Validating a New Non-Penetrating Sham Acupuncture Device: Two Randomised Controlled Trials ACUPUNCTURE IN GASTROSCOPY Acupuncture and Moxibustion in the Treatment of Active Crohn’s Disease: A Randomized Controlled Study [Comparative studies of the effectiveness of brief psychotherapy, acupuncture and papaverin therapy in patients with irritable bowel syndrome]. Acupuncture for irritable bowel syndrome: a blinded placebo-controlled trial. [Acupuncture--needle-pricking within a complex intervention]. [Acupuncture to alleviate pain during colonoscopy]. Treatment With Hypnotherapy Reduces the Sensory and Motor Component of the Gastrocolonic Response in Irritable Bowel Syndrome Acupuncture and moxibustion in the treatment of ulcerative colitis: A randomized controlled study Observation of the efficacy of acupuncture and moxibustion in 62 cases of chronic colitis. Clinical observation on acupuncture treatment in 35 cases of diabetic gastroparesis. Long-Term Trends in the Use of Complementary and Alternative Medical Therapies in the United States Cognitive-behavioral therapy versus education and desipramine versus placebo for moderate to severe functional bowel disorders. Adverse events following acupuncture: prospective survey of 32 000 consultations with doctors and physiotherapists Rectal Hypersensitivity Reduced by Acupoint TENS in Patients with Diarrhea-Predominant Irritable Bowel Syndrome: A Pilot Study Introducing a placebo needle into acupuncture research Acupuncture Treatment for Irritable Bowel Syndrome The role of acupuncture in the treatment of irritable bowel syndrome: a pilot study. The contributions of suggestion, desire, and expectation to placebo effects in irritable bowel syndrome patients: An empirical investigation Clinical study on acupuncture treatment of stomach carcinoma pain. Body acupuncture: effect on colonic function in chronic constipation. Acupuncture treatment of chronic superficial gastritis by the eight methods of intelligent turtle. Effect of Electrical Stimulation on Acupuncture Points in Diabetic Patients with Gastric Dysrhythmia: A Pilot Study Acupuncture treatment in irritable bowel syndrome
For clinical trials of acupuncture , it would be desirable to have a sham procedure that is indistinguishable from the real treatment , yet inactive . A sham needle has been design ed which telescopes instead of penetrating the skin . The Park Sham Device involves an improved method of supporting the sham needle and requires validation . The objective of these studies was to test whether the sham procedure using the new device was 1 ) indistinguishable from the same procedure using real needles in acupuncture naïve subjects , and 2 ) inactive , where the specific needle sensation ( de qi ) is taken as a surrogate measure of activity . The studies were design ed as subject and assessor blind , r and omised controlled trials . Study 1 ) included 58 patients enrolled in a clinical trial of acupuncture for acute stroke . Study 2 ) included 63 healthy , acupuncture naïve , adult volunteers . The interventions used were real or sham acupuncture using the Park Sham Device . Study 1 ) was set in a district general hospital , and study 2 ) in a university laboratory . The outcome measure in study 1 ) was the form of treatment that patients believed they had received . In study 2 ) the outcome measure was experience of de qi , as judged by three acupuncture experts . No patient in either group ( study 1 ) believed he or she had been treated with the sham needle . In 40 volunteers ( study 2 ) for whom experts achieved consensus , the relative risk of experiencing de qi with real acupuncture to that with sham acupuncture was 15.38 ( 95 % CI 2.26 to 104.86 ) . The inter-rater reliability of all 13 experts ( study 2 ) , calculated from their judgements on 10 subjects selected by r and omisation , was 0.52 ( 95 % CI 0.19 to 0.61 ) . In conclusion , the results suggest that the procedure using the new device is indistinguishable from the same procedure using real needles in acupuncture naïve subjects , and is inactive , where the specific needle sensation ( de qi ) is taken as a surrogate measure of activity . It is therefore a valid control for acupuncture trials . The findings also lend support to the existence of de qi , a major concept underlying traditional Chinese acupuncture The analgesic effect of acupuncture was evaluated by a double-blind controlled trial in 90 patients undergoing gastroscopy .  The endoscopy was much easier and better tolerated after real acupuncture had been performed Background : Acupuncture has traditionally been used in the treatment of inflammatory bowel disease in China and is increasingly being applied in Western countries . The purpose of this study was to investigate the efficacy of acupuncture in the treatment of active Crohn ’s disease ( CD ) . Methods : A prospect i ve , r and omized , controlled , single-blind clinical trial was carried out to analyze the change in the CD activity index ( CDAI ) after treatment as a main outcome measure , and the changes in quality of life and general well-being , serum markers of inflammation ( α1-acid glycoprotein , C-reactive protein ) as secondary outcome measures . 