Friday, June 17, 2011

Research: Acupuncture and Moxibustion for IBS

An article examining treatment modalities for irritable bowel syndrome revealed acupuncture is promising as a stand-alone or adjunct therapy. In all of the studies below, improvement was demonstrated by adding or using acupuncture to treat IBS symptoms. Although sham groups also showed improvement, I do not agree with the authors that this means it is all an "in-your-head" placebo effect, especially as the last study cited showed the best improvement came from a combination of acupuncture and moxibustion therapy. Many "sham" controls elicit a therapeutic effect because all forms of acupuncture release endorphins, but the effect is more masking than curative. Long-term relief comparison studies between sham and true acupuncture are remarkably absent in the literature and are necessary to dispel the notion that you can stick a needle anywhere and get the same outcome.  Additionally, there is no "standardized" acupuncture treatment protocol for IBS because acupuncture uses pattern discrimination, not medical diagnosis, to determine individual treatment plans. 

Excerpt from the June 2011 issue of Alternative Medicine Review:

Acupuncture and Moxibustion
Acupuncture can cause physiological changes that affect various endogenous neurotransmitter systems. Of specific interest to the treatment of IBS is the influence of acupuncture and moxibustion on the serotonergic and cholinergic neurotransmission of the brain-gut axis. Both animal and human trials indicate specific targets for acupuncture on serotonergic, cholinergic, and glutamatergic pathways as well as reductions in blood Cortisol levels.

In a controlled, randomized pilot study, 30 subjects received routine clinical care or acupuncture for IBS. After three months of treatment, outcomes of acupuncture intervention revealed statistically and clinically significant improvements in symptom severity, including pain, distension, bowel habits, and QOL compared to usual care only. In this study, however, the type of IBS was not defined for the sample population.

In a large, randomized, controlled study, 230 subjects with IBS were assigned to one of three groups. The two intervention groups were either three weeks of true or sham acupuncture following a three-week run-in period of sham acupuncture therapy with a "limited" (friendly, interactive) patient-practitioner relationship, while the third arm was a waitlist control group. Findings indicated no significant difference in global outcome measurements between real and sham acupuncture, but both interventions showed significant improvement over the waitlist control group.

In another similar study, Schneider and colleagues randomized 43 subjects to receive either
acupuncture or sham acupuncture for 10 sessions(an average of two per week). Although the Functional Diseases QOL questionnaire (FDDQL) in this study revealed that both groups improved significantly in overall QOL, there was no difference between the two groups, suggesting that the effect of acupuncture was primarily a placebo response.

According to Anastasi and colleagues, a combination of acupuncture and moxibustion (acu/moxa)can be highly effective in IBS treatment. Twenty-nine subjects who met Rome II criteria were randomized into either individualized acu/moxa treatments or sham/placebo acu/moxa treatments. Results indicated that acu/moxa reduced abdominal pain, significantly reduced gas and bloating, and improved stool consistency over a four-week, eight-session intervention period. A Cochrane meta-analysis suggests larger-scale studies are warranted to confirm the benefits of acu/moxa in alleviating IBS symptoms.

Thursday, June 09, 2011

Another Blog Award!

Very happy to announce another blog award for Acupuncture News. While I do not bring Reiki into the writing often, both disciplines work with energy in their own way to help the body optimize functioning.

Monday, June 06, 2011

Symptoms Without a Diagnosis? Acupuncture Helps!

A recent study from the UK found significant improvement in patients with multiple physical symptoms after a series of five-element style acupuncture sessions. When the control group was offered the same treatment after the initial series was completed, they reported similar improvement. What I find interesting about the "mystery symptoms" moniker is the bypassing of somatoform disorder as a diagnosis. This condition tends to do well with psychotherapy, an aspect of treatment many acupuncturists include as part of their practice, whether or not it is formal or intentional. I do not downplay the significance of acupuncture as a contributing factor to recovery and improvement - as part of my current doctoral training in mental health I have been integrating auricular acupuncture as part of CBT with impressive success. It is important to give credit to the interpersonal aspect that contribute to symptom improvement and look at designing future studies that make clear differentiation between interventions and with clear measurement of  their individual and/or combined effects effects. 

Acupuncture for mystery symptoms

The researchers looked at a group of 80 adults with an average age of 50 years, 80% of whom were female. All of the patients had consulted their GP at least eight times in the past year; they had symptoms such as chronic pain, fatigue and emotional problems that affected work; around 60% had symptoms of musculoskeletal health problems which had been ongoing for a year. The patients had each had different experiences: some had spent time in hospital, visited outpatient clinics, undergone physiotherapy, chiropody and counselling, some had also had MRI scans and visited complementary therapists.

Dividing the study participants into two random groups, one was given acupuncture treatment of up to 12 sessions over a period of 26 weeks. (The same treatment was offered to the control group, once the 26-week period was complete.) At the end of the treatment period, the patients completed questionnaires to assess their overall health. The acupuncture group had a significantly improved score, when compared to the control group. Once the control group were also given the acupuncture treatment, their results also improved. The beneficial effects continued for up to a year afterwards.

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