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Alternative Therapy (Yoga, Acupuncture, etc.) new
      #13947 - 07/14/03 01:48 PM
HeatherAdministrator

Reged: 12/09/02
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All articles pertaining to alternative therapies such as yoga, acupuncture, meditation, etc. and digestive health research should be posted here.

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Stress Management for Gastrointestinal Disorders:The Use of Kundalini Yoga Meditation Techniques new
      #13960 - 07/14/03 02:18 PM
HeatherAdministrator

Reged: 12/09/02
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Full Text of: Shannahoff Khalsa: Gastroenterol Nurs, Volume 25(3).May/June 2002.126-129

Gastroenterology Nursing (C) The Society of Gastroenterology Nurses & Associates 2002.
All Rights Reserved.

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Volume 25(3) May/June 2002 pp 126-129
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Complementary Healthcare Practices: Stress Management for Gastrointestinal Disorders: The Use of Kundalini Yoga Meditation Techniques

[Departments] Shannahoff-Khalsa, David Section Editor(s): Krebs, Kathleen BS, RN

About the Department Editor: Kathleen Krebs, BS, RN, is the new editor of the Complementary Healthcare Practices column. Kathleen has received clinical training in Mind/Body Medicine from Harvard University's Mind/Body Medical Institute under the medical direction of Dr. Herbert Benson. In her role at Allegheny General Hospital's Integrated Medicine Program, Kathleen provides instruction in stress management, mind/body medicine, and healthy lifestyle strategies, and helps to integrate conventional and natural therapies for patients with acute and chronic conditions. Kathleen works with a large gastroenterology practice at Allegheny General Hospital and has been a member of SGNA since 1998.

About the Author: David Shannahoff-Khalsa is Director, The Research Group for Mind-Body Dynamics, Institute for Nonlinear Science (mail code 0402), University of California, San Diego, 9500 Gilman Drive, La Jolla, CA 92093-0402 (e-mail dsk@ucsd.edu). Contact the author for more information about the use of Kundalini Yoga meditation techniques.

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Outline

Overview of the Techniques
Summary
References

Graphics

Table 1
Table 2
Table 3

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It is well known that stress exacerbates the symptoms of irritable bowel syndrome (IBS) and other functional gastrointestinal (GI) disorders. Drossman et al. (1999) hypothesized that functional GI disorders result from the dysregulation of "brain-gut" neuroenteric systems. They suggest the primary origin of functional GI disorders is not a disease of any GI organ or the brain, but the interaction of both. These disorders may, therefore, benefit from techniques that can alter the activities of
the central nervous system (CNS), autonomic nervous system (ANS), and enteric nervous system (ENS).

Recently, Kundalini Yoga meditation techniques (Shannahoff-Khalsa et al., 1999) have been demonstrated to have a dramatically beneficial effect on obsessive compulsive disorders (OCD), one of the most disabling of the anxiety disorders (Rapoport, 1990). OCD has a lifelong prognosis and is estimated to be the fourth most common psychiatric disorder following phobias, substance abuse, and the major depressive disorders. OCD is twice as common as schizophrenia and panic disorder (Rasmussen & Eisen,1990). OCD often begins during childhood or adolescence, has a lifetime prevalence rate of 2.5% to 5.0% (Rasmussen &
Eisen, 1990), and has proven to be refractory to traditional insight-oriented psychotherapy (Jenike, 1990). Also, 40% to 60% of patients exhibit only minimal improvement or no change with serotonin reuptake inhibitors alone (Goodman, 1992). As many as one-third are unimproved after apparently adequate drug treatment (Goodman, 1992), yielding a drug-treatment-resistant patient (Goodman, et al., 1992). In addition, medication in responders produces only a 30% to 60% symptom reduction and patients tend to remain chronically symptomatic to some degree despite the best of pharmacologic interventions (Jenike, 1992).

These OCD statistics are similar to those of IBS and other GI disorders for incidence and treatment success rates. While Kundalini Yoga meditation techniques have not yet been tested specifically for IBS or other GI disorders, they have a longstanding history over thousands of years as therapies for stress management, anxiety disorders, and a wide range of other psychiatric disorders (Shannahoff-Khalsa, 1991). The intent here is to help familiarize therapists and clinicians that may want to increase their repertoire of tools in the alternative medicine domain for the treatment of "brain-gut" disorders.

Overview of the Techniques

While there are 11 techniques in the meditation protocol specific for OCD (Shannahoff-Khalsa, 1997), including a breathing pattern specific for treating OCD (not listed below), these techniques can be employed for the stress-related exacerbation conditions of GI disorders. Several are described here. In addition to these, in the OCD-specific protocol, there is a 3-minute technique to help individuals learn to manage fears, a 5-minute technique for turning negative thoughts into positive thoughts, a technique that only requires a few breaths to help meet mental challenges, and an 11-minute technique for tranquilizing the angry mind. Whether practicing in a group or by oneself, the first technique, "tuning in" is always employed. Tuning in helps to induce a meditative state of mind and can provide the individual with the experience of being in a womb of blissful healing energy, especially when practiced beyond the minimum requirement of three repetitions (Table 1).

This technique helps to create a meditative state of mind and is always used as a precursor to the other techniques. There is no upper time limit for this technique; the longer the better.

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TABLE 1 Technique 1 "Tuning In"
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Techniques 2, Spine Flexing, and 3, Shoulder Shrug (Table 2), are also used to help induce an energized and positive state of being that can help the patient when engaging in the other techniques. These techniques increase metabolism, uplift the spirit, and induce the healthy glandular changes that give the energetic experience of vitality. These are helpful precursors to the other techniques. They help set the mood and increase metabolism.

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TABLE 2 Techniques 2 & 3 for Vitality
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Techniques 4, 5, and 6 (see Table 3) are all useful for managing anxiety, emotional stress, and mental tension-conditions that are believed to play an elementary role in the disturbance of the "brain-gut" connection. Technique 4 for reducing anxiety, stress, and mental tension is a powerful technique that induces a calm and quiet mind within minutes. It works even if you are feeling absolutely insane. In fact, in ancient times it was used to treat insanity. It can also be used to curb a restless and stressed mind and to bring an inner stillness and extraordinary experience of mental silence and well-being.

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TABLE 3 Techniques 4, 5, & 6 for Reducing Anxiety, Stress, and Mental Tension
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Technique 5 helps to alleviate emotional stress. Yogis also claim it helps rejuvenate the nervous, glandular, and
cardiovascular systems. This technique helps build respiratory capacity. The more slowly and deeply you breathe, the more relaxed you will be. Technique 6 takes about 75 seconds once learned and helps strip away any residual mental tension, especially after employing techniques 4 and 5. It can also be used independently.

Summary

Techniques in this protocol are from the system of Kundalini Yoga as taught by Yogi Bhajan (Master of Kundalini Yoga). They have a long-standing history of use for the management of stress, anxiety, and a wide variety of psychiatric and other disorders. While they have not been rigorously tested for the treatment of IBS or other functional GI disorders during modern times, they are likely to prove beneficial for helping the GI patient manage the daily stress that is often found to exacerbate and perhaps perpetuate the symptoms and conditions of the functional bowel or "brain-gut" disorders. Helping a patient to manage stress and achieve a profound sense of relaxation is likely to tend to the "brain" side of the "brain-gut" disorder, and thus help reduce these inter-system disorders.

References

1. Drossman, D.A., Creed, F.H., Olden, K.W., Svedlund, J., Toner, B.B., Whitehead, W.E. (1999). Psychological aspects of the functional gastrointestinal disorders. Gut, 45(suppl. 2), 1125-1130.

2. Goodman, W.K., McDougle, C.J., Price, L.H. (1992). Pharmacotherapy of obsessive compulsive disorder. Journal of Clinical Psychiatry, 53, 29-37. [Medline Link] [PsycINFO Link] [BIOSIS Previews Link]

3. Goodman, W.K., McDougle, C.J., Barr, L.C., Aronson, S.C., Price, L.H. (1993). Biological approaches to treatment-resistant obsessive compulsive disorder. Journal of Clinical Psychiatry, 54, 16-26. [Medline Link] [PsycINFO Link] [BIOSIS Previews Link]

4. Jenike, M.A. (1990). Psychotherapy of the patient with obsessive compulsive personality disorder. In M.A. Jenike, L. Baer, W.E. Minichiello (Eds.). Obsessive-compulsive disorders: Theory and management. St. Louis: Mosby-Year Book.

5. Jenike, M.A. (1992). Pharmacologic treatment of obsessive compulsive disorders. Psychiatric Clinics of North America, 15, 895-919. [Medline Link] [PsycINFO Link]

6. Rapoport, J.L. (1990). The waking nightmare: An overview of obsessive compulsive disorder. Journal of Clinical Psychiatry, 51, 25-28. [Medline Link] [PsycINFO Link] [BIOSIS Previews Link]

7. Rasmussen, S.A., Eisen, J.L. (1990). Epidemiology of obsessive compulsive disorder. Journal of Clinical Psychiatry, 51, 10-13. [Medline Link] [PsycINFO Link] [BIOSIS Previews Link]

8. Shannahoff-Khalsa, D.S. (1991). Stress technology medicine: A new paradigm for stress and considerations for
self-regulation. In M. Brown, G. Koob, C. Rivier (Eds.). Stress: Neurobiology and neuroendocrinology (pp. 647-686). New York: Marcel Dekker.

9. Shannahoff-Khalsa, D.S. (1997). Yogic techniques are effective in the treatment of obsessive compulsive disorders, In E. Hollander D Stein (Eds.). Obsessive-compulsive disorders: Diagnosis, etiology, and treatment (pp. 283-329). New York: Marcel Dekker.