51 patients with mild to moderately active CD were treated in a single center for  complementary medicine  by three trained acupuncturists and r and omly assigned to receive either traditional acupuncture ( TCM group , n = 27 ) or control treatment at non-acupuncture points ( control group , n = 24 ) . Patients were treated in 10 sessions over a period of 4 weeks and followed up for 12 weeks . Results : In the TCM group the CDAI decreased from 250 ± 51 to 163 ± 56 points as compared with a mean decrease from 220 ± 42 to 181 ± 46 points in the control group ( TCM vs. control group : p = 0.003 ) . In both groups these changes were associated with improvements in general well-being and quality of life . With regard to general well-being  , traditional acupuncture was superior to control treatment ( p = 0.045 ) . α1-acid glycoprotein concentration fell significantly only in the TCM group ( p = 0.046 ) . Conclusions : Apart from a marked placebo effect , traditional acupuncture offers an additional therapeutic benefit in patients with mild to moderately active CD At a comparison among 5 therapy methods the  small psychotherapy  with a success-rate of 74 % is high-significantly more prospero us than the other examined methods . The acupuncture with 31 % long-term success is significantly superior to the  pseudoacupuncture  ( 17.2 % ) . The papaverine therapy results in a long-lasting status free of symptoms in 17.2 % of the patients and is significantly different from the results of the papaverine-placebo-therapy ( 0 % ) . Distinct differences in the success-rates of the  small psychotherapy  with different therapists prove the role of the personality and the perfection in mastering the methods with psychotherapeutic procedures . Comparable differences between the examiners were not found among the effects of a spasmolytic therapy AIM Irritable bowel syndrome ( IBS ) is a common disorder and many patients fail to find adequate relief from conventional therapies for their symptoms . This study tests the cl aim that acupuncture is effective for a majority of these patients . METHODS A prospect i ve , blinded , sham acupuncture-controlled trial of traditional Chinese acupuncture was performed at a single postgraduate teaching hospital in Europe . Sixty patients with well-established IBS were recruited . The blinded comparator was sham acupuncture administered by the second of two acupuncturists who alone was aware of the r and omization , and who otherwise followed the prescription of the first . The primary end-point was a defined fall in the symptom score at 13 wk ( by intention to treat ) . The prior expectation was a 30 % placebo response , and a response rate of 70 % from acupuncture , for which the study was adequately powered . RESULTS Patients in treated and sham groups improved significantly during the study -mean improvement in scores being equal ( minus 1.9 ) and significant for both ( P<0.05 ; one-tailed t test ) . There was a small numeric but non-significant difference between the response rate in patients receiving acupuncture ( 40.7 % ) and sham treatment ( 31.2 % ) . Several secondary end-points marginally favored active treatment , but an improved symptom score of any degree of magnitude occurred more often with sham therapy ( 65.6 % vs 59.2 % ) . For no criterion was statistical significance approached . CONCLUSION Traditional Chinese acupuncture is relatively ineffective in IBS in the European hospital setting , and the magnitude of any effect appears insufficient to warrant investment in acupuncture services The results of the large acupuncture studies initiated by the German Federal Committee of Physicians and Health Insurers raised several new questions concerning acupuncture effects . Based on the current evidence it is postulated that not yet entirely defined specific und unspecific factors contribute to outcome in acupuncture treatment . Consequently , acupuncture has to be regarded as a ' complex intervention ' consisting of several components . A phased approach to evaluate ' complex intervention ' is presented and transferred to acupuncture research . According to this phased approach unspecific factors contributing to acupuncture effects have to be identified and increasingly considered in future acupuncture research . Thus , several research methods to identify and evaluate unspecific  acupuncture effects are suggested , e.g. qualitative methods . Therefore , the particular German situation of acupuncture , provided by physicians and state-licensed non-medical therapists ( ' Heilpraktiker ' ) , is taken into account . Furthermore , it is discussed to what extent unspecific  acupuncture effects can be assessed within r and omized controlled trials 36 patients ( 18 males and 18 females , mean age 51 [ 21 - 76 ] years ) were prepared for colonoscopy  with acupuncture ( points : Hegu , Neiguan , Zusanli and Gongsun bilaterally ) , without acupuncture or pretend acupuncture at points not expected to bring about pain relief . In the 12  acupuncture patients  mean pain sensitivity , estimated during the examination by means of a visual analog scale , was significantly ( P = 0.003 ) lower ( 1.4 + /- 0.4 ) than in the groups without acupuncture ( n = 12 ; 2.7 + /- 0.3 ) or pretend acupuncture ( n = 12 ; 3.0 + /- 0.3 ) . In addition , analgesics and sedatives needed to be given significantly less to those with acupuncture ( one patient each ; P = 0.005 ) than those without ( analgesics to five , sedatives to eight patients ) or with pretend acupuncture ( analgesics to four , sedatives to five patients ) . These data demonstrate that pain connected with colonoscopy can be reduced by preceding acupuncture Objective Postpr and ial symptoms in irritable bowel syndrome are common and relate to an exaggerated motor and sensory component of the gastrocolonic response . We investigated whether this response can be affected by hypnotherapy . Methods We included 28 patients with irritable bowel syndrome refractory to other treatments . They were r and omized to receive gut-directed hypnotherapy 1 hour per week for 12 weeks ( N = 14 ) or were provided with supportive therapy ( control group ; N = 14 ) . Before r and omization and after 3 months , all patients underwent a colonic distension trial before and after a 1-hour duodenal lipid infusion .  