Guest post from Kelli S. Hancock, PA-C, MPAS
As a currently practicing gastroenterology physician assistant, one of the most frustrating diseases for both me and my patients is irritable bowel syndrome (IBS). IBS is a diagnosis of exclusion, or a “catch all diagnosis” as several of my patients have termed it. They’re right. All other tests have come back negative. They’ve likely had a normal colonoscopy, upper endoscopy, or both. Maybe they had a CT scan that was also normal.
Yet, in spite of all the normal tests, my patients say they’re having diarrhea, or constipation, or alternating between diarrhea and constipation. Or maybe it’s abdominal pain or bloating or burping.
They tell me, “I know there’s something wrong, this is not normal.” And they’re right again. What they’re experiencing is not normal.
Right now, the only diagnosis I have to give them, the only diagnosis medical science has to give them, is irritable bowel syndrome. Unfortunately, what causes their symptoms is not clear (it is,
however, an area of active research). Since we don’t have a specific dysfunctional area to target with medications, we are stuck trying to treat symptoms instead of the root cause.
Not every medication works for every patient. As a result, the system is trial and error. We may try several medications before we find the right one. Sometimes, the best we get is improvement, but not feeling completely back to normal.
This led me to look into whether there are other things that can help my patients. To my surprise, I found several studies published in reputable medical journals examining whether
acupuncture was helpful for IBS symptoms. Acupuncture is based on the traditional Chinese medicine concept of energy flow through the body in pathways called meridians. The insertion of a needle at certain points in the meridian helps balance the flow which promotes health.
On examining the literature, I found mixed results. Some studies did show that acupuncture was helpful for IBS. Others showed there was no difference in effect between true acupuncture and sham
acupuncture (where the needles were not completely inserted or were inserted into the wrong area of the body). A few Chinese studies found that acupuncture was more effective than some medications at controlling IBS symptoms. Other authors concluded that acupuncture was useful as a component of a comprehensive treatment plan, which could also include Western medications and lifestyle modifications. I came to a Cochrane meta-analysis (a scientifically rigorous and well-respected study in the scientific community) which looked at all the trials using acupuncture for irritable bowel syndrome up to 2012. The conclusion reached was that more data was needed to make a concrete recommendation. A Chinese meta-analysis published the following year found that acupuncture was helpful for IBS patients. Most interesting of all, though, was a study published in July this year (2017). In this study, 53% of those who had true acupuncture reported benefit regarding their IBS symptoms, while 42% of those who’d received sham acupuncture also did. While the difference between the two was not significant when ran through statistical calculations, the thing which struck me was that half of the people who tried acupuncture said it improved their IBS. Of course, I was curious why 42% improved from sham acupuncture. Is it the placebo effect (they believed they would get better so they did)? Were the pressure points pressed during the sham treatment and this was helpful? Was it the power of caring human touch in a nonclinical setting? No answers to those questions — at least not yet.
So, what to tell my patients? When making recommendations to patients, I often employ a method of thinking called a risk/benefit analysis. In this way of thinking, I look at the potential benefit to
the treatment along with the risk associated with the treatment. If the potential benefit outweighs the risk, I recommend the treatment. According to the study above, the potential for benefit with
acupuncture occurs in about half of IBS patients. According to the Mayo Clinic, the risks associated with acupuncture are low and may include some soreness, bleeding, or minor bruising at needle insertion sites. There have been rare case reports of needles inserted too far into the body causing damage to internal organs or the transmission of infection through dirty needles, but this is unlikely in the hands of a licensed practitioner.
Put like that, I think acupuncture is worth trying for my IBS patients, especially those who have tried and failed several medications. Maybe acupuncture will be what they need to finally feel better.