significantlydifferent in both groups(P＜0.01),and it was higher in treatment group than that in controlgroup.4 Evaluation results of SDS:After treatment,scores of SDS,degrees of depression both reduced markedlycompared with those before treatment with significant difference(P＜0.01)in both groups.And derating values of EASI of depression after treatment were not significantly differentwith that before treatment in both groups.5 Evaluation results of SAS:After treatment,scores of SAS,degrees of anxiety both reduced markedly comparedwith that before treatment with significant difference(P＜0.01)in both groups..And deratingvalues of EASI of anxiety after treatment were not significantly different with that beforetreatment in both groups. 6 Evaluation results of clinical symptoms:(1)After treatment,scores of clinical symptoms both reduced markedly after treatmentin two groups.And compared with those before treatment,it showed significant differencesin treatment group(P＜0.001)and also in control group(P＜0.01).Percentage of clinicalsymptoms-alleviation before and after treatment was significantly different in two groups(P＜0.05),and it was higher in treatment group than that in control group.(2)Scores of 35 common clinical symptoms in both groups reduced.Compared withthose in control group,18 common clinical symptoms were all ameliorated to variousdegrees.CONCLUSIONS1 Acupuncture treatment can effectively improve scores in PHYS and subjectivefeelings relevant to health of CFS patients,and then significantly enhance their quality oflife.2 Acupuncture treatment can not only effectively improve physical fatigue of CFSpatients,but mental fatigue also.And especially in aspect of ameliorating mental fatigue,theeffect of acupuncture treatment is more outstanding in treatment group compared with thatin control group.3 Acupuncture treatment can effectively reduce the degree of pain in CFS patients.4 Acupuncture treatment can effectively reduce the degree of depression in CFSpatients.But it showed no significant difference between the two groups.5 Acupuncture treatment can effectively reduce the degree of anxiety in CFS patients.But it showed no significant difference between the two groups.6 Over half of common clinical symptoms of CFS and symptoms that are closely relatedto diagnosis of CFS can be improved through acupuncture treatment to varying degrees.To sum up,acupuncture treatment can enhance QOL of CFS patient,effectivelyameliorate PHYS,subjective feelings relevant to health,degree of fatigue,pain,depression,anxiety,and part of clinical symptoms of patients.Therefore,it holds a positive clinicalsignificance to provide effective method so as to ameliorate QOL of CFS patients.