Colonic sensory thresholds and tonic and phasic motor activity were assessed . Results Before r and omization , reduced thresholds after vs. before lipid infusion were seen in both groups for all studied sensations . At 3 months , the colonic sensitivity before duodenal lipids did not differ between groups . Controls reduced their thresholds after duodenal lipids for gas ( 22 ± 1.7 mm Hg vs. 16 ± 1.6 mm Hg , p < .01 ) , discomfort ( 29 ± 2.9 mm Hg vs. 22 ± 2.6 mm Hg , p < .01 ) , and pain ( 33 ± 2.7 mm Hg vs. 26 ± 3.3 mm Hg , p < .01 ) , whereas the hypnotherapy group reduced their thresholds after lipids only for pain ( 35 ± 4.0 mm Hg vs. 29 ± 4.7 mm Hg , p < .01 ) . The colonic balloon volumes and tone response at r and omization were similar in both groups . At 3 months , baseline balloon volumes were lower in the hypnotherapy group than in controls ( 83 ± 14 ml vs. 141 ± 15 ml , p < .01 ) . In the control group , reduced balloon volumes during lipid infusion were seen ( 141 ± 15 ml vs. 111 ± 19 ml , p < .05 ) , but not after hypnotherapy ( 83 ± 14 ml vs. 80 ± 16 ml , p > .20 ) . Conclusion Hypnotherapy reduces the sensory and motor component of the gastrocolonic response in patients with irritable bowel syndrome . These effects may be involved in the clinical efficacy of hypnotherapy in IBS Objective . Acupuncture has traditionally been used in the treatment of inflammatory bowel disease in China and is increasingly applied in Western countries . The objective of this study was to investigate the efficacy of acupuncture and moxibustion in the treatment of active ulcerative colitis ( UC ) . Material and methods . In a prospect i ve , r and omized , controlled clinical trial 29 patients with mild to moderately active UC ( mean age 37.8±12.0 years ) were r and omly assigned to receive either traditional acupuncture and moxa ( TCM group , n=15 ) , or sham acupuncture consisting of superficial needling at non-acupuncture points ( control group , CG , n = 14 ) . All patients were treated in 10 sessions over a period of 5 weeks and followed-up for 16 weeks . The main outcome measure was the change in the Colitis Activity Index ( CAI ) after treatment ; secondary outcome measures were changes in quality of life , general well-being and serum markers of inflammation . Results . In the TCM group , the CAI decreased from 8.0 ( ±3.7 ) to 4.2 ( ±2.4 ) points and in the control group from 6.5 ( ±3.4 ) to 4.8 ( ±3.9 ) points ( TCM versus CG : p=0.048 ) . In both groups these changes were associated with significant improvements in general well-being ( TCM group : from 3.0 ( ±1.8 ) to 1.8 ( ±1.0 ) ; CG : from 3.2 ( ±1.9 ) to 2.2 ( ±1.7 ) ) and quality of life ( TCM group : from 146 ( ±23 ) to 182 ( ±18 ) ; CG : from 157 ( ±20 ) to 183 ( ±23 ) ) . No significant differences between the TCM and CG were found regarding these secondary outcome measures . Conclusions . Differences in efficacy between traditional acupuncture and sham acupuncture were small and significant only for CAI as the main outcome measure . Both traditional and sham acupuncture seem to offer an additional therapeutic benefit in patients with mild to moderately active UC 62 patients with chronic colitis were r and omly divided into two groups . Acupuncture and moxibustion at acupoints such as Tianshu ( St 25 ) , Guanyuan ( Ren 4 ) were applied in the treatment group , and western drugs were applied in the control group . The results showed that acupuncture and moxibustion had a marked curative effective with few side effects , and therefore was readily acceptable to the patients In order to observe the therapeutic effects of acupuncture on diabetic gastroparesis , 80 cases were divided r and omly into 3 groups . In addition to the routine treatment for diabetes , 35 cases in the treatment group were additionally treated with acupuncture , and 25 cases in the control group 1 with domperidone , while 20 cases in the control group 2 with nothing . The three groups were all observed for 25 days . The results turned out to be that the total effective rate in the treatment group reached 94.2 % , that in the control group 1 , 72 % , and in the control group 2 , 40 % , the treatment group showing a better therapeutic effect than the other two control groups ( P < 0.05 , P < 0.01 ) . It can be concluded that in addition to the routine treatment for controlling blood sugar , acupuncture can give quite good therapeutic effects on diabetic gastroparesis Community surveys done over the past decade have documented that a substantial proportion of Americans use complementary and