10. Shannahoff-Khalsa, D.S., Ray, L.E., Levine, S., Gallen, C.C., Schwartz, B.J., Sidorowich, J.J. (1999). Randomized
controlled trial of yogic meditation techniques for patients with obsessive compulsive disorders. CNS Spectrums: The International Journal of Neuropsychiatric Medicine, 4( 12), 34-46.

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Accession Number: 00001610-200205000-00008
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A Systematic Review of Alternative Therapies in IBS new
      #13978 - 07/14/03 03:17 PM
HeatherAdministrator

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Posts: 7795
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Spanier et al. Arch Intern Med.2003; 163: 265-274.

A Systematic Review of Alternative Therapies in IBS

A recent study conducted by the Division of Gastroenterology and Hepatology, Department of Internal Medicine, Northwestern University Medical School, Chicago, IL found that irritable bowel syndrome is a common disorder associated with a significant burden of illness, poor quality of life, high rates of absenteeism, and high health care utilization. Management can be difficult and treatment unrewarding; these facts have led physicians and patients toward alternative therapies. They explored a variety of treatments that exist beyond the scope of commonly used therapies for irritable bowel syndrome. Guarded optimism exists for traditional Chinese medicine and psychological therapies, but further well-designed trials are needed. Oral cromolyn sodium may be useful in chronic unexplained diarrhea and appears as effective as and safer than elimination diets. The roles of lactose and fructose intolerance remain poorly understood. Alterations of enteric flora may play a role in irritable bowel syndrome, but supporting evidence for bacterial overgrowth or probiotic therapy is lacking.

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Acupuncture treatment for irritable bowel syndrome. new
      #14129 - 07/15/03 06:42 PM
HeatherAdministrator

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Posts: 7795
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Digestion. 2001;64(2):100-3.

Acupuncture treatment for irritable bowel syndrome. A double-blind controlled study.

Fireman Z, Segal A, Kopelman Y, Sternberg A, Carasso R.

Department of Gastroenterology, Hillel Yaffe Medical Center, Hadera, Israel. fireman@hillel-yaffe.health.gov.il

BACKGROUND/AIM: Irritable bowel syndrome is one of the most common gastrointestinal disorders in Western society, affecting around 15% of the population, especially young adults. The cause(s) of irritable bowel syndrome and effective treatment(s) have remained elusive. This study aimed at exploring the therapeutic value of acupuncture by comparing the responses of irritable bowel syndrome sufferers to true acupuncture versus sham acupuncture in a controlled double-blind study. METHODS: Twenty-five patients who fulfilled the Rome criteria (irritable bowel syndrome symptoms persisting for more than 1 year) comprised the final study population. They were recruited through a 'call for' bulletin sent to gastroenterologists practicing in the region of our medical center. True acupuncture was performed at LI-4 (colonic meridian, needle only) and sham acupuncture at BL-60 (urinary vesicle meridian, needle only). Patient assignment to one of the two groups was random. RESULTS: The effect of the first true acupuncture on overall symptoms and abdominal pain was a clear and significant improvement (p = 0.05). No comparable effect was seen in the second session. CONCLUSIONS: Although the true acupuncture results were consistently better, no difference was found between the two groups in the overall statistical analysis. We could not show a therapeutic benefit of this treatment modality in irritable bowel syndrome. Copyright 2001 S. Karger AG, Basel

Publication Types:
Clinical Trial
Randomized Controlled Trial

PMID: 11684823 [PubMed - indexed for MEDLINE]
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Effectiveness of acupuncture for treatment of childhood constipation. new
      #14130 - 07/15/03 06:43 PM
HeatherAdministrator

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Dig Dis Sci. 2001 Jun;46(6):1270-5.

Effectiveness of acupuncture for treatment of childhood constipation.

Broide E, Pintov S, Portnoy S, Barg J, Klinowski E, Scapa E.

Institute of Gastroenterology, Liver Disease and Nutrition, Assaf Harofeh Medical Center, Zerifin, Israel.

The aim of the present study was to examine the influence of acupuncture on chronic constipation in children and to investigate their basal plasma panopioid level and the changes of this treatment. Seventeen children constipated for at least six months were treated by five weekly placebo acupuncture sessions, followed by 10 weekly true acupuncture sessions. Their parents filled a bowel habit questionnaire. Panopioid activity was measured at time 0 and after 5, 10, and 15 acupuncture sessions. The frequency of bowel movements in males increased more gradually compared to females and reached a maximal improvement only after 10 true acupuncture sessions, from 1.4 +/- 0.6/week to 4.4 +/- 0.6/week and females from 1.4 +/- 0.3/week up to 5.6 +/- 1.2/week. The basal panopioid activity was lower in constipated children as compared to the control population and increased gradually up to control level after 10 true acupuncture sessions. This study is the first to describe a successful treatment by acupuncture of constipated children.

Publication Types:
Clinical Trial

PMID: 11414304 [PubMed - indexed for MEDLINE]
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Acupuncture for gastrointestinal and hepatobiliary disorders. new
      #14131 - 07/15/03 06:45 PM
HeatherAdministrator

Reged: 12/09/02
Posts: 7795
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J Altern Complement Med. 1999 Feb;5(1):27-45.

Acupuncture for gastrointestinal and hepatobiliary disorders.

Diehl DL.

Division of Digestive Diseases, UCLA School of Medicine, USA.

Acupuncture has been used for various gastrointestinal (GI) conditions. Voluminous data support the effect of acupuncture on the physiology of the GI tract, including acid secretion, motility, neurohormonal changes, and changes in sensory thresholds. Much of the neuroanatomic pathway of these effects has been identified in animal models. A large body of clinical evidence supports the effectiveness of acupuncture for suppressing nausea associated with chemotherapy, postoperative state, and pregnancy. Prospective randomized controlled trials have also shown the efficacy of acupuncture for analgesia for endoscopic procedures, including colonoscopy and upper endoscopy. Acupuncture has also been used for a variety of other conditions including postoperative ileus, achalasia, peptic ulcer disease, functional bowel diseases (including irritable bowel syndrome and nonulcer dyspepsia), diarrhea, constipation, inflammatory bowel disease, expulsion of gallstones and biliary ascariasis, and pain associated with pancreatitis. Although there are few prospective randomized clinical studies, the well-documented physiological basis of acupuncture effects on the GI tract, and the extensive history of successful clinical use of acupuncture, makes this a promising modality that warrants further investigation.

Publication Types:
Review
Review, Tutorial

PMID: 10100029 [PubMed - indexed for MEDLINE]
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The role of acupuncture in the treatment of irritable bowel syndrome new
      #14132 - 07/15/03 06:45 PM
HeatherAdministrator

Reged: 12/09/02
Posts: 7795
Loc: Seattle, WA

Hepatogastroenterology. 1997 Sep-Oct;44(17):1328-30.

The role of acupuncture in the treatment of irritable bowel syndrome: a pilot study.

Chan J, Carr I, Mayberry JF.

Gastrointestinal Research Unit, Leicester General Hospital, England.

BACKGROUND/AIMS: The aim of this pilot study was to investigate the potential value of acupuncture in the treatment of irritable bowel syndrome (IBS). METHODOLOGY: The study was an open design study of 7 patients with established irritable bowel syndrome in which assessment was by a diary card. RESULTS: The results showed a significant improvement both in general well-being and in symptoms of bloating. CONCLUSIONS: Acupuncture seems to be effective in the treatment of irritable bowel syndrome and merits further study.

Publication Types:
Clinical Trial

PMID: 9356848 [PubMed - indexed for MEDLINE]
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Yoga-based guided relaxation reduces sympathetic activity new
      #14134 - 07/15/03 06:50 PM
HeatherAdministrator

Reged: 12/09/02
Posts: 7795
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Psychol Rep. 2002 Apr;90(2):487-94.

Yoga-based guided relaxation reduces sympathetic activity judged from baseline levels.

Vempati RP, Telles S.

Swami Vivekananda Yoga Research Foundation, Chamarajpet, Bangalore, India.

35 male volunteers whose ages ranged from 20 to 46 years were studied in two sessions of yoga-based guided relaxation and supine rest. Assessments of autonomic variables were made for 15 subjects, before, during, and after the practices, whereas oxygen consumption and breath volume were recorded for 25 subjects before and after both types of relaxation. A significant decrease in oxygen consumption and increase in breath volume were recorded after guided relaxation (paired t test). There were comparable reductions in heart rate and skin conductance during both types of relaxation. During guided relaxation the power of the low frequency component of the heart-rate variability spectrum reduced, whereas the power of the high frequency component increased, suggesting reduced sympathetic activity. Also, subjects with a baseline ratio of LF/HF > 0.5 showed a significant decrease in the ratio after guided relaxation, while subjects with a ratio < or = 0.5 at baseline showed no such change. The results suggest that sympathetic activity decreased after guided relaxation based on yoga, depending on the baseline levels.

PMID: 12061588 [PubMed - indexed for MEDLINE]
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Recovery from stress in two different postures and in a yogic relaxation posture. new
      #14143 - 07/15/03 09:09 PM
HeatherAdministrator

Reged: 12/09/02
Posts: 7795
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Indian J Physiol Pharmacol. 1998 Oct;42(4):473-8.

Recovery from stress in two different postures and in Shavasana--a yogic relaxation posture.

Bera TK, Gore MM, Oak JP.

Scientific Research Department, Kaivalyadhama S.M.Y.M. Samiti, Lonavla.

