Acupuncture for IBD

How it could work is unknown and research has variable results

In This Article

Inflammatory bowel disease (IBD) is a chronic, lifelong condition for which there is currently no cure. The two main forms, Crohn’s disease and ulcerative colitis, are often treated with a combination of medication, lifestyle changes, diet, and complementary and alternative medicine (CAM). One form of CAM that is sometimes used to treat IBD is acupuncture. Acupuncture is a type of traditional Chinese medicine, the use of which may go back as far as 3000 years. 

Among those who live with IBD, as many as a third may use some form of CAM as a therapy. However, for some types of CAM, it is not known if their use for IBD is effective. While it may seem as though trying CAM does not present any risks, the truth is that there may be potential harms. Harms are often thought of as adverse effects (side effects) but they can also include factors such as time and money that are invested in a therapy that’s not proven to have any beneficial effects.

Acupuncture for treating IBD is an area of active research. There’s currently no general agreement about whether or not acupuncture should be recommended to treat IBD. More study on why and if acupuncture will be helpful in IBD is underway. While the use of acupuncture in ulcerative colitis is still murky because the studies are not standardized, there has been more in the way of good data for the use of acupuncture in Crohn’s disease. Check with a gastroenterologist before beginning acupuncture to treat IBD.

About Acupuncture

Acupuncture is a type of therapy that uses the insertion of thin needles into specific areas on the body. The theory behind acupuncture is that it stimulates the energy (qi) in the body by engaging certain pressure points.

It is far from a uniform practice; there are several different types of acupuncture. Traditional acupuncture uses needles but there are other forms in use that involve electrical stimulation of pressure points, either with or without needles. In addition, other therapies are often used at the same time as acupuncture to enhance its effectiveness. One such therapy is called moxibustion. Moxibustion is a type of heat therapy where a cone or stick of mugwort is is burned on or near the body’s acupuncture points.

Acupuncture has been used to treat a long list of conditions, and this includes digestive diseases such as Crohn’s disease and ulcerative colitis, as well as motility disorders and irritable bowel syndrome (IBS). It is also commonly used to treat pain, such as back pain. The overall concept behind the practice of acupuncture is that it can balance out the energy in the body, trigger healing, and promote relaxation.

It’s currently not known exactly how acupuncture works to treat health conditions even though it is an old practice that is widely used. One theory is that the insertion of needles encourages the release of the pain-relieving “feel good" chemicals called endorphins in the body. Another idea is that the practice affects the autonomic nervous system. The autonomic nervous system is the part of the nervous system that affects certain body processes that involve internal organs. This includes digestion, blood pressure, body fluids, and metabolism, among other functions.

Studies on Acupuncture and IBD Show Variable Results

One meta-analysis looked at 63 randomized controlled trials of acupuncture and/or moxibustion for treating ulcerative colitis. The researchers found that the studies had a lot of variability in how they were conducted, which made it difficult to compare them and then draw some conclusions. Studies may have used acupuncture alone, acupuncture along with moxibustion therapy, or some combination of these in conjunction with Western and/or traditional Chinese medicine. In addition, there was a difference between studies in how many acupoints were used. The length of the studies was anywhere between fewer than 10 days to over 70 days, and several had an unknown time frame.

The study goes on to describe the clinical scales that were used to track how effective the acupuncture methods were in treating the ulcerative colitis. The authors describe the different ways of tracking symptoms and disease activity to have a “high degree of randomness.” This is important to know because it means that it is difficult to compare the studies to one another because they didn’t use the same standards. With all the variability in the methods, materials, and outcomes in the studies, the authors could make little in the way of actual conclusions about the use of acupuncture to treat ulcerative colitis.