alternative medical ( CAM ) therapies ( 14 ) , which have been defined as interventions neither taught widely in medical schools nor generally available in U.S. hospitals ( 1 ) . Many managed care organizations have responded to this evidence by providing insurance coverage for some CAM therapies ( 5 ) . Furthermore , most U.S. medical schools have begun offering courses on CAM therapies ( 6 ) . These responses imply that CAM therapies are perceived to be a force to be reckoned with for some time to come . Yet , little is known about the likelihood that this will be the case . The prevailing assumption is that CAM therapies were used by a fairly narrow segment of the population until the 1970s , at which time the ideology associated with the youth counterculture led to a rapid dissemination and use of CAM therapies that has persisted through the present ( 7 ) . However , lack of rigorous trend data from epidemiologic surveys have precluded evaluating this assumption rigorously or projecting the future growth of CAM therapies on the basis of evidence of past trends . In the current report , we present nationally representative trend data of this sort from a prevalence study . The data came from retrospective self-reports of a nationally representative sample of the U.S. general population in a 19971998 telephone survey ( 4 ) about age at first use of 20 representative CAM therapies .  In our analysis , we studied trends by examining between-cohort differences in rates of initiation of CAM therapy use ( 8) . In the absence of prospect i ve data , which do not exist , our results represent , to our knowledge , the most accurate information currently available on U.S. trends in CAM therapy use over the past half-century . Methods Sample The telephone survey was conducted between November 1997 and February 1998 in a nationally representative household sample . R and om-digit dialing was used to select households , and a r and om- selection method was used to select one respondent 18 years of age or older for interview in each sample household . Eligibility was limited to English speakers without cognitive or physical impairment that would prevent interview completion . The average administration time was 30 minutes . A $ 20 financial incentive for participation was offered . The Beth Israel Deaconess Committee on Clinical Investigations , Boston , Massachusetts , approved the survey methods . Of the initial sample of 9750 telephone numbers , 26 % did not work , 17 % were not assigned to households , and 9 % were unavailable despite six attempted follow-up contacts . Of the remaining households , 481 were ineligible because of language barrier or cognitive or physical incapacity . Of the 4167 total eligible respondents , 1720 ( 41.3 % ) completed the interview on initial request . Of a r and om sub sample of 1066 persons who initially declined and were offered an increased stipend ( $ 50 ) , 335 agreed to participate . In all , 2055 interviews were completed . After we extrapolated the conversion rate to all persons who had initially declined and weighted the data for the undersampling of those who participated after initially declining , the weighted overall response rate among eligible respondents was 60 % . The data were weighted for three factors : 1 ) probability of selection within household as well as geographic variation in cooperation ( by region of the country and urbanicity [ local population density ] ] , 2 ) nonresponse , and 3 ) post-stratification for aggregate discrepancies between the sample distributions and Census population distributions on a variety of sociodemographic variables ( 9 , 10 ) . More details on the sample design have been presented elsewhere ( 4 ) . Age data were missing for 6 respondents ; our analyses are limited to the remaining 2049 respondents . Measures The interview was described to respondents as a survey by investigators from Harvard Medical School about the health care practice s of Americans . Interviewers made no mention of CAM therapies . The first substantive questions concerned perceived health , functional impairment due to health problems , interactions with physicians , and history of chronic medical conditions . Interviewers then queried respondents about their lifetime and recent use of 20 CAM therapiesacupuncture , aromatherapy , biofeedback , chiropractic care , commercial diet programs , energy healing ( for example , laying on of h and s ) , folk remedy , herbal medicine , homeopathy , hypnosis , imagery , lifestyle diet ( such as vegetarianism or macrobiotics ) , massage , megavitamin therapy , naturopathy , osteopathy , relaxation techniques , self-help group , spiritual healing by others  , and  yoga .  