The recovery from induced physiological stress in Shavasana (a yogic relaxation posture) and two other postures (resting in chair and resting supine posture) was compared. Twenty one males and 6 females (age 21-30 yrs) were allowed to take rest in one of the above postures immediately after completing the scheduled treadmill running. The recovery was assessed in terms of Heart Rate (HR) and Blood pressure (BP). HR and BP were measured before and every two minutes after the treadmill running till they returned to the initial level. The results revealed that the effects of stress was reversed in significantly (P < 0.01) shorter time in Shavasana, compared to the resting posture in chair and a supine posture.

PMID: 10874346 [PubMed - indexed for MEDLINE]
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Meditation-based stress reduction intervention in the treatment of anxiety disorders new
      #14146 - 07/15/03 09:11 PM
HeatherAdministrator

Reged: 12/09/02
Posts: 7795
Loc: Seattle, WA

Gen Hosp Psychiatry. 1995 May;17(3):192-200.

Three-year follow-up and clinical implications of a mindfulness meditation-based stress reduction intervention in the treatment of anxiety disorders.

Miller JJ, Fletcher K, Kabat-Zinn J.

Department of Psychiatry, University of Massachusetts Medical Center, Worcester 01655, USA.

A previous study of 22 medical patients with DSM-III-R-defined anxiety disorders showed clinically and statistically significant improvements in subjective and objective symptoms of anxiety and panic following an 8-week outpatient physician-referred group stress reduction intervention based on mindfulness meditation. Twenty subjects demonstrated significant reductions in Hamilton and Beck Anxiety and Depression scores postintervention and at 3-month follow-up. In this study, 3-year follow-up data were obtained and analyzed on 18 of the original 22 subjects to probe long-term effects. Repeated measures analysis showed maintenance of the gains obtained in the original study on the Hamilton [F(2,32) = 13.22; p < 0.001] and Beck [F(2,32) = 9.83; p < 0.001] anxiety scales as well as on their respective depression scales, on the Hamilton panic score, the number and severity of panic attacks, and on the Mobility Index-Accompanied and the Fear Survey. A 3-year follow-up comparison of this cohort with a larger group of subjects from the intervention who had met criteria for screening for the original study suggests generalizability of the results obtained with the smaller, more intensively studied cohort. Ongoing compliance with the meditation practice was also demonstrated in the majority of subjects at 3 years. We conclude that an intensive but time-limited group stress reduction intervention based on mindfulness meditation can have long-term beneficial effects in the treatment of people diagnosed with anxiety disorders.

PMID: 7649463 [PubMed - indexed for MEDLINE]
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Physiological and psychological effects of Hatha-Yoga exercise in healthy women new
      #14147 - 07/15/03 09:13 PM
HeatherAdministrator

Reged: 12/09/02
Posts: 7795
Loc: Seattle, WA

Int J Psychosom. 1994;41(1-4):46-52.

Physiological and psychological effects of Hatha-Yoga exercise in healthy women.

Schell FJ, Allolio B, Schonecke OW.

Department of Internal Medicine, University of Wurzburg, Germany.

Hatha-Yoga has become increasingly popular in western countries as a method for coping with stress. However, little is known about the physiological and psychological effects of yoga practice. We measured heart rate, blood pressure, the hormones cortisol, prolactin and growth hormone and certain psychological parameters in a yoga practicing group and a control group of young female volunteers reading in a comfortable position during the experimental period. There were no substantial differences between the groups concerning endocrine parameters and blood pressure. The course of heart rate was significantly different, the yoga group had a decrease during the yoga practice. Significant differences between both groups were found in psychological parameters. In the personality inventory the yoga group showed markedly higher scores in life satisfaction and lower scores in excitability, aggressiveness, openness, emotionality and somatic complaints. Significant differences could also be observed concerning coping with stress and the mood at the end of the experiment. The yoga group had significant higher scores in high spirits and extravertedness.

Publication Types:
Clinical Trial
Controlled Clinical Trial

PMID: 7843867 [PubMed - indexed for MEDLINE]

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Chronic pain patients and the practice of mindfulness meditation new
      #14150 - 07/15/03 10:57 PM
HeatherAdministrator

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Posts: 7795
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Gen Hosp Psychiatry. 1982 Apr;4(1):33-47.

An outpatient program in behavioral medicine for chronic pain patients based on the practice of mindfulness meditation: theoretical considerations and preliminary results.

Kabat-Zinn J.

The practice of mindfulness meditation was used in a 10-week Stress Reduction and Relaxation Program to train chronic pain patients in self-regulation. The meditation facilitates an attentional stance towards proprioception known as detached observation. This appears to cause an "uncoupling " of the sensory dimension of the pain experience from the affective/evaluative alarm reaction and reduce the experience of suffering via cognitive reappraisal. Data are presented on 51 chronic pain patients who had not improved with traditional medical care. The dominant pain categories were low back, neck and shoulder, and headache. Facial pain, angina pectoris, noncoronary chest pain, and GI pain were also represented. At 10 weeks, 65% of the patients showed a reduction of greater than or equal to 33% in the mean total Pain Rating Index (Melzack) and 50% showed a reduction of greater than or equal to 50%. Similar decreases were recorded on other pain indices and in the number of medical symptoms reported. Large and significant reductions in mood disturbance and psychiatric symptomatology accompanied these changes and were relatively stable on follow-up. These improvements were independent of the pain category. We conclude that this form of meditation can be used as the basis for an effective behavioral program in self-regulation for chronic pain patients. Key features of the program structure, and the limitations of the present uncontrolled study are discussed.

PMID: 7042457 [PubMed - indexed for MEDLINE]

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Probiotics for irritable bowel syndrome new
      #14154 - 07/15/03 11:20 PM
HeatherAdministrator

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Eur J Gastroenterol Hepatol. 2001 Oct;13(10):1135-6.

Probiotics for irritable bowel syndrome: a light in the darkness?

Thompson WG.

Medicine, University of Ottawa, Canada. wgthompson@home.com

Probiotics have been used with apparent success for several gut disorders, so it is not surprising they have been tried in the treatment of irritable bowel syndrome (IBS). However, the pathogenesis of this disease is unknown, and opinions about how probiotics might work are speculative. Nevertheless, two small trials suggest they might benefit patients with IBS, particularly those suffering from pain and bloating. This possibility deserves further study. It is important though, that future trials employ criteria-identified subjects, be sufficiently powered and strictly double blind, and select a suitable outcome measure. Until state-of-the-art trials of probiotics are available, their use should remain in the experimental arena.

Publication Types:
Comment
Editorial

PMID: 11711765 [PubMed - indexed for MEDLINE]

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Bibliography of Yoga Studies and Health Conditions new
      #14545 - 07/21/03 03:41 PM
HeatherAdministrator

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This is the International Association of Yoga Therapists bibliography page, with links organized by various health conditions (from eating disorders and pain management to depression and menstruation, and more). The bibliographies contain citations for books, chapters or sections in books, magazine and journal articles, online resources, audiotapes/CDs, and videotapes/DVDs related to each subject. Where applicable, an "Ongoing Research" section is included that describes in-progress studies and provides contact information for each researcher. Some bibliographies also provide contact information for practitioners specializing in the subject area.

(Broken link removed)

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Edited by lctuscher (09/26/14 03:17 PM)

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Acupuncture In Unexplained Urinary Retention And Sluggish Bowel new
      #15250 - 07/28/03 03:09 PM
HeatherAdministrator

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Acupuncture In Unexplained Urinary Retention And Sluggish Bowel
Muzaffar K. Awan, MD

ABSTRACT

Background
Auricular therapy is used in many conditions to provide relief from symptoms and to increase patient function.

Objective
To describe the use of auricular acupuncture in a patient with urinary retention and sluggish bowel of unknown etiology.

Design, Setting, and Patient
A 39-year-old woman with urinary retention of 3 weeks duration requested acupuncture to relieve her bladder retention and restore voiding.

Intervention
The patient's only treatment consisted of a 40-minute auricular acupuncture session. Left ear points selected were: thoracic, lumbar, and sacral vertebrae, urethra, urinary bladder, kidney, smooth muscle, cerebral cortex, and 3 parts of the trunk. Right ear points selected were: 2nd urethra, pelvic plexus, ureter, inferior mesenteric sympathetic ganglion, Shenmen, liver, and brain.

Main Outcome Measure
Restoration of bladder and bowel function, including elimination of the need for self-catheterization.

Results
Within an hour after treatment, the patient reported elimination of urinary retention and restoration of normal voiding function. By the 3rd day after treatment, bowel and bladder functions were at their premorbid level. This patient was followed up for 12 weeks without any relapse.

Conclusion
Auricular acupuncture was effective in the treatment of this patient with unexplained urinary retention and sluggish bowel function.

(Broken Link Removed)


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Acupuncture for the Management of Irritable Bowel Syndrome new
      #17062 - 08/12/03 12:29 PM
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Acupuncture for the Management of Irritable Bowel Syndrome

From Alternative Medicine Alert ' August 2003

By David L. Diehl, MD, FACP
Acupuncture is a complementary and alternative medicine (CAM) modality that has undergone progressive acceptance by both patients and Western medical practitioners. Its major clinical application in the United States is for musculoskeletal conditions such as low-back pain, myofascial pain, headache, sciatica, and other similar conditions. Positive effects of acupuncture for digestive disorders have been known in Chinese medicine for centuries, but adoption of acupuncture for these conditions in Western medicine has lagged behind musculoskeletal indications. This may be due in part to a lack of convincing randomized data showing the efficacy of acupuncture for gastrointestinal (GI) conditions.

