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.
Research and Resources on Irritable Bowel Syndrome and Acupuncture:
A scholarly search of the available research papers on the terms “acupuncture” + “IBS” yields over 6640 papers, and narrowing this to “RCT” to identify Randomised Controlled Trials, gives over 900 results; of which 40% have been carried out since 2017 (Google Scholar). This suggests that acupuncture is being used traditionally and currently in this area, leading to a body of research being carried out, the pace of which has increased in recent years, indicating increased recognition that it is worthy of scientific appraisal regarding its potential role.
For constipation, see also our dedicated page here
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 British Acupuncture Council has a Research digest where they examined some recent studies on IBS, such as MacPherson et al (2017; n=116) in a follow up two years after their RCT acupuncture for IBS, finding a favourable result 24 months on. Another RCT for diarrhoea type IBS (Zheng et al, 2016; n=448) found the acupuncture group found a level of improvement in line with that of the group assigned pharmacological (Loperamide) intervention in terms of reducing stool frequency.
Zhu et al (2018a) conducted a network meta-analysis of diarrhoea type IBS, with 29 studies (n=9369) entailed in it, finding that acupuncture may improve symptoms, but that further high quality research was needed to corroborate the overall results. A meta analysis of diarrhoea predominant IBS (Deng et al, 2017) looked at 17 trials (n=1333), finding improvement in clinical symptoms in the acupuncture groups. Similar trends have been seen in the trials for acupuncture in constipation predominant IBS, in a network meta-analysis, in which the quality of the trials was predominantly of high quality (40 trials n=11032; Zhu et al, 2018b).
Qi et al (2022; n=90; pilot, multicentre RCT) examined a potential biological mechanism of action on IBS by reducing “visceral hypersensitivity” and modulating the gut-brain axis. They compared 3 groups: Specific acupuncture (real points); non-specific points; and sham acupuncture, and compared measurements of abdominal pain scores and types of stool. Both the specific and non-specific groups showed meaningful improvement in the IBS-D symptoms from baseline. It’s of note that non-specific real points do nonetheless have an impact, although the verum acupuncture effect is longer lived.
Research is ongoing, and recently, a protocol for a systematic review for anxiety and depression in IBS is awaited with interest (Li et al, 2021a), as is a systematic review of a comparison of acupuncture and pinaverium bromide in IBS (Li et al, 2021b), and a systematic review of acupuncture for adults with IBS-D (Guo et al, 2020). Search terms “acupuncture” + “IBS” + “RCT” + “protocol” since 2021 yield over 80 results, showing there is more to come in this area of growing interest in the very near future.
Mechanisms of Action
Acupuncture stimulates the body to create its own natural painkilling substances, such as Beta Endorphins (β-Endorphin). In studies acupuncture has been shown to stimulate the production of natural painkillers called opioid-like peptides (OLPs), including β-Endorphin: For example, this was shown in an RCT in 90 patients with a range of painful disorders (Petti et al, 1998). The same study showed acupuncture also and enhanced the activity of immune cells (lymphocytes, natural killer cells and monocytes) that help fight infections and diseases (Petti et al, 1998).
Moxibustion (an adjunctive acupuncture technique that involves burning herbs near the skin to stimulate acupuncture points) was found to reduce the expression of pro-inflammatory biomarkers (namely, TLR2, IRAK1, IKK-β and NF-κB) in an ulcerative colitis rat model; and to increase the expression of anti-inflammatory biomarkers (specifically, IFN- β and IL-10) in the rats’ colonic mucosa (Wang et al, 2015). Therefore it may have a protective and anti-inflammatory effect on the gut tissue.
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.
British Acupuncture Council evidence based factsheet about IBS including specific research, trials and mechanisms of action for acupuncture in this condition.
British Acupuncture Council Research Digest – Irritable Bowel Syndrome (IBS) (approx halfway down the document)
Deng, D., Guo, K., Tan, J., Huang, G., Li, S., Jiang, Q., Xie, J., Xie, H., Zhang, Z., Chen, Y. and Peng, L., 2017. Acupuncture for diarrhea-predominant irritable bowel syndrome: a meta-analysis. Zhongguo zhen jiu= Chinese acupuncture & moxibustion, 37(8), pp.907-912.
Guo, J., Xing, X., Wu, J., Zhang, H., Yun, Y., Qin, Z. and He, Q., 2020. Acupuncture for Adults with Diarrhea-Predominant Irritable Bowel Syndrome or Functional Diarrhea: A Systematic Review and Meta-Analysis. Neural plasticity, 2020.
Li, H., Chen, Y., Hu, Z., Jiang, J., Ye, J., Zhou, Y., Yu, Z. and Tang, H., 2021a. Effectiveness of acupuncture for anxiety and depression in irritable bowel syndrome: A protocol for systematic review and meta-analysis. Medicine, 100(8).
Li, H., Chen, Y., Hu, Z., Jiang, J., Ye, J., Zhou, Y., Yu, Z. and Tang, H., 2021b. Effectiveness of acupuncture for anxiety and depression in irritable bowel syndrome: A protocol for systematic review and meta-analysis. Medicine, 100(8).
MacPherson, H., Tilbrook, H., Agbedjro, D., Buckley, H., Hewitt, C. and Frost, C., 2017. Acupuncture for irritable bowel syndrome: 2-year follow-up of a randomised controlled trial. Acupuncture in Medicine, 35(1), pp.17-23.
Petti, F.., Bangrazi, A., Liguori, A., Reale, G. and Ippoliti, F., 1998. Effects of acupuncture on immune response related to opioid-like peptides. Journal of Traditional Chinese Medicine 18(1), pp.55-63.
Wang, X., Liu, Y., Dong, H., Wu, L., Feng, X., Zhou, Z., Zhao, C., Liu, H. and Wu, H., 2015. Herb-partitioned moxibustion regulates the TLR2/NF-κB signaling pathway in a rat model of ulcerative colitis. Evidence-Based Complementary and Alternative Medicine, 2015.
Zheng, H., Li, Y., Zhang, W., Zeng, F., Zhou, S.Y., Zheng, H.B., Zhu, W.Z., Jing, X.H., Rong, P.J., Tang, C.Z. and Wang, F.C., 2016. Electroacupuncture for patients with diarrhea-predominant irritable bowel syndrome or functional diarrhea: a randomized controlled trial. Medicine, 95(24).
Zhu, L., Ma, Y., Ye, S. and Shu, Z., 2018a. Acupuncture for diarrhoea-predominant irritable bowel syndrome: a network meta-analysis. Evidence-Based Complementary and Alternative Medicine, 2018.
Zhu, L., Ma, Y. and Deng, X., 2018b. Comparison of acupuncture and other drugs for chronic constipation: A network meta-analysis. PloS one, 13(4), p.e0196128.