Users of each therapy were asked their age at first use as well as details about the conditions for which the therapy was initiated . The final set of questions dealt with sociodemographic issues . Cohorts were aggregated into three sub sample s : prebaby boom ( respondents 54 years of age at interview , born before 1945 ) ; baby boom ( 34 to 53 years of age at interview , born 19451964 ) ; and postbaby boom ( 18 to 33 years of age at interview , born 19651979 ) . For sociodemographic variables , we used two categories for sex ( male or female ) , four for race/ethnicity ( non-Hispanic white , non-Hispanic black , Hispanic , or other ) , four for education ( less than high school , high school graduate , some college , or college graduate ) , four for U.S. region ( northeast , midwest , south , or west ) , and four for urbanicity ( residence in a large city , small city , suburb , town/rural ) . Statistical Analysis All analyses were performed with weighted data by using SAS statistical software ( 11 ) . To assess differences in trends among cohorts , the KaplanMeier ( 12 ) method was used to generate a graphic representation of the cumulative lifetime prevalences of CAM therapy use according to cohort . The significance of historical changes in lifetime use was estimated by using discrete-time survival analysis ( 13 ) , a method of survival analysis appropriate for data in which events are recorded only at discrete time points ( for example , in yearly increments ) . Discrete-time survival analysis was operationalized as a logistic regression with person-year as the unit of analysis and first use of CAM therapy as the outcome variable . The predictors of primary interest were a series of dummy variables for decades of historical time , and covariates included sociodemographic and dummy variables adjusted for the baseline hazard rate of each year of a person 's life . This model results in an intercept for each time period , and the odds ratios ( ORs ) can be interpreted as the relative risk for the annual risk for use of alternative therapy . Sub sample models were estimated to study sociodemographic variation in trends . Disaggregated models were estimated to study trends in the use of particular CAM therapies . To adjust for the design effects introduced by weighting of the data , the method of jackknife repeated replications ( 14 ) was used to estimate st and ard errors ( SEs ) . For this method , we used user-written macros in SAS statistical software . For this process , 50 r and om primary sampling units were created with two r and om half- sample s in each unit for a total of 100 r and om replicates . Jackknife repeated replication is a method that uses simulations of coefficient distributions in sub sample s to generate empirical estimates of SEs and significance tests . The ratios of the coefficients to these adjusted SEs are used to compute the 95 % CIs of the ORs . Tests for the significance of sets of predictors taken together were computed by using the Wald chi-square test from coefficient variancecovariance matrices based on the jackknife repeated replications simulations . Results Differences in Aggregate Use Trends among Cohorts At the time of interview , 67.6 % of all respondents had used at least one CAM therapy at some time in their lives . The Figure presents KaplanMeier age-of-onset curves showing trends in each cohort in the cumulative probabilities of use according to age . Of note are the dramatic differences in use among cohorts . This is seen most clearly by focusing on cumulative probabilities of use for age 33 years , the oldest age represented in all three cohorts . Approximately 3 of every 10 respondents in the prebaby boom cohort used some type of CAM therapy by the age of 33 years compared with 5 of 10 in the baby boom cohort and 7 of 10 in the postbaby boom cohort . Figure . Weighted KaplanMeier estimates of age of first use of any  complementary and alternative medical ( CAM ) therapy among lifetime users according to cohort . Historical Trends in Aggregate Use The aggregate data in the Figure are presented in a different format in the bottom row of Table 1 , where the risk ratios are shown from a discrete-time survival model that estimated the effects of historical time in predicting age at first use of CAM therapy among respondents after adjustment for person-year and sociodemographic variables . The contrast category is first use before 1960 . Consistent with the pattern in the Figure , the results of the model for the outcome of any therapy show monotonically increasing risk ratios in each decade from the 1960s through the 1990s . Table 1 . Trends in Relative Risk for First Use of 20 Specific Complementary and Alternative Medical Therapies , according to Decade Possible demographic sub sample differences in time trends were examined by estimating separate sub sample models that were identical to the discrete-time survival model for any therapy and by evaluating the statistical significance of differences in trends across sub sample s. No statistically significant ( 0.05 level in two-sided tests ) differences in trends were found for sex , race/ethnicity , education level , region of the country , or urbanicity . Trends in the Use of Specific Therapies Table 1 also shows the risk ratios to estimate first use of each of the 20 CAM therapies assessed . All BACKGROUND & AIMS Studies of antidepressants and psychological treatments in functional bowel disorders ( FBD ) are method ologically limited . The aim of this study was to assess the clinical efficacy and safety of cognitive-behavioral therapy ( CBT ) against education ( EDU ) and desipramine ( DES ) against placebo ( PLA ) in female patients with moderate to severe FBD ( irritable bowel syndrome , functional abdominal pain , painful constipation , and unspecified FBD ) . We also evaluated the amenability of clinical ly meaningful subgroups to these treatments . METHODS This r and omized , comparator-controlled , multicenter trial enrolled 431 adults from the