The main aim of this trial is to evaluate whether additional acupuncture or mindfulness-based stress reduction is more efficacious than usual care only to reduce fatigue in patients with multiple sclerosis.

In multiple sclerosis, fatigue is the most common clinical symptom, reported by up to 97% of patients. No successful evidence-based therapy exists so far. The main aim of this trial is to evaluate whether additional acupuncture or mindfulness-based stress reduction is more efficacious than usual care only to reduce fatigue in patients with multiple sclerosis. We want to include 141 patients with multiple sclerosis and fatigue. Participants will be randomised into three groups to compare 1) usual care, 2) usual care plus standardised acupuncture, and 3) usual care plus mindfulness-based stress reduction. Treatment duration will be 12 weeks. The primary outcome is the Fatigue Severity Scale (FSS) after 12 weeks, follow-up measurement will be performed after 26 weeks. Secondary outcomes include other fatigue specific parameters, other MS specific parameters, cost, and physiological, immunological and functional magnetic resonance imaging parameters.

Inclusion Criteria:

• female or male
• 18 to 65 years of age
• able to give oral and signed written informed consent
• clinical diagnosis of multiple sclerosis
• fatigue in "multiple sclerosis" for at least 3 months
• other stable pre-study treatment with respect to target symptom fatigue for at least 3 months before inclusion
• stable immunomodulatory or immunosuppressive therapy or stable no such a therapy for at least the 3 months before inclusion
• fatigue score of ≥4 on the Fatigue Severity Scale at inclusion
• patient's mental and physical ability to participate in the trial
• willingness to be randomised, to attend visits, to complete questionnaires, and willingness to participate and fMRI measurements

Exclusion Criteria:

• fatigue because of a malignant disease
• acute relapse or cortisone therapy therapy in the last 30 days before inclusion
• EDSS (Extended disability status scale) > 6
• fatigue specific acupuncture in the last 12 months
• during the last 12 months performing of MBSR exercises learnt in the past
• change of immunomodulatory or immunosuppressive therapy during the 3 months before inclusion
• other new therapies are planned which could have a positive effect on fatigue (e.g. exercise, acupuncture, relaxation therapy)
• for female patients: pregnancy or anticipated pregnancy during the intervention period
• severe acute and or chronic disease which does not allow participation in the therapy
• other limitations which do not allow participation in the therapy
• alcohol or substance abuse
• parallel participation in another clinical trial
• BDI > 29
• contra indications for fMRI session (e.g. metal clips)