One randomized clinical trial looked at how using acupuncture had an effect on mild to moderate Crohn’s disease. For the study, 92 patients (46 in the treatment group and 46 in the placebo group) were followed for up to 24 weeks after having treatment with acupuncture. The treatment group received acupuncture with moxibustion and the placebo group received a sham treatment in place of the moxibustion and acupuncture. Researchers used a measuring tool called the Crohn’s Disease Activity Index (CDAI) to keep track of how patients were doing before the trial and after. A lower CDAI score is better, and after receiving treatment, patients who were in the acupuncture group had lower CDAI scores than those in the placebo group.

It should be noted that there was no difference in endoscopic findings between the treatment group and the control group. That is to say, when a colonoscopy was done, the patients receiving acupuncture did not have any improvement in the mucosa (inner layer) in their colon over those not receiving acupuncture. However, intestinal tissue did show a difference between the two groups; those receiving acupuncture had reductions in their histology scores. Lower histology scores means that inflammation was decreasing in those patients. The authors concluded that the acupuncture may have prompted this benefit .

There’s no consensus about acupuncture and IBD yet, and it’s still an area that’s under study. One of the factors being looked at is how acupuncture might work to treat IBD. Several mouse studies have been done to try and determine how acupuncture affects different aspects of the digestive system that are commonly found in patients with IBD or are thought to have an effect on the development or continuation of IBD. It’s thought that IBD is related to dysbiosis in the digestive system: an imbalance in the bacteria that live there. Some studies have focused on how acupuncture may affect the flora of the gut, the microbiome, in order to better understand why acupuncture may or may not have an effect.

At this time, acupuncture isn’t widely used to treat IBD. Researchers are calling for more rigor to be put around clinical trials on acupuncture and IBD so that the results can be used to make better comparisons across trials.

What Happens During Acupuncture Treatment

Whenever using CAM to treat Crohn’s disease or ulcerative colitis, a gastroenterologist should be consulted. Every case of IBD is different, so not only is it important to ensure that acupuncture is appropriate, but it also ensures that everyone on the care team can work together. A primary care physician or gastroenterologist may also be able to help locate a licensed acupuncturist.

Much like a visit with any other practitioner, an appointment with an acupuncturist will start with a personal medical history. There will be several questions about signs and symptoms of IBD as well as any other medical conditions. It is important to also let an acupuncturist know about all supplements and medications being taken. This is especially true when receiving any drugs which may have an effect on bleeding, such as the blood thinner warfarin (Coumadin).

After taking a history and discussing treatment goals, an acupuncturist will make a recommendation about the number and type of treatments that might be used and how much time each session will take. There might also be additional therapies that are used or suggested to augment the treatment, such as using heat or electrical stimulation.

The patient and the acupuncturist should together come to an agreement about how many sessions are needed (six or more might be typical, especially for a chronic condition like IBD) and if any other therapies might be used. Treatment might be once or twice a week for several weeks, at which time the effects on symptoms will be evaluated.

During the actual acupuncture session, patients are asked to lie down on an exam table, relax, and remain still. Whether the patient lies on their side, back, or stomach depends on where it is that the needles need to be inserted. Needles should be single-use, disposable, and sterile. Good clinical practices should be used to ensure that all needles are retrieved and accounted for after the treatment session.

Patients may feel some discomfort when needles are inserted and manipulated, which is often described as a temporary stinging sensation. Others may feel a dull ache, or tingling, or even nothing at all. If the acupuncturist uses heated needles or applies electrical stimulation, this could result in other sensations. For the most part, acupuncture should not be painful or uncomfortable.

The number of needles used will vary but could be as few as five or as many as 20. Needles are left in the body for a certain amount of time, as determined by the acupuncturist, which in some cases could be anywhere from about 10 minutes to up to half an hour.

Adverse Effects and Risks of Acupuncture

Most adverse effects reported after the use of acupuncture are not serious. However, some of the effects can include a temporary worsening of symptoms, feeling faint after the use of needles, and bruising or bleeding. There can be more serious side effects that include needles being left in the body after completion of the treatment, damage to internal organs, or needles breaking.