University of North Carolina and the University of Toronto with moderate to severe symptoms of FBD . Participants received psychological ( CBT vs. EDU ) or antidepressant ( DES vs. PLA ) treatment for 12 weeks . Clinical , physiologic , and psychosocial assessment s were performed before and at the end of treatment . RESULTS The intention-to-treat analysis showed CBT as significantly more effective than EDU ( P = 0.0001 ; responder rate , 70 % CBT vs. 37 % EDU ; number needed to treat [ NNT ] , 3.1 ) . DES did not show significant benefit over PLA in the intention-to-treat analysis ( P = 0.16 ; responder rate , 60 % DES vs. 47 % PLA ; NNT , 8.1 ) but did show a statistically significant benefit in the per- protocol analysis ( P = 0.01 ; responder rate , 73 % DES vs. 49 % PLA ; NNT , 5.2 ) , especially when participants with nondetectable blood levels of DES were excluded ( P = 0.002 ) . Improvement was best gauged by satisfaction with treatment . Subgroup analyses showed that DES was beneficial over PLA for moderate more than severe symptoms , abuse history , no depression , and diarrhea-predominant symptoms ; CBT was beneficial over EDU for all subgroups except for depression . CONCLUSIONS For female patients with moderate to severe FBD , CBT is effective and DES may be effective when taken adequately . Certain clinical subgroups are more or less amenable to these treatments Acupuncture is increasingly popular , but it is not free from risk for the patient.1 Safety is best established with prospect i ve surveys . Our aim was to ascertain the incidence of adverse events related to acupuncture treatment , as currently practised in Britain by doctors and physiotherapists . Volunteer acupuncture practitioners were recruited through journals circulated to members of the British Medical Acupuncture Society and the Acupuncture Association of Chartered Physiotherapists ( approximately 2750 members).2 A prospect i ve survey was undertaken using forms for intensive event monitoring that had been piloted previously.3 Minor adverse events were defined as “ any ill-effect , no matter how small , that is unintended and non-therapeutic , even if not unexpected . ” These events were reported every month , along with the total number of consultations . Minor or serious events that were considered to be “ significant”—“unusual , novel , dangerous , significantly inconvenient , or requiring further information”—were reported on separate forms when they occurred . Anonymous reporting was accepted . A sample size of Our aim was to compare rectal perception of patients with diarrhea-predominant irritable bowel syndrome ( IBS-D ) , constipation-predominant irritable bowel syndrome ( IBS-C ) , functional constipation ( FC ) , and healthy controls and to evaluate the therapeutic effect of acupoint transcutaneous electric nerve stimulation ( TENS ) .  Age- and sex-matched patients ( 24 IBS-D , 20 IBS-C , and 30 FC ) were selected , and 30 volunteers served as healthy controls . Rectal sensory thresholds were evaluated by  rectal balloon distension . Short- and long-term acupoint TENS was given respectively . IBS-D patients had significantly lower rectal sensory thresholds of the first sensation of stool , urgency of defecation , and pain than IBS-C or FC patients or healthy controls ( P < 0.05 ) , but there were no differences in rectal sensory thresholds among IBS-C and FC patients and healthy controls . In each group , females had significantly lower rectal sensory thresholds than males ( P < 0.05 ) , but there was no difference between younger ( ≤50 years old ) and older ( > 50 years old ) patients . Short-term acupoint TENS  increased rectal sensory thresholds of IBS-D patients . After 2-month acupoint TENS treatment in IBS-D patients , rectal sensory thresholds were significantly increased , stool times and the intensity of abdominal pain were decreased , and psychological scores were relieved to normal . Lowered rectal perception threshold is a hallmark of IBS-D patients . Females have significantly lower rectal sensory thresholds than males . Acupoint TENS is effective to treat BACKGROUND A problem acupuncture research has to face is the concept of a control group . If , in control groups , non-acupoint needling is done , physiological acupuncture effects are implied . Therefore the effects shown in this group are often close to those shown in the acupuncture group . In other trials , control groups have received obviously different treatments , such as transcutaneous electrical nervous stimulation or TENS-laser treatment ; it is not clear if the effects of acupuncture are due only to the psychological effects of the treatment . METHODS We developed a placebo acupuncture needle , with which it should be possible to simulate an acupuncture procedure without penetrating the skin . In a cross-over experiment with 60 volunteers we tested whether needling with the placebo needle feels any different from real acupuncture . FINDINGS Of 60 volunteers , 54 felt a penetration with acupuncture  ( mean visual analogue scale [ VAS ] 13.4 ; SD 10.58 ) and 47 felt it with placebo ( VAS 8.86 ; SD 10.55 ) , 34 felt a dull pain sensation ( DEQI ) with acupuncture and 13 with placebo . None of the volunteers suspected that the needle may not have penetrated the skin . INTERPRETATION The placebo needle is sufficiently credible to be used in