Brain regions involved in moxibustion-induced analgesia in irritable bowel syndrome with diarrhea: a functional magnetic resonance imaging study.

Yi Zhu,Zhiyuan Wu,Chunhui Bao,Yunhua Cui,Xiaopeng Ma,Cili Zhou,Huirong Liu,Zhongwei Zhang,Huangan Wu,Huan Zhang,Xiaomei Wang,Ling Yang,Haipeng Jia,Yuemin Wang

doi:10.1186/1472-6882-14-500

Abstract

BackgroundMoxibustion is one of the most commonly used therapies in acupuncture practice, and is demonstrated to be beneficial for patients with diarrhea from irritable bowel syndrome (D-IBS). But its mechanism remains unclear. Because visceral hypersensitivity in IBS patients has been documented by evaluation of perceived stimulations through functional magnetic resonance imaging (fMRI) studies, we focused on observing brain imaging changes in D-IBS patients during rectal balloon distention before and after moxibustion in order to reveal its possible central mechanism and further evaluate its effect.MethodsThis clinical trial is registered under the number: ChiCTR-TRC-10000887. Eighty D-IBS patients were randomly divided into a moxibustion and sham moxibustion group (control group) for a 4-week treatment. Fifteen patients in moxibustion group and thirteen patients in control group completed two fMRI scans during a 50 and 100 ml rectal balloon distention before and after treatment. Rectal pain were obtained with a scan test. Birmingham IBS Symptom Scale and IBS Quality of Life (QOL) Scale were used to evaluate therapeutic effect.ResultsAfter treatment, the decrease in Birmingham IBS Symptom Scale and IBS QOL Scale scores in moxibustion group was significantly greater than that of control group (P < 0.01). The defecation urge threshold and the pain perception threshold of moxibustion group was also significantly higher after treatment than that of control group (P < 0.01). The decrease in pain score during the 100 ml rectal balloon distention in moxibustion group was significantly greater than that of control group (P < 0.05). There was no definite activated center during the 50 ml rectal distention in either group before treatment. After treatment, the prefrontal cortex (PFC) was affected in moxibustion group, while the PFC and the anterior cingulated cortex (ACC) were affected in control group. During the 100 ml distention before treatment in both groups, the PFC and ACC were activated. After treatment, they disappeared in moxibustion group but remained in control group.ConclusionsMoxibustion can improve symptoms and quality of life in D-IBS patients. It can also decrease rectal sensitivity. The activation of PFC and ACC during a 100 ml rectal distention disappeared after moxibustion treatment.

Highlights

Moxibustion is one of the most commonly used therapies in acupuncture practice, and is demonstrated to be beneficial for patients with diarrhea from irritable bowel syndrome (D-Irritable bowel syndrome (IBS))
Our results demonstrate the clinical effects of moxibustion on
After aconite-separated moxibustion treatment, the defecation urge threshold and pain detection threshold were increased while the pain score after a 100 ml rectal balloon distention was decreased

Summary

Introduction

Moxibustion is one of the most commonly used therapies in acupuncture practice, and is demonstrated to be beneficial for patients with diarrhea from irritable bowel syndrome (D-IBS). Irritable bowel syndrome (IBS) is a lasting condition involving recurrent attacks of a group of clinical symptoms including abdominal pain, distention, bowel habit changes, and abnormal stool. It is a common gastrointestinal (GI) disorder, affecting 10–15% of the population in developed countries. Moxibustion treatment for D-IBS has been shown to have a good clinical effect [9,10]. It can effectively relieve diarrhea, abdominal pain, abdominal distension, and other symptoms [11]. Moxibustion helps D-IBS patients improve their symptoms, its mechanism remains unclear

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