The functional digestive disorders, of which irritable bowel syndrome (IBS) is one of the most common, are a group of disorders of surprisingly high prevalence, whose adequate treatment continues to elude modern medicine. The functional disorders present a rich potential area of application for any CAM therapy. In patients attending GI clinics, those with IBS are most likely to see CAM practitioners.(1)

Mechanism of Action
There is a plethora of information regarding the physiological basis of acupuncture effects on the digestive system. Extensive research using animal models, as well as data from human subjects, has shed light on how acupoint stimulation leads to changes in gastric acid secretion, GI motility, and hormone and neuropeptide metabolism. Regional or systemic autonomic nervous system changes also may contribute to these effects. A recent review examined the physiologic effects of acupuncture on the digestive tract.(2)

IBS is a multifactorial condition; contributions from diet, psychosocial factors, and underlying physiology all come together to shape an individual's experience of pain or discomfort. Furthermore, any clinician with experience caring for patients with IBS knows that "there is IBS and there is IBS." The heterogeneity of the diagnosis of IBS conspires to make clinical studies of this condition hard to do, and hard to interpret.

Common Usage
As relates to the GI tract, acupuncture is best known and most extensively studied for its effects on nausea. In a number of carefully designed and conducted trials, acupuncture has been shown to be useful for anti-emesis. Beyond the treatment of nausea, there is a paucity of controlled trials of acupuncture for any GI condition, although there is a long and distinguished history of acupuncture for GI symptoms in the Chinese medical literature dating back more than 2,000 years.

Special Considerations Concerning Acupuncture Research
Acupuncture research, in comparison to pharmaceutical research, necessitates some special considerations. First, what is a proper control group to use? "Sham needling" (an invasive but "non-therapeutic" procedure such as shallow needling at non-acupuncture points) often is held to be the best, but also may dilute some of the effect of acupuncture due to non-specific effects of the minimal needling. "Placebo needling" involves non-penetrating simulation of needle placement (for example, taping a needle to the skin while the patient looks away). This obviously would require a subject naïve to previous acupuncture treatment. Blinding of the subjects and the investigators also is of great importance. Double blinding requires the use of a blinded evaluator who is not aware of allocation of the patient to the real or sham/placebo group.

There is much debate about which approach to point selection should be used for acupuncture studies as well. Some studies employ a "one-size-fits-all" approach, with all treated patients randomized to the active arm getting the same assortment of needles (which may range from one to 20 needles) applied to the same points. Other investigators insist that the treatment must be tailored to the individual patient and the presentation at that particular visit. Thus, the treatment may change from visit to visit. Some practitioners favor treatments three times a week (and occasionally more), while others may try to require visits no more frequently than once a week. Different schools of acupuncture theory and practice can alter specific point selection markedly, and this can lead to disagreement over the selection of the most efficacious treatment.

Finally, it must be understood that acupuncture is only a single part of an integrated health care treatment system that traditionally includes dietary manipulation, herbal medicine, massage (Tui Na), exercise modalities (such as Tai Qi), and breathing/meditation practice (Qi Gong). Evaluating acupuncture in isolation may lead to results that would be different than when several of these modalities are combined.

Clinical Studies
There have been very few prospective randomized trials of acupuncture for IBS. All the studies that have been conducted have methodological failings, ranging from moderate to severe.

Lowe et al published (in abstract form) the results of a prospective randomized trial of real vs. sham acupuncture in a sample of 50 patients with IBS.(3) Treatments were given at nine points (specific acupoints were not specified in the abstract) twice weekly for four weeks. There was follow-up at four weeks and also at three months. The primary outcome was individual patient-determined treatment success rate; secondary outcome measures included McGill Pain Score and the IBS-36 (a validated IBS-specific quality-of-life tool).

There was no significant difference between patients' perceptions of improvement (using 0-100% scale) in the two groups. Interestingly, both real and sham groups did show marked improvement compared to baseline in the McGill Pain Score as well as in the quality-of-life measurement. The authors concluded that acupuncture has no method-specific therapeutic benefit, but that participation in a trial can positively influence these measures.

Because this study was published only in abstract form, it is hard to assess certain specifics about methodology such as blinding. In addition, the study appears to be underpowered to detect an effect of real acupuncture.

Fireman et al performed a double-blind controlled study in a group of 25 patients.(4) Patients received two 30-minute sessions of real or control acupuncture, and then three weeks later were crossed over to receive the other treatment. The acupuncture treatment group was needled only at a single point, Large Intestine-4 (Li-4). Visual analog scales (VAS) were used to quantify response to either real or placebo needling. The authors found significant improvement in symptoms of alternating diarrhea and constipation, and overall feeling of well-being after the first needling session, but the change was not significant after the second session. There was no short- or long-term follow-up in this study.

This study contains a number of methodologic flaws and does not employ a sound research protocol for examining the effect of acupuncture on patients with IBS. First, only one point was used, and for only two sessions. It also is not clear whether the VAS was administered either immediately after the needling or at a later time. Despite the title of this study, it is not a reasonable evaluation of acupuncture treatment for IBS.

Chan et al performed a pilot study in which seven patients with IBS were offered a four-week course of acupuncture.(5) The patients filled out IBS symptom diaries on a daily basis for 28 days. The study used the same points on all patients. In all, eight acupoints were used, all stimulated bilaterally (for a total of 16 needles), and the needles were retained for only 3-5 seconds each. The authors found improvement in general sense of well-being and bloating, but no change in abdominal discomfort and bowel frequency. The obvious drawbacks to this study are small sample size, the absence of a control group and blinding, short follow-up, and the rather unusual needling technique involving "cookbook" selection of points and extremely short needle retention times.

In a description of a non-randomized clinical experience with IBS patients refractory to usual western therapy, Diehl et al offered acupuncture to a group of patients with functional dyspepsia (n = 14) and IBS (n = 10).(6) Initially, acupuncture was given weekly, and the interval between treatments was lengthened if possible. Outcomes were determined using patient and physician assessment of improvement and a quality-of-life survey. Length of follow-up was 2-14 months. In the 10-patient IBS group, three had a good response (almost complete or complete resolution of symptoms), six patients had a partial response (some improvement in symptoms or fewer recurrences of symptoms), while one patient had no response. The majority of patients experienced improvement in their symptoms, but ongoing therapy appeared to be necessary (at intervals of approximately 2-3 weeks) to maintain clinical improvement.

Adverse Effects
Acupuncture is a remarkably safe medical procedure. A long list of potential complications has been noted,(7) with transmission of viral infection and pneumothorax being among the most severe. Fainting, or so-called needle-shock, is perhaps the most common adverse effect, and can be seen in up to 2% of subjects. In two large recent studies of the safety of acupuncture, a total of 66,000 treatments by physicians or physiotherapists(8) or traditional acupuncturists(9) were evaluated prospectively. No fatalities were noted; significant adverse effects were seen in approximately 0.1% of patients in both studies. These results indicate that acupuncture is a very safe form of therapy.

Contraindications and Precautions
In some situations, IBS is a diagnosis of exclusion. Patients with atypical presentations, shorter duration of symptoms, or alarm symptoms of weight loss, rectal bleeding, or abnormal blood tests or GI radiology should be fully evaluated before the diagnosis of IBS can be made with certainty. In this way, a more serious underlying process will not be missed while CAM therapy is pursued.

Conclusion
At present, there are insufficient data to demonstrate that acupuncture is effective in the treatment of IBS, and the few studies that are available for review have significant methodological shortcomings.

Recommendation
While we await funding for and completion of better-designed studies, there is little risk associated with acupuncture treatment for IBS, and individual patients may derive a benefit from this intervention.

Dr. Diehl is Associate Clinical Professor, New York University School of Medicine, and Director of Gastro- intestinal Endoscopy, Bellevue Hospital Center, in New York, NY.

References
1. Smart HL, et al. Alternative medicine consultations and remedies in patients with the irritable bowel syndrome. Gut 1986;27:826-828.

2. Diehl DL. Acupuncture for gastrointestinal and hepatobiliary disorders. J Altern Complement Med 1999;5: 27-45.

3. Lowe C, et al. A placebo-controlled, double-blind trial of acupuncture in the treatment of irritable bowel syndrome (abstract #3168). Gastroenterology 2000;118: A617.

4. Fireman Z, et al. Acupuncture treatment for irritable bowel syndrome. A double-blind controlled study. Digestion 2001;64:100-103.

5. Chan J, et al. The role of acupuncture in the treatment of irritable bowel syndrome: A pilot study. Hepatogastroenterology 1997,44:1328-1330.

6. Diehl DL, et al. Acupuncture treatment for refractory function bowel diseases (abstract). Gastroenterology 1994;106:A488.

7. Lao L, et al. Is acupuncture safe? A systematic review of case reports. Altern Ther Health Med 2003;9:72-83.

8. White A, et al. Adverse events following acupuncture: Prospective survey of 32,000 consultations with doctors and physiotherapists. BMJ 2001;323:485-486.

9. MacPherson H, et al. The York acupuncture safety study: Prospective survey of 34,000 treatments by traditional acupuncturists. BMJ 2001;323:486-487.




Content (c) 2003 Thomson American Health Consultants, Inc.
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Former UCLA medical school professor recommends yoga for IBS new
      #56180 - 03/30/04 02:14 PM
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Healthy twist - Former UCLA medical school professor recommends yoga for IBS

By Mariko Thompson

Even doctors need medical help once in a while, and that's how Dr. Richard Usatine discovered yoga. The former UCLA medical school professor suffered a back injury in a car accident. After a year of failed attempts to get rid of the pain, Usatine was willing to try anything.

He went to see a friend and colleague who specialized in physical medicine. The prescription came as a surprise. Try yoga, the friend said.

Yoga worked so well that Usatine now recommends the ancient practice to patients who complain about stress-related conditions. He also researched yoga and its potential benefits for 20 health conditions in a book called "Yoga Rx.' The book, which recommends yoga for a range of problems from asthma to back pain to irritable bowel syndrome, was published last year with yoga therapist Larry Payne.