investigations of the effects of acupuncture Background / Aim : Irritable bowel syndrome is one of the most common gastrointestinal disorders in Western society , affecting around 15 % of the population , especially young adults . The cause(s ) of irritable bowel syndrome and effective treatment(s ) have remained elusive . This study aim ed at exploring the therapeutic value of acupuncture by comparing the responses of irritable bowel syndrome sufferers to true acupuncture versus sham acupuncture in a controlled double-blind study . Methods : Twenty-five patients who fulfilled the Rome criteria ( irritable bowel syndrome symptoms persisting for more than 1 year ) comprised the final study population . They were recruited through a ‘ call for ’ bulletin sent to gastroenterologists practicing in the region of our medical center .  True acupuncture was performed at LI-4 ( colonic meridian , needle only ) and sham acupuncture at BL-60 ( urinary vesicle meridian , needle only ) . Patient assignment to one of the two groups was r and om . Results : The effect of the first true acupuncture on overall symptoms and abdominal pain was a clear and significant improvement ( p = 0.05 ) . No comparable effect was seen in the second session . Conclusions : Although the true acupuncture results were consistently better , no difference was found between the two groups in the overall statistical analysis . We could not show a therapeutic benefit of this treatment modality in irritable bowel syndrome BACKGROUND / AIMS The aim of this pilot study was to investigate the potential value of acupuncture in the treatment of irritable bowel syndrome ( IBS ) . METHODOLOGY The study was an open design study of 7 patients with established irritable bowel syndrome in which assessment was by a diary card . RESULTS The results showed a significant improvement both in general well-being and in symptoms of bloating . CONCLUSIONS Acupuncture seems to be effective in the treatment of irritable bowel syndrome and merits further study In order to investigate external factors that may influence the magnitude of placebo analgesia as well as psychological factors that mediate placebo analgesia , 13 irritable bowl syndrome ( IBS ) patients rated evoked rectal distension and cutaneous heat pain under the conditions of natural history ( NH ) , rectal placebo ( RP ) , rectal nocebo ( RN ) , rectal lidocaine ( RL ) and oral lidocaine ( OL ) . Patients were given verbal suggestions for pain relief and rated expected pain levels and desire for pain relief for both evoked visceral and cutaneous pain , respectively . Large reductions in pain intensity and pain unpleasantness ratings were found in the RP , RL and OL condition as compared to the natural history condition , whereas no significant difference in pain reduction between the three treatment conditions was found . Ratings during RN and NH were not statistically different . Compared to a previous study , which shows that rectal lidocaine reverses visceral and cutaneous hyperalgesia , these results suggest that adding a verbal suggestion for pain relief can increase the magnitude of  placebo  analgesia to that of an active agent . Since IBS patients rate these stimuli as much higher than do normal control subjects and since placebo effects were very large , they probably reflect anti‐hyperalgesic mechanisms to a major extent . Expected pain levels and desire for pain relief accounted for large amounts of the variance in visceral pain intensity in the RP , RL , and OL condition ( up to 81 % ) , and for lower amounts of the variance in cutaneous pain intensity . Hence , the combination of expected pain levels and desire for pain relief may offer an alternative means of assessing the contribution of placebo factors during analgesia Clinical observation on 48 cases of stomach carcinoma pain indicated that acupuncture including filiform needle group and point-injection group had better therapeutic effects in treatment of stomach carcinoma pain when patient 's mind was concentrated at the site of disease . After treatment for 2 months , the long-term effective rates of analgesia in both the filiform needle group and the point-injection group were similar to that in the western medicine group , all being about 81 % . While the long-term markedly effective rates in the two groups were superior to that in the western medicine group . Life quality of the patients in all the groups were improved . The toxic action and side effects caused by chemotherapy were prevented , the high viscous state showed by indexes of blood rheology was improved , and the lowered Cu-Zu-SOD activity in erythrocytes in patients of stomach carcinoma was increased in the filiform needle group and the point-injection group . Based on the results of clinical study , we consider that acupuncture analgesic effect on stomach carcinoma is related to the increase of PLEK , improvement of cellular immune function and the elevation of life quality after acupuncture Acupuncture has been cl aim ed to be an efficacious treatment for chronic constipation , though there are no studies to prove this . We therefore investigated the effect of body acupuncture on stool frequency and colonic transit time of radiopaque markers in 8 constipated patients ( 58 + /- 6 years , 3 female ; vigorous straining necessary to open bowels without the use of laxatives for