Neuroendocrinological effects of acupuncture treatment in patients with irritable bowel syndrome
Complementary Therapies in Medicine (2007) 15, 255—263
Objectives: Quality of life (QoL) improvement in patients with irritable bowel syndrome (IBS) during acupuncture (AC) treatment seems to be due to a placebo effect.
The aim was to explore if acupuncture has some specific influence on the neuroendocrinic and autonomic nervous system (ANS). Design/setting: Patients with IBS were randomly assigned to receive either acupuncture (AC) or sham acupuncture (SAC) using the so-called ‘‘Streitberger needle’’. QoL was measured with the functional quality of life diseases quality of life questionnaire
(FDDQL) and SF-36. The effect on ANS was evaluated by measuring salivary cortisol and by cardiovascular responses on a tilt table before and after 10 AC treatments. Complete data sets of tilt table and salivary morning cortisol were available for 9 patients in the AC and 12 in SAC group.
Results: QoL increased in both groups (p = 0.001) with no group differences. Salivary cortisol decreased in all groups (F = 10.55; p = 0.006). However, the decrease was more pronounced in the AC group (F = 4.07; p = 0.033) (ANOVA repeated measures model). Heart rate response decreased during orthostatic stress in the AC group while it increased in the SAC group (F = 9.234; p = 0.005), indicating an increased
parasympathetic tone in the AC group. Improvement of pain was positively associated with increased parasympathetic tone in the AC group (F = 10.1; p = 0.006), but not in the SAC group.
MacPherson H, et al.
Acupuncture for irritable bowel syndrome: 2-year follow-up of a randomised controlled trial
Background A recent randomised controlled trial (RCT) of acupuncture as a treatment for irritable bowel syndrome (IBS) demonstrated sustained benefits over a period of 12 months post-randomisation.
Aim To extend the trial follow-up to evaluate the effects of acupuncture at 24 months post- randomisation.
Methods Patients in primary care with ongoing IBS were recruited to a two-arm pragmatic RCT of acupuncture for IBS. Participants were randomised to the offer of up to 10 weekly sessions of acupuncture plus usual care (n=116 patients) or to continue with usual care alone (n=117). The primary outcome was the self- reported IBS symptom severity score (IBS SSS) measured at 24 months post-randomisation. Analysis was by intention-to-treat using an unstructured multivariate linear model incorporating all repeated measures.
Results The overall response rate was 61%. The adjusted difference in mean IBS SSS at
24 months was −18.28 (95% CI −40.95 to 4.40) in favour of the acupuncture arm. Differences at earlier time points estimated from the multivariate model were: −27.27 (−47.69 to−6.86) at 3 months; −23.69 (−45.17 to −2.21) at 6 months; −24.09 (−45.59 to −2.59) at
9 months; and −23.06 (−44.52 to −1.59) at
Conclusions There were no statistically significant differences between the acupuncture and usual care groups in IBS SSS at 24 months post-randomisation, and the point estimate for the mean difference was approximately 80% of the size of the statistically significant results seen at 6, 9 and 12 months.
It is currently accepted that the neural transduction pathways of gastrointestinal (GI) visceral pain include the peripheral and central pathways. Existing research on the neurological mechanism of electroacupuncture (EA) in the treatment of GI visceral pain has primarily been concerned with the regulation of relevant transduction pathways. The generation of pain involves a series of processes, including energy transduction of stimulatory signals in the sensory nerve endings (signal transduction), subsequent conduction in primary afferent nerve fibers of dorsal root ganglia, and transmission to spinal dorsal horn neurons, the ascending transmission of sensory signals in the central nervous system, and the processing of sensory signals in the cerebral cortex. Numerous peripheral neurotransmitters, neuropeptides, and cytokines participate in the analgesic process of EA in visceral pain. Although EA has excellent efficacy in the treatment of GI visceral pain, the pathogenesis of the disease and the analgesic mechanism of the treatment have not been elucidated. In recent years, research has examined the pathogenesis of GI visceral pain and its influencing factors and has explored the neural transduction pathways of this disease.