"I'm a believer,' says Usatine, now a professor of family and community medicine at the University of Texas Health Science Center in San Antonio. "I'm in favor of more studies on yoga, but I don't need them to prescribe it. What's most important is that yoga is exercise and relaxation therapy.'

Usatine is among the growing ranks of medical doctors intrigued by yoga and its combination of deep breathing, stretching and strength-building. In the early 1990s, best-selling author Dr. Dean Ornish included yoga as part of his nutrition and exercise recommendations for heart health. Today it's not unusual for doctors in pain management, heart health and other specialties to suggest yoga and for hospitals to offer classes to their patients.

This openness to yoga as therapy in part reflects an acceptance of the mind-body connection, doctors say. Only a few randomized controlled clinical trials, the gold standard of medical research, have been conducted on yoga. But doctors who are yoga enthusiasts say it's easy to extrapolate from studies that have documented the ill effects of chronic stress on the immune system and the benefits of exercise and relaxation.

"There is good data showing stress reduction has health benefits,' says Julienne Bower, a UCLA Jonsson Cancer Center researcher. "That makes yoga more palatable to the medical system.'

Cedars-Sinai Medical Center in Los Angeles has been a proponent of therapeutic yoga for 10 years. The center's research into heart disease prevention found yoga improved blood pressure and blood sugar control. Those findings, along with Ornish's research, prompted the hospital to launch a yoga class for cardiac rehabilitation patients, says Dr. Noel Bairey Merz, director of the Preventive and Rehabilitative Cardiac Center. The gentle one-hour class was designed for heart patients by instructor Nirmala Heriza.

"Most of them, when they come in, are new to yoga, and a lot of them are skeptical,' Heriza says. "They quickly find there's nothing unusual or strange. It's very easy to do. It's not strenuous.'

No formal study has been done at Cedars-Sinai on whether the yoga class prevents a second heart attack, Merz says. But participants who attend the hospital's program twice a week believe yoga keeps them healthy. Gary Bart says the class taught him how to relax. The 57-year- old film producer was diagnosed with an enlarged heart three years ago. His doctors told him to avoid stress and learn how to better cope with tension.

"Yoga brings peace and calm to my life,' Bart says. "My friends call me 'Mr. Mellow.' I used to be Type-A personality from New York.'

Stress reduction is just one element of yoga that's under the microscope. When yoga instructors talk about the effect on the body, they speak in terms of the body's chakras, or energy centers. As a medical researcher, Bower doesn't speak the lingo, but she does want to know about yoga's effect on energy.

An assistant professor at the UCLA Cousins Center for Psychoneuroimmunology, Bower has been investigating the causes of fatigue in breast cancer survivors. Thirty-seven percent report persistent fatigue after treatments have finished. Based on anecdotal reports, Bower decided to conduct a pilot study on yoga and cancer fatigue.

She is now recruiting breast cancer survivors who will take yoga twice a week for three months. The women will be assessed for energy and mood. Researchers also will take blood samples to look for any changes in biological immune measures that correlate with fatigue.

"We'd like to know if it works, but also how it works,' Bower says.

Another UCLA pilot study recently examined the effects of yoga on posture. Dr. Gail Greendale, professor of medicine and geriatrics, had a yoga class designed for elderly women with hyperkyphosis, a curvature of the spine also known as dowager's hump. The rounding is thought to be caused by osteoporosis or as the result of aging and lack of physical activity.

"It's very common,' Greendale said. "We did not believe it was fait accompli, that it would be possible to straighten people out.'

The movements focused on posture and alignment. Using a rigorous method of measuring height, the researchers found that the women stood taller and straighter by the end of the study.

Yoga had two other benefits as well. The participants showed increased leg strength and better balance, both important factors in reducing falls in the elderly, said Greendale, who hopes to conduct a larger study later this year.

No matter what the outcome of the scientific inquiries, the yoga faithful will show up to their classes, the same as before. Still, Brenda Strong, co-owner of Yoga Villa in North Hollywood, feels yoga can only benefit from the surging interest by doctors and researchers. Strong's studio offers specialized yoga classes, one designed to promote female fertility, another for people recovering from injuries or suffering from chronic conditions.

"In this day and age of technology, it's important that this esoteric teaching have a foundation in science,' Strong says. "There's this beautiful bridging going on right now between Western medicine and Eastern knowledge.'

Even if more people turn to yoga to ease their ailments, pharmaceutical companies have little to fear. All of the studies in the world won't necessarily get sedentary Americans off the couch, Greendale says.

Even among the patients who are willing to try yoga, not all will develop a lasting interest or feel that they derive any benefit. And that's OK, Usatine says. They haven't lost anything by trying.

"We're not calling yoga a cure-all,' Usatine says. "At the same time, there's no real harm in yoga, and that's what's great."

(Broken link removed)

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Heather is the Administrator of the IBS Message Boards. She is the author of Eating for IBS and The First Year: IBS, and the CEO of Heather's Tummy Care. Join her IBS Newsletter. Meet Heather on Facebook!

Edited by lctuscher (09/26/14 03:14 PM)

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Yoga for IBS Diarrhea new
      #65374 - 04/27/04 04:36 PM
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Appl Psychophysiol Biofeedback. 2004 Mar;29(1):19-33.

Yogic versus conventional treatment in diarrhea-predominant irritable bowel syndrome: a randomized control study.

Taneja I, Deepak KK, Poojary G, Acharya IN, Pandey RM, Sharma MP.

Department of Physiology, All India Institute of Medical Sciences, New Delhi 110029, India.

This study was conducted to evaluate the comparative effect of yogic and conventional treatment in diarrhea-predominant irritable bowel syndrome (IBS) in a randomized control design. The patients were 22 males, aged 20-50 years, with confirmed diagnosis of diarrhea-predominant IBS. The conventional group (n = 12, 1 dropout) was given symptomatic treatment with loperamide 2-6 mg/day for 2 months, and the yogic intervention group (n = 9) consisted of a set of 12 asanas (yogic poses, i.e., Vajrasana, Shashankasana, Ushtrasana, Marjariasana, Padhastasana, Dhanurasana, Trikonasana in two variations, Pawanmuktasana, and Paschimottanasana) along with Surya Nadi pranayama (right-nostril breathing) two times a day for 2 months. All participants were tested at three regular intervals, at the start of study--0 month, 1 month, and 2 months of receiving the intervention--and were investigated for bowel symptoms, autonomic symptoms, autonomic reactivity (battery of five standard tests), surface electrogastrography, anxiety profile by Spielberger's Self Evaluation Questionnaire, which evaluated trait and state anxiety. Two months of both conventional and yogic intervention showed a significant decrease of bowel symptoms and state anxiety. This was accompanied by an increase in electrophysiologically recorded gastric activity in the conventional intervention group and enhanced parasympathetic reactivity, as measured by heart rate parameters, in yogic intervention group. The study indicates a beneficial effect of yogic intervention over conventional treatment in diarrhea-predominant IBS.

PMID: 15077462

http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=Abstract&list_uids=15077462


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Yoga and Irritable Bowel Syndrome new
      #108493 - 09/26/04 03:44 PM
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By Kathleen Nelson

If you suffer from Irritable Bowel Syndrome, yoga can help alleviate symptoms and keep stress in check. At one time or another, everyone has eaten something that "doesn't quite sit right." But for the more than 30 million adults in the United States who suffer from Irritable Bowel Syndrome (IBS)-two-thirds of whom are women-that awful feeling is an ongoing struggle.

IBS symptoms can include abdominal discomfort from diarrhea, constipation, and bloating or varying degrees of gas. Sometimes a particular food or an allergy triggers an episode, but generally no one factor can be blamed. IBS has often been dismissed as psychosomatic, but recently it has been redefined as "a disorder with variable symptoms having possible neurological, immunological, or psycho-emotional roots," says Gary Kraftsow, founder of American Viniyoga Institute and author of Yoga for Transformation (Penguin USA, 2002).

Without any known organic cause or cure for IBS, treatment primarily focuses on symptom relief. Medications like antidiarrheals, antispasmodics, or tricyclic antidepressants can be helpful when symptoms are overwhelming. Yet research has suggested that lifestyle modifications can also be an effective method of easing the pain. A Mayo Clinic study in the American Journal of Gastroenterology (February, 1998) showed that exercise, diet, and stress management reduced IBS symptoms. "The Mayo study shows people do better if they use active and positive coping strategies for pain," says Bruce Naliboff, Ph.D., a functional disorders and pain specialist at the UCLA Center for Integrative Medicine and West Los Angeles VA Health Care Center.

This is why many experts recommend regular stress reduction and exercise like yoga as a more effective way to prevent recurrences over the long run. "With IBS the goal is to reduce symptoms and restore efficient functioning to the system," says Kraftsow. "And certain yoga postures may be restorative no matter where on the spectrum your symptoms lie."

Abdominal breathing in particular has proven helpful in IBS sufferers, says Naliboff, and deep inhalations and exhalations may benefit those who breathe shallowly when stressed or swallow air while eating or talking, trapping air in the stomach.

IBS sufferers often battle bowel habits that are painful and unpredictable. During a flare-up, Kraftsow recommends concentrating on postures that provide a soothing effect. He suggests forward bends and simple abdominal twists like Jathara Parivrtti (a revolved twist) and Apanasana (a knee-to-chest pose), which may help soothe a hyperactive bowel or stimulate a sluggish one.

For constipation, you can stimulate digestion by working the abdomen more strongly in Uttanasana (Standing Forward Bend) or PParivrtta Trikonasana (Revolved Triangle Pose); just move into the postures with the belly held in after releasing an exhalation.

