Acupuncture Treatment Effects in IBS Are Predominantly Placebo Effects

Abstract

Purpose: Despite occasional positive reports on the efficacy of acupuncture on functions of the gastrointestinal tract, published data not provide conclusive evidence that acupuncture (AC) is effective in the treatment of the irritable bowel syndrome (IBS). Methods: Forty-three patients with the diagnosis of IBS according to Rome II criteria were randomly assigned to receive either acupuncture (n = 22) or sham acupuncture (n = 21) (SAC) using the so-called “Streitberger needle”, and a standardized acupuncture treatment according to Traditional Chinese Medicine (TCM). Treatment duration was 10 sessions with an average 2 acupuncture sessions per week, and primary endpoint was improvement of quality of life (QOL) using the FDDQOL and the SF36, compared to baseline assessment at the end of treatment. QoL measurement was repeated three months after treatment. Results: Both the AC as well as the SAC group improved significantly in global QOL by the FDDQOL at the end of treatment (p = .022), with no differences between both groups; the SF36 was insensitive to these changes. This effect was partially reversed three months later. Based on the the small differences found between AC and SAC, a study including 570 patients would be neccessary to prove efficacy of AC over SAC. 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 FDDQOL (sleep, coping) (F = 6.746, p = .003) in a stepwise regression model. Conclusions: Acupuncture efficacy in IBS is primarily a placebo response that may in part be predicted by high coping capacity and low sleep quality in individual patients. (Supported by the German Medical Acupuncture Association, DÄGfA)