more than one year , total colonic marker transit > 60 h ) in a control period and during a three weeks treatment period with six sessions . Acupuncture was performed as body acupuncture with electric needles ( 10 Hz , current titrated to individual threshold , 25 min each session ) on acupuncture points Di4 [ He Gu ] , Ma25 [ Tian Shu ] , Le3 [ Yuan ] , and B125 [ Da Chang Yu ] ) . Two patients dropped out during acupuncture because symptoms of constipation worsened . In the other 6 patients , stool frequencies and colonic transit times were not significantly different during control and acupuncture period ( 0.38 + /- 0.09 vs. 0.40 + /- 0.14 defecations per day + /- s.e.m . , 95 % confidence interval for the difference control minus acupuncture [ -0.34 ; 0.30 ] , and 97 + /- 17 vs. 108 + /- 24h , 95 % Cl [ -50 ; 27 ] ) . Segmental transit times for right and left hemicolon , and rectosigmoid colon did not differ significantly either . In conclusion , acupuncture as performed in this study does not influence objective parameters of colonic function to a clinical ly relevant degree With the clinical manifestations and the point electric conduction volume as the indexes , the authors observed the immediate effects of the acupuncture treatment on chronic superficial gastritis with the points selected according to the date and time set by Ling Gui Ba Fa ( [ symbol : see text ] Eight Methods of Intelligent Turtle ) , which was compared with the effects in the control group treated with the points selected according to syndrome-differentiation . A higher symptom improvement rate ( P < 0.01 ) and a higher channel 's balance-inverting rate were noticed in the former ( P < 0.01 ) , indicating that Ling Gui Ba Fa can give a better therapeutic results Background / Aims : Abnormal gastric slow-wave frequencies have been observed in diabetic gastroparesis and are associated with impaired antral motor activity . In this study , we aim ed at evaluating the effect of acupuncture on gastric slow waves in diabetic patients with symptoms suggesting gastric motor dysfunction . Methods : Fifteen patients with type II diabetes who had had dyspeptic symptoms for more than 3 months were enrolled .  Two acupuncture needles were inserted into the subjects ’ legs at the Zusanli points , and electrical stimulation ( 2-Hz pulses ) was delivered for 30 min .  Cutaneous electrogastrography  was performed for 30 min at baseline , for 30 min during acupuncture , and for an additional 30 min after acupuncture .  Serum gastrin , motilin , and human pancreatic polypeptide levels were also measured . Results : There was a significant increase in the percentages of normal frequency during and after acupuncture ( baseline vs. acupuncture and after acupuncture 21.99 ± 19.38 % vs. 45.93 ± 19.72 and 48.92 ± 19.56 % ; p < 0.01 ) . In addition , the percentage of tachygastric frequency was decreased significantly during and after acupuncture . The dominant frequency was also changed significantly . There was an increase of serum human pancreatic polypeptide  during acupuncture ( baseline vs. acupuncture 56.96 ± 27.64 vs. 73.11 ± 22.37 pmol/l ; p < 0.05 ) . Conclusions : The results of this study revealed that electrical stimulation at the Zusanli points could increase the percentage of normal electrogastrography frequency and decrease the percentage of tachygastric frequency in diabetic patients . The data indicate that acupuncture may enhance the regularity of gastric myoelectrical activity in diabetic patients Background and aims : Despite occasional positive reports on the efficacy of acupuncture ( AC ) on functions of the gastrointestinal tract , there is no conclusive evidence that AC is effective in the treatment of irritable bowel syndrome ( IBS ) . Patients and methods : Forty three patients with IBS according to the Rome II criteria were r and omly assigned to receive either AC ( n = 22 ) or sham acupuncture ( SAC ) ( n = 21 ) using the so-called “ Streitberger needle ” . Treatment duration was 10 sessions with an average of two AC sessions per week . The primary end point was improvement in quality of life ( QOL ) using the functional digestive diseases quality of life question naire ( FDDQL ) and a general quality of life question naire ( SF-36 ) , compared with baseline assessment s. QOL measurements were repeated three months after treatment . Results : Both the AC and SAC groups improved significantly in global QOL , as assessed by the FDDQL , at the end of treatment ( p = 0.022 ) , with no differences between the groups . SF-36 was insensitive to these changes ( except for pain ) . This effect was partially reversed three months later . Post hoc comparison of responders and non-responders in both groups combined revealed a significant prediction of the placebo response by two subscales of the FDDQL ( sleep , coping ) ( F = 6.746 , p = 0.003 ) in a stepwise regression model . Conclusions : Acupuncture in IBS is primarily a placebo response . Based on the small differences found between the AC and SAC groups , a study including 566 patients would be necessary to prove the efficacy of AC over SAC . The placebo response may be predicted by high coping capacity and low sleep quality in individual patients
The purpose of this work was to assess the evidence for effectiveness of  acupuncture ( AC ) treatment in gastrointestinal diseases .