But yoga is just one component to fighting IBS. When symptoms recur, experts have found that IBS responds best to a care plan that incorporates anxiety relief, exercise, and a diet that eliminates aggravating foods and includes nutritional or herbal supplements, or as Kraftsow says, "treatment that respects the whole person."

http://www.yogajournal.com/health/781_1.cfm

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Exercise could ease IBS, diarrhea and constipation new
      #221839 - 10/28/05 12:08 PM
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Exercise, eating right could ease IBS, diarrhea and constipation

Oct 4, 2005, 00:32

Physical activity may help reduce gastrointestinal (GI) symptoms in people who are obese. In a study published today in the American Gastroenterological Association (AGA) journal Clinical Gastroenterology and Hepatology, researchers found that a high body mass index (BMI) and lack of physical activity were associated with an increase in GI symptoms such as stomach pain, diarrhea, constipation and irritable bowel syndrome (IBS).

Obesity is a chronic disease that has become a major health problem in the United States and around the world. In fact, many patients who are seen by gastroenterologists are overweight or obese. Over the last 20 years, obesity has emerged as the most important nutrition problem in the United States.

Researchers from the University of Washington in Seattle and the University of Minnesota in Minneapolis found that obese people who incorporated some form of physical activity into their routine suffered less from GI symptoms than others who were inactive. High BMI was associated with an increase in symptoms of IBS, abdominal pain and diarrhea and binge eating was associated with an increase in abdominal pain, constipation and bloating. Of those participating in the study, more than 13 percent had IBS and nearly 6 percent were binge eaters. On average, participants in this study were classified as obese, with an average BMI of 33.

"It is well-documented that maintaining a healthy diet and regular physical activity can benefit GI health," said Rona L. Levy, PhD, lead study author and professor at the University of Washington in Seattle. "Our study is the first to show the benefit of maintaining these healthy habits and staving off the occurrence of GI symptoms in obese people. These findings have future implications for the treatment of both obesity and various GI disorders and symptoms that are more prevalent in this population."

Data collected from 1,801 men and women enrolled in a 24-month randomized trial evaluating telephone- and mail-based interventions for weight loss was used in this study. Participants were members of a Managed Care Organization and were randomized to one of three groups: a mail-based weight intervention using prepared lessons that gave nutrition and physical activity tips; a telephone-based weight intervention with a trained counselor that also used prepared lessons; or a usual care group who did not receive specific weight loss instructions, but were allowed access to telephone and clinic-based weight loss counseling at modest cost. Study participation was based on eligibility factors, such as age, gender, smoking status, amount of physical activity, BMI and binge eating status.

The average body weight of Americans has increased by approximately 10 percent during the last 20 years, with more than half the adult population being overweight and nearly one in every three adults diagnosed as obese. Adopting a diet rich with fruits and vegetables and increasing physical activity are two simple ways to control weight and lead a healthier lifestyle.

"Potential reduction of GI symptoms is yet another reason for obese people to consider engaging in physical activity," said Levy. "It could mean the difference between leading a normal life or leading one filled with constant discomfort."


References
1. American Gastroenterological Association (AGA) journal Clinical Gastroenterology and Hepatology

http://www.rxpgnews.com/article_2547.shtml

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Acupuncture for IBS new
      #239601 - 01/18/06 04:59 PM
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Lu and colleagues discussed the use of acupuncture, investigated in a randomized, controlled trial of 27
patients with IBS diagnosed by their own criteria and
assigned to receive acupuncture treatment or relaxation
sessions.

Using a crossover design method, the subjects
received both modalities. In addition to demographic
information and specific IBS symptoms reported, patients
also rated their overall quality of life on entry to and
exit from the study. The study authors treated the patients
with acupuncture or relaxation sessions 3 times a week for a
period of 2 weeks.

A follow-up observation run was then
performed for 4 weeks. These investigators found that patients' quality-of-life and gastrointestinal symptom scores were improved equally in the 23 who completed both the acupuncture trial and the relaxation sessions. A statistically significant reduction in abdominal pain was observed in both groups at the end of the trial.

However, when the patients were followed for the
4-week period posttrial, only in the acupuncture group did
pain reduction persist (P < .05). Furthermore, a significant
reduction in stress perception was also observed in the
acupuncture group, but not in the relaxation group (P <
.05). It was concluded that acupuncture appears to be an
effective modality in the treatment of IBS, particularly for
pain and disease-related stress, and exceeds standard
relaxation treatment.

This intriguing finding is of particular interest because of the increasing attention paid to so-called alternative treatments for IBS by patients and the medical community itself. Additional studies will be needed to confirm these results. The work of Lu and colleagues, however, is an important step in this direction.

Clearly, acupuncture as well as other alternative modalities
deserve additional study in this disease setting.

Lu B, Hu Y, Tenner S. A randomized controlled trial of
acupuncture for irritable bowel syndrome. Program and
abstracts of the 65th Annual Scientific Meeting of the
American College of Gastroenterology; October 16-18, 2000,
New York, NY. Poster 268, p. 428.

http://listserv.nodak.edu/cgi-bin/wa.exe?A2=ind0103a&L=co-cure&O=D&P=2507

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Systematic review: complementary and alternative medicine in the irritable bowel syndrome new
      #243424 - 02/01/06 12:35 PM
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Aliment Pharmacol Ther. 2006 Feb;23(4):465-71. Related Articles, Links


Systematic review: complementary and alternative medicine in the irritable bowel syndrome.

Hussain Z, Quigley EM.

Department of Medicine, Alimentary Pharmabiotic Centre, Cork University Hospital, Cork, Ireland.

Background Complementary and alternative medical therapies and practices are widely employed in the treatment of the irritable bowel syndrome. Aim To review the usage of complementary and alternative medicine in the irritable bowel syndrome, and to assess critically the basis and evidence for its use. Methods A systematic review of complementary and alternative medical therapies and practices in the irritable bowel syndrome was performed based on literature obtained through a Medline search. Results A wide variety of complementary and alternative medical practices and therapies are commonly employed by irritable bowel syndrome patients both in conjunction with and in lieu of conventional therapies. As many of these therapies have not been subjected to controlled clinical trials, some, at least, of their efficacy may reflect the high-placebo response rate that is characteristic of irritable bowel syndrome. Of those that have been subjected to clinical trials most have involved small poor quality studies. There is, however, evidence to support efficacy for hypnotherapy, some forms of herbal therapy and certain probiotics in irritable bowel syndrome. Conclusions Doctors caring for irritable bowel syndrome patients need to recognize the near ubiquity of complementary and alternative medical use among this population and the basis for its use. All complementary and alternative medicine is not the same and some, such as hypnotherapy, forms of herbal therapy, specific diets and probiotics, may well have efficacy in irritable bowel syndrome. Above all, we need more science and more controlled studies; the absence of truly randomized placebo-controlled trials for many of these therapies has limited meaningful progress in this area.

PMID: 16441466 [PubMed - in process]

http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=Abstract&list_uids=16441466&query_hl=9&itool=pubmed_docsum

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Acupuncture for chronic pain new
      #267542 - 06/04/06 12:07 PM
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Expert Rev Neurother. 2006 May;6(5):661-7.

Mechanisms of acupuncture analgesia for clinical and experimental pain.

Staud R, Price DD.

University of Florida, Department of Medicine College of Medicine, Gainesville, FL 32610-0221, USA. staudr@ufl.edu

There is convincing evidence that acupuncture (AP) is effective for the treatment of postoperative and chemotherapy-induced nausea/vomiting, as well as postoperative dental pain. Less convincing data support AP's efficacy for chronic pain conditions, including headache, fibromyalgia and low back pain. There is no evidence that AP is effective in treating addiction, insomnia, obesity, asthma or stroke deficits. AP seems to be efficacious for alleviating experimental pain by increasing pain thresholds in human subjects and it appears to activate analgesic brain mechanisms through the release of neurohumoral factors, some of which can be inhibited by the opioid antagonist naloxone. In contrast to placebo analgesia, AP-related pain relief takes some time to develop and to resolve. Furthermore, repetitive use of AP analgesia can result in tolerance that demonstrates cross-tolerance with morphine. However, it appears that not all forms of AP are equally effective for providing analgesia. In particular, electro-AP seems to best deliver stimuli that activate powerful opioid and nonopioid analgesic mechanisms. Thus, future carefully controlled clinical trials using adequate electro-AP may be able to provide the necessary evidence for relevant analgesia in chronic pain conditions, such as headache, fibromyalgia, irritable bowel syndrome and low back pain.

PMID: 16734514 [PubMed - in process]

http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=Abstract&list_uids=16734514&query_hl=1&itool=pubmed_docsum

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Acupuncture combined with massage for treatment of irritable bowel syndrome
      #292156 - 12/01/06 02:17 PM
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Zhongguo Zhen Jiu. 2006 Oct;26(10):717-8.

[Acupuncture combined with massage for treatment of irritable bowel syndrome][Article in Chinese]

Huang ZD, Liang LA, Zhang WX.

Department of Acupuncture and Massage, Affiliated Ruikang Hospital of Guangxi TCM College, Nanning 530011, China.

OBJECTIVE: To observe the therapeutic effect of acupuncture combined with massage on irritable bowel syndrome.

METHODS: Ninety-three cases of irritable bowel syndrome were randomly divided into three groups: group of acupuncture combined with massage (group A), simple acupuncture control group (group B), simple massage control group (group C), 31 cases in each group. Their therapeutic effects were compared.

RESULTS: The cured rate and the effective rate in the group A were significantly higher than those in both group B and group C (P < 0.05). CONCLUSION: Acupuncture combined with massage therapy shows a better therapeutic effect on irritable bowel syndrome, and they should be jointly used in clinical treatment.