One study done in London looked at 325 reports of patient safety incidents that occurred with acupuncture between January 2009 and December 2011. The researchers found that 95% of them were of “low to no harm.” The breakdown of adverse effects among these reports was :

  • Retained needles (31%)
  • Dizziness (30%) 
  • Loss of consciousness/unresponsive (19%) 
  • Falls (4%) 
  • Bruising or soreness at needle site (2%)
  • Pneumothorax (1%)
  • Other adverse reactions (12%)

There is at least one case report of pyoderma gangrenosum occurring in a patient with ulcerative colitis after receiving acupuncture. Pyoderma gangrenosum is a skin condition that is uncommon, but affects about 5% of people who have ulcerative colitis and about 1% of those with Crohn’s disease . It sometimes begins after there is trauma to the skin, such as a scratch, pinprick, or cut. The skin surrounding the scratch begins to break down and rapidly turns into an ulcer. It may or may not be related to having active IBD at the time. Pyoderma gangrenosum can become quite serious and difficult to treat. Concerns about skin disorders related to IBD should be discussed with a gastroenterologist, the acupuncturist, and/or a dermatologist.

It’s important to note that acupuncture shouldn’t be used as the sole method of treatment for any condition. Acupuncture should be done by a licensed practitioner and the other members of the IBD care team should be made aware of the use of this therapy.

The Cost of Acupuncture

Acupuncture may be covered by some types of insurance. When it is not covered by insurance, the cost of a consultation could be anywhere from approximately $75 to $95. Visits after the initial consultation could be between $50 and $70.

A Word From Verywell

There currently isn’t a lot of good evidence that acupuncture is effective for treating ulcerative colitis, mostly due to the nature of the clinical trials that were done. It's important for trials to be done in the same way so that results can be repeated; that's how we know a therapy is actually working. This doesn't mean that acupuncture might not be effective in ulcerative colitis, but so far there's not been the clinical proof that's needed to recommend it on a more widespread basis.

There is more quality evidence available that acupuncture might be helpful in treating Crohn’s disease. As with any type of CAM, the potential harms need to be weighed against the potential benefits. While adverse effects aren’t typical after treatment with acupuncture, there is the potential for soreness, bruising, or bleeding. It may not be an appropriate treatment for people who have other conditions, such as anemia or bleeding disorders, or for those who are taking certain types of medication.

Even when seeing a reputable, licensed practitioner, checking with a primary care physician and/or a gastroenterologist is a good idea before starting acupuncture. With a complicated condition like IBD, it’s important to discuss all treatment decisions with the care team, get all the facts, and make a decision together on how to proceed. 

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Article Sources

  1. Opheim R, Hoivik ML, Solberg IC, Moum B; IBSEN Study Group. Complementary and alternative medicine in patients with inflammatory bowel disease: the results of a population-based inception cohort study (IBSEN)J Crohns Colitis. 2012;6(3):345-353. doi:10.1016/j.crohns.2011.09.007 

  2. Bao CH, Zhao JM, Liu HR, et al. Randomized controlled trial: moxibustion and acupuncture for the treatment of Crohn's disease. World J Gastroenterol. 2014;20(31):11000–11011. doi:10.3748/wjg.v20.i31.11000.

  3. Wheway J, Agbabiaka TB, Ernst E: Patient safety incidents from acupuncture treatments: a review of reports to the National Patient Safety Agency. Int J Risk Saf Med 24(3):163–9, 2012.

  4. Castro-Durán J, Martín-Armada M, Jiménez-Alonso J. Pyoderma gangrenosum induced by acupuncture in a patient with ulcerative colitis. Arch Intern Med. 2000;160(15):2394. 

  5. Crohn’s and Colitis Foundation. Skin Complications of IBD. May 1, 2012. Available at: https://site.crohnscolitisfoundation.org/resources/skin-complications-of-ibd.html 

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