Constipation – Condition Resources

Important to know: Chronic health conditions should be addressed under direct medical supervision of your GP or consultant, and acupuncture would be an adjunct or complement to usual care – we advise that you let you doctor know when you use this approach.

A scholarly search of the available research papers on the terms “acupuncture” + “constipation” yields over 27,500 papers, and narrowing this to “RCT” to identify Randomised Controlled Trials, gives over 2,900 results; of which 43% have been carried out since 2017 (Google Scholar). This suggests that acupuncture is being used traditionally and currently in this area, much research has been carried out, and that the pace of research here has increased in recent years, meaning the research community recognise its potential role is worthy of appraisal in a scientific manner.

Interpreting the research:

When reading health research, it is important to know that Systematic Reviews or Meta Analyses of a large number of high-quality research studies are the very best way to be able to say to what extent a given treatment can address a condition, symptom, or set of symptoms.  The next best level of evidence is the individual Randomised Controlled Study (RCT) which uses a systematic technique to compare two or more groups of patients receiving different treatments (or a treatment against a “control”, or no treatment).  In acupuncture trials, the nature of the control group is of particular interest as it is hard to blind a patient to whether they are having a needle inserted or not, and even more challenging to blind the researcher/team to this.

The means and quality of how research is carried out varies considerably from country to country, and in terms of how an intervention is compared to another intervention (or a control).  Of note is the fact that “sham” acupuncture (where needles are placed in apparently inert locations rather than traditional acupuncture points) is not really an inert process as it has physiological effects, so that comparing sham and “true acupuncture” may therefore not give a clear picture alone; but and form a part of a research body where acupuncture versus no treatment, vs conventional treatment or vs a different approach/modality also form part of the evidence base.

The n= figure (where quoted in research) tells you how many people were participants in the study, and usually the larger a study (when it is of good quality and design), the more likely it is to be reliable and applicable to larger populations. When (statistical) “significance” is discussed in view of studies it has a very particular meaning – it is the confidence in the data (using statistical tests) that tells us how likely a result could have just come about by chance. The lower the possibility of a chance result, the more likely it is due to the intervention in the experiment. When you are reading a trial/study, the “p” is the number telling us of significance, and this must be under 5% (or p less than 0.05) to mean we can say it is a (statistically) “significant” result.

The Research:

The British Acupuncture Council has a Research digest where they examined some recent studies on constipation including an RCT taken in 15 hospitals in China (n=1075) where the acupuncture group was seen to increase the number of weekly spontaneous bowel movements, with the researchers recommending that further studies are needed to see the longer term outcomes (Liu et al, 2016). 

Another RCT (Zheng et al, 2018; n=684) similarly showed promise in this area, but was limited somewhat by its design in not having a sham acupuncture control (they only had three different types of verum acupuncture compared with pharmacological intervention), meaning it was difficult to know the magnitude of the effect.

A systematic review and meta-analysis of 33 trials (n=4324 total; Zheng et al, 2019) compared eight different non-drug treatments, finding acupuncture and TENS were the most effective in addressing chronic functional constipation symptoms, but interpreting the results with caution due to small study effects. A later systematic review, (Wang et al, 2020) drew similar conclusions, noting increased quality of life in acupuncture groups as well as trends towards symptomatic relief, but noting evidence quality was low, warranting further studies (28 RCT’s; n=3525). A smaller systematic review of electro-acupuncture in this field drew similar conclusions to the above in terms of positive yet tentative trends (Zhang et al, 2020; 6 studies, n=1457).

Research continues, and a number of protocols for systematic reviews in this area have been published recently, the results of which are awaited with interest: e.g. Zhu et al, 2021; Yang et al, 2020; and Chen et al, 2020.

Regarding Your Individual Condition and Symptoms:

Whilst the scientific studies are of great interest to researchers and acupuncturists in terms of comparing protocols, for the patient not versed in research they are less accessible, which is why when we asked “can acupuncture work for my (condition or symptom) we are not able to give a simple yes or no response.  We are able to tell you what experience we have had in our decades of experience in practise, of the types of outcomes we have seen in similar cases, and give you an idea of our level of experience and knowledge in that area, and how this could relate to your own individual situation.  For this, we recommend booking a free telephone consultation where we can answer any questions you have and give a realistic appraisal of what acupuncture may be able to provide.

Resources:

British Acupuncture Council evidence based factsheet about Gastrointestinal tract issues including specific research, trials and mechanisms of action for acupuncture in this condition.

British Acupuncture Council Research Digest – Constipation (approx halfway down the document)

References:

Chen, C., Liu, B., He, L., Lv, X., Guo, S. and Ai, Y., 2020. Efficacy of Acupuncture in Subpopulations with Constipation: A protocol for a Systematic Review and Individual Patient data Meta-analysis.

Liu, Z., Yan, S., Wu, J., He, L., Li, N., Dong, G., Fang, J., Fu, W., Fu, L., Sun, J. and Wang, L., 2016. Acupuncture for chronic severe functional constipation: a randomized trial. Annals of internal medicine165(11), pp.761-769.

Wang, L., Xu, M., Zheng, Q., Zhang, W. and Li, Y., 2020. The Effectiveness of Acupuncture in Management of Functional Constipation: A Systematic Review and Meta-Analysis. Evidence-Based Complementary and Alternative Medicine2020.

Yang, P., Wang, Y., Xiao, Y., Ma, Q., Ma, R., Mi, J. and Hui, J., 2020. Acupuncture for opioid-induced constipation: Protocol for a systematic review and meta-analysis. Medicine99(49).

Zhang, N., Hou, L., Yan, P., Li, X., Wang, Y., Niu, J., Feng, L., Li, J., Yang, K. and Liu, X., 2020. Electro-acupuncture vs. sham electro-acupuncture for chronic severe functional constipation: a systematic review and meta-analysis. Complementary Therapies in Medicine, p.102521.

Zheng, H., Liu, Z.S., Zhang, W., Chen, M., Zhong, F., Jing, X.H., Rong, P.J., Zhu, W.Z., Wang, F.C., Liu, Z.B. and Tang, C.Z., 2018. Acupuncture for patients with chronic functional constipation: a randomized controlled trial. Neurogastroenterology & Motility30(7), p.e13307.

Zheng, H., Chen, Q., Chen, M., Wu, X., She, T.W., Li, J., Huang, D.Q., Yue, L. and Fang, J.Q., 2019. Nonpharmacological conservative treatments for chronic functional constipation: A systematic review and network meta‐analysis. Neurogastroenterology & Motility31(1), p.e13441.

Zhu, D., Hu, J., Chi, Z., Ouyang, X., Xu, W., Luo, Z., Cheng, C., Wu, J., Chen, R. and Jiao, L., 2021. Effectiveness and safety of acupuncture in the treatment of chronic severe functional constipation: A protocol for systematic review and meta-analysis. Medicine100(7).

Helen
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