PMID: 17117571 [PubMed - in process]


http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?db=pubmed&cmd=Retrieve&dopt=AbstractPlus&list_uids=17117571&query_hl=1&itool=pubmed_docsum

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Effects of music on gastric myoelectrical activity new
      #310525 - 07/05/07 04:24 PM
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Effects of music on gastric myoelectrical activity in healthy humans

Authors: Lin, H-H; Chang, W-K; Chu, H-C; Huang, T-Y; Chao, Y-C; Hsieh, T-Y

Source: International Journal of Clinical Practice, Volume 61, Number 7, July 2007 , pp. 1126-1130(5)

Publisher: Blackwell Publishing

Abstract:

Summary

The aim was to study the effects of listening to music on gastric myoelectrical activity in healthy humans. Gastric myoelectrical activity was recorded using surface electrogastrography from 17 healthy volunteers before and for 30min after they listened to music.

All subjects listened to the same music. Ten perceived the music as enjoyable and seven did not. The percentages of normal slow wave, dominant frequency and dominant power did not differ significantly between baseline and during music intervention.

An analysis of covariance model that included the subjects' feelings about the music and dominant power showed significantly higher dominant power during music intervention in subjects who enjoyed the music. In the individuals who enjoyed the music, dominant power was significantly higher during music intervention than at baseline.

In the subjects who did not enjoy the music, dominant power was significantly lower during music intervention than at baseline. Listening to enjoyable music increases the amplitude of gastric myoelectrical activity in healthy humans.

Music therapy may improve gastric motility and may be used to stimulate gastric emptying.
Document Type: Research article

DOI: 10.1111/j.1742-1241.2006.01090.x

http://www.ingentaconnect.com/content/bsc/ijcp/2007/00000061/00000007/art00014

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Meditation, Yoga Might Switch Off Stress Genes new
      #332567 - 07/16/08 11:47 AM
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WEDNESDAY, July 2 (HealthDay News) -- Researchers say they've taken a significant stride forward in understanding how relaxation techniques such as meditation, prayer and yoga improve health: by changing patterns of gene activity that affect how the body responds to stress.

The changes were seen both in long-term practitioners and in newer recruits, the scientists said.

"It's not all in your head," said Dr. Herbert Benson, president emeritus of the Benson-Henry Institute for Mind/Body Medicine at Massachusetts General Hospital and an associate professor of medicine at Harvard Medical School. "What we have found is that when you evoke the relaxation response, the very genes that are turned on or off by stress are turned the other way. The mind can actively turn on and turn off genes. The mind is not separated from the body."

One outside expert agreed.

"It's sort of like reverse thinking: If you can wreak havoc on yourself with lifestyle choices, for example, [in a way that] causes expression of latent genetic manifestations in the negative, then the reverse should hold true," said Dr. Gerry Leisman, director of the F.R. Carrick Institute for Clinical Ergonomics, Rehabilitation and Applied Neuroscience at Leeds Metropolitan University in the U.K.

"Biology is not entirely our destiny, so while there are things that give us risk factors, there's a lot of 'wiggle' in this," added Leisman, who is also a professor at the University of Haifa in Israel. "This paper is pointing that there is a technique that allows us to play with the wiggle."

Benson, a pioneer in the field of mind-body medicine, is co-senior author of the new study, which is published in the journal PLoS One.

Benson first described the relaxation response 35 years ago. Mind-body approaches that elicit the response include meditation, repetitive prayer, yoga, tai chi, breathing exercises, progressive muscle relaxation, biofeedback, guided imagery and Qi Gong.

"Previously, we had noted that there were scores of diseases that could be treated by eliciting the relaxation response -- everything from different kinds of pain, infertility, rheumatoid arthritis, insomnia," Benson said.

He believes that this study is the first comprehensive look at how mind states can affect gene expression. It also focuses on gene activity in healthy individuals.

Benson and his colleagues compared gene-expression patterns in 19 long-term practitioners, 19 healthy controls and 20 newcomers who underwent eight weeks of relaxation-response training.

More than 2,200 genes were activated differently in the long-time practitioners relative to the controls and 1,561 genes in the short-timers compared to the long-time practitioners. Some 433 of the differently activated genes were shared among short-term and long-term practitioners.

Further genetic analysis revealed changes in cellular metabolism, response to oxidative stress and other processes in both short- and long-term practitioners. All of these processes may contribute to cellular damage stemming from chronic stress.

Another expert had a mixed response to the findings.

Robert Schwartz, director of the Texas A&M Health Science Center's Institute of Biosciences and Technology in Houston, noted that the study was relatively small. He also wished that there had been more data on the levels of stress hormones within the control group, for comparison purposes.

However, Schwartz called the study "unique and very exciting. It demonstrates that all these techniques of relaxation response have a biofeedback mechanism that alters gene expression."

He pointed out that the researchers looked at blood cells, which consist largely of immune cells. "You're getting the response most probably in the immune cell population," Schwartz said.

"We all are under stress and have many manifestations of that stress," Benson added. "To adequately protect ourselves against stress, we should use an approach and a technique that we believe evokes the relaxation response 20 minutes, once a day."

http://www.everydayhealth.com/publicsite/news/view.aspx?id=617094&cen=&pd=2008/07/02

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Complementary and alternative medicine use and cost in functional bowel disorders new
      #333608 - 07/30/08 12:21 PM
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BMC Complement Altern Med. 2008 Jul 24;8(1):46.

Complementary and alternative medicine use and cost in functional bowel disorders: a six month prospective study in a large HMO.

van Tilburg MA, Palsson OS, Levy RL, Feld AD, Turner M, Drossman DA, Whitehead WE.


ABSTRACT: BACKGROUND: Functional Bowel Disorders (FBD) are chronic disorders that are difficult to treat and manage. Many patients and doctors are dissatisfied with the level of improvement in symptoms that can be achieved with standard medical care which may lead them to seek alternatives for care. There are currently no data on the types of Complementary and Alternative Medicine (CAM) used for FBDs other than Irritable Bowel Syndrome (IBS), or on the economic costs of CAM treatments. The aim of this study is to determine prevalence, types and costs of CAM in IBS, functional diarrhea, functional constipation, and functional abdominal pain.

METHODS: 1012 Patients with FBD were recruited through a health care maintenance organization and followed for 6 months. Questionnaires were used to ascertain: Utilization and expenditures on CAM, symptom severity (IBS-SS), quality of life (IBS-QoL), psychological distress (BSI) and perceived treatment effectiveness. Costs for conventional medical care were extracted from administrative claims.

RESULTS: CAM was used by 35% of patients, at a median yearly cost of $200. The most common CAM types were ginger, massage therapy and yoga. CAM use was associated with female gender, higher education, and anxiety. Satisfaction with physician care and perceived effectiveness of prescription mediation were not associated with CAM use. Physician referral to a CAM provider was uncommon but the majority of patients receiving this recommendation followed their physician's advice.

CONCLUSIONS: CAM is used by one-third of FBG patients. CAM use does not seem to be driven by dissatisfaction with conventional care. Physicians should discuss CAM use and effectiveness with their patients and refer patients if appropriate.

PMID: 18652682 [PubMed - as supplied by publisher]

http://www.ncbi.nlm.nih.gov/pubmed/18652682?ordinalpos=4&itool=EntrezSystem2.PEntrez.Pubmed.Pubmed_ResultsPanel.Pubmed_RVDocSum

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Exercise may help people with irritable bowel new
      #336850 - 10/09/08 01:50 PM
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Exercise may help people with irritable bowel

Reuters

NEW YORK (Reuters Health) - Regular exercise may relieve constipation in people who suffer from irritable bowel syndrome, according to a study in the International Journal of Sports Medicine.

Irritable bowel syndrome, or IBS, is a common disorder affecting up to 30 percent of the population by some estimates. Symptoms may include chronic abdominal pain, bloating, diarrhea, and constipation.

Studies involving healthy adults have shown that regular exercise can relieve constipation and feelings of bloating. Therefore, it seems "intuitively appealing" to encourage IBS sufferers to exercise regularly to find relief from these symptoms, the study team notes.


Regular exercise may relieve constipation in people who suffer from irritable bowel syndrome, according to a study

****To check out the notion, Dr. Amanda J. Daley of the University of Birmingham in the UK and colleagues recruited 56 adults (mostly women) with doctor-diagnosed IBS for a study lasting 12 weeks.

The participants were randomly assigned to usual care (i.e., a "control" group) or to an exercise program, consisting of two 40-minute one-on-one exercise consultations designed to provide exercise skills, knowledge, confidence and motivation -- the goal being 30 minutes of moderate intensity exercise 5 days a week.

The researchers chose this type of intervention, they say, because it has been found to boost exercise in other patient groups, and because it could be more easily integrated into current healthcare practice than supervised programs.

After 12 weeks, the exercise group chalked up significantly more weekly exercise than the control group and they reported significantly greater declines in symptoms of constipation.

The fact that this brief, pragmatic exercise intervention led to a significant increase in the amount of exercise IBS patients engaged in is "encouraging," Daley and her colleagues say, especially considering that people with IBS may avoid participating in exercise because of their abdominal symptoms.

This study, they conclude, highlights the possibility that exercise may be an effective way for people to manage their IBS symptoms, particularly constipation.

SOURCE: International Journal of Sports Medicine, September 2008.





© Reuters 2008

http://www.canada.com/topics/bodyandhealth/story.html?id=ca9e159f-f1a3-4016-98b3-9d110393acfb

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Yoga’s stress reduction helps alleviate IBS new
      #339537 - 12/17/08 01:46 PM
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Yoga's stress reduction helps alleviate IBS

By SARAH AVERY
McClatchy Newspapers

The ancient practice of yoga is increasingly finding a new following — among doctors and medical researchers who are working to prove its benefits for a variety of illnesses.

