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.

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