Researchers at University of North Carolina Hospitals are studying yoga's benefits for people with irritable bowel syndrome. Doctors at Duke University in Durham, N.C., recently completed a study showing that yoga provided significant help for postmenopausal women with early breast cancer.

And in eastern North Carolina, an oncologist sees improvement in his patients who take yoga classes. He has written a book about the importance of mindfulness.

"There's been an explosion of data using yoga as a treatment option," said Shelley Wroth, an obstetrician at Duke Integrative Medicine and a yoga teacher. She said studies have found that yoga helps people suffering diseases such as hypertension, anxiety, arthritis, chronic back pain, carpal tunnel syndrome, fibromyalgia, stress, depression, diabetes and epilepsy — among others.

"It shows so much promise," Wroth said.

A recent study at Duke involved breast cancer patients who were experiencing severe hot flashes and other menopause symptoms. Because of their illness, they were prohibited from taking hormone replacement therapy, so yoga was proposed as an alternative. The study found significant improvement among the women in the study who took yoga classes, compared to another group of women who did not.

"There's a lot of reactions to stress that exacerbate the menopausal symptoms," said Laura Porter, co-author of the Duke study. "Yoga — the physical poses and the more cognitive aspects of it — dampens the stress reactivity."

But even as the science establishes yoga's benefits, less is known about why it is helpful. Porter and others postulate that the practice reduces stress through stretching poses, practiced breathing and meditation. For people battling illness, stress reduction may pack extra potency.

"A lot of our diseases have some sort of origins in stress and the stress reaction," said William Frey, who is leading a yoga class at Rex Healthcare in Raleigh, N.C., as part of a UNC-Chapel Hill study among patients with irritable bowel syndrome. "By taking care of stress, you're starting to eliminate some of the diseases that are caused by it."

Frey said he began offering yoga eight years ago through his university's Integrative Medicine program.

"There was some concern we might be bringing spiritual elements into a very clinical setting," Frey said. "Getting the word out was difficult — so much else was going on that was scientifically based, this was pushed off. But as people have seen its staying power, and see the results and research, there's beginning to be more respectability."

Yoga's legitimacy has increased with interest by the National Institutes of Health, which now funds studies on yoga and its effect on diseases. But some skepticism remains — in the medical profession and among patients.

Gioia O'Connell, a 54-year-old breast cancer survivor from Apex, N.C., said she wasn't sure that yoga would help her. Her main hesitation was that yoga stemmed from Eastern roots, and she worried it was incompatible with her Christian faith. Still, she signed up this summer as part of the study at Duke.

"I have to tell you, it was energizing," O'Connell said. After being diagnosed with cancer in 1994 and undergoing a lumpectomy, chemotherapy, radiation and rounds of daily drugs, she felt wrung out. "It helped with stiffness, aches and pains. And the breathing really did help my energy level. That's what I deal with, being a cancer survivor, the fatigue."

Sources: PubMed; Duke University

(Broken link removed)

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Edited by lctuscher (09/26/14 03:13 PM)

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77% of IBS patients view yoga as an acceptable IBS treatment new
      #343428 - 03/18/09 05:54 PM
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BMC Complement Altern Med. 2008 Dec 19;8:65.


Treatments for irritable bowel syndrome: patients' attitudes and acceptability.

Harris LR, Roberts L.
Primary Care Clinical Sciences, University of Birmingham, Edgbaston, Birmingham, B15 2TT, UK.

BACKGROUND: Irritable Bowel Syndrome, a highly prevalent chronic disorder, places significant burden on the health service and the individual. Symptomatic distress and reduced quality of life are compounded by few efficacious treatments available. As researchers continue to demonstrate the clinical efficacy of alternative therapies, it would be useful to gain a patient-perspective of treatment acceptability and identify patient's attitudes towards those modalities considered not acceptable.

METHODS: Six hundred and forty-five participants identified from an earlier IBS-prevalence study received a postal questionnaire to evaluate preferences and acceptability of nine forms of treatment. Proportions accepting each form of treatment were calculated and thematic analysis of qualitative data undertaken.

RESULTS: A total of 256 (39.7%) of 645 potential respondents completed the questionnaire (mean age 55.9 years, 73% female). Tablets were most acceptable (84%), followed by lifestyle changes (diet (82%), yoga (77%)). Acupuncture (59%) and suppositories (57%) were less acceptable. When explaining lack of acceptability, patient views fell into four broad categories: dislike treatment modality, do not perceive benefit, general barriers and insufficient knowledge. Scepticism, lack of scientific rationale and fear of CAM were mentioned, although others expressed a dislike of conventional medical treatments. Past experiences, age and health concerns, and need for proof of efficacy were reported.

CONCLUSION: Most patients were willing to accept various forms of treatment. However, the reservations expressed by this patient-population must be recognised with particular focus directed towards allaying fears and misconceptions, seeking further evidence base for certain therapies and incorporating physician support and advice.

PMID: 19099570 [PubMed - indexed for MEDLINE]
PMCID: PMC2633319


http://www.ncbi.nlm.nih.gov/pubmed/19099570?ordinalpos=4&itool=EntrezSystem2.PEntrez.Pubmed.Pubmed_ResultsPanel.Pubmed_DefaultReportPanel.Pubmed_RVDocSum

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Acupuncture for treatment of chronic functional constipation new
      #356595 - 03/11/10 01:43 PM
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Zhongguo Zhen Jiu. 2010 Feb;30(2):97-101.

[Clinical study on acupuncture for treatment of chronic functional constipation]

Jin X, Ding YJ, Wang LL, Ding SQ, Shu L, Jiang YW, Huo WY.

The First Clinical Medical College, Nanjing University of TCM, Nanjing 210029, China.

OBJECTIVE: To discuss the effect of acupuncture for treatment of chronic functional constipation (CFC).

METHODS: Ninety cases were treated with acupuncture. The following two groups of acupoints were used alternatively once every other day. The acupoints in the first group were Tianshu (ST 25), Qihai (CV 6), Shangjuxu (ST 37) etc., and Zhongliao (BL 33), Xialiao (BL 34), Dachangshu (BL 25) etc. in the second group, electroacupuncture was used at Zhongliao (BL 33), Xialiao (BL 34), Tianshu (ST 25) and Shangjuxu (ST 37), once a day, 10 times constituting one course. The defecation frequency, difficulty degree of defecation, defecation time, endless sensation of defecation, stool quality and awareness of defecation were observed and the Patient Assessment of Constipation Quality of Life (PAC-QOL) was evaluated by constipation patients' diaries.

RESULTS: The scores of defecation frequency, difficulty degree of defecation, defecation time, endless sensation of defecation, stool quality, awareness of defecation and PAC-QOL were obviously improved after treatment (all P < 0.01). The total effective rate was 67.7% (61/90). The effect of acupuncture for chronic functional constipation in different dynamic mechanism was different. The effect of slow transit constipation (STC) was better than that of spastic pelvic floor syndrome (SPFS) (P < 0.05), and the effect of constipation caused by irritable bowel syndrome (IBS-C) was better than that of SPFS and relaxant pelvic floor syndrome (RPFS) (both P < 0.05). Fifty-two cases were effectively followed up. Three cases were cured, 6 cases were remarkably effective, 23 cases were effective and 20 cases were ineffective after 1 month of treatment. Three cases were cured, 5 cases were remarkably effective, 16 cases were effective and 28 cases were ineffective after 3 months.

CONCLUSION: The effect of acupuncture for CFC with exact etiology, disease location and classification diagnosis is definite, but different dynamic mechanism has different effect. The treatment programs for SPFS and RPFS need to be optimized to improve the therapeutic effect.

PMID: 20214063 [PubMed - in process]

http://www.ncbi.nlm.nih.gov/pubmed/20214063

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Exercise may help soothe irritable bowels new
      #362893 - 01/13/11 01:05 PM
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Exercise may help soothe irritable bowels

By Amy Norton

NEW YORK ' Wed Jan 12, 2011 4:24pm EST

NEW YORK (Reuters Health) - People with irritable bowel syndrome may be able to find some relief by getting regular exercise, a small clinical trial suggests.

The study, of 102 adults with the disorder, found that those who were told to get some more exercise had better odds of seeing improvements in problems like cramps, bloating, constipation and diarrhea.

After three months, 43 percent of the exercisers showed a "clinically significant" improvement in their symptoms -- meaning it was making a difference in their daily lives. That compared with a quarter of the participants who maintained their normal lifestyle.

For people who are currently less-than-active, even a moderate increase in exercise may curb irritable bowel symptoms, according to senior researcher Dr. Riadh Sadik, of the University of Gothenburg in Sweden.

In an email, Sadik said the researchers had told those in the exercise group to get 20 to 60 minutes of moderate-to-vigorous exercise -- like brisk walking or biking -- on three to five days out of the week.

That's a level that is generally safe and achievable, Sadik said. On top of that, the researcher added, "it will also improve your general health."

About 15 percent of Americans have irritable bowel syndrome, or IBS, which causes bouts of abdominal cramps, bloating and diarrhea or constipation.

It is different from inflammatory bowel disease, which includes two digestive diseases -- ulcerative colitis and Crohn's disease -- that are believed to involve an abnormal immune system reaction in the intestines.

The exact cause of IBS is unknown, but people with the condition often find that they have certain symptom "triggers," such as particular foods, larger-than-normal meals or emotional stress.

The typical treatment includes diet changes, as well as anti-diarrheal medication and, for constipation, laxatives or fiber supplements. There's also some evidence that behavioral therapy and stress-reduction tactics help some people.

According to Sadik, exercise may be helpful for several reasons. Past studies have shown that it can get things moving along in the gut, relieving gas and constipation. (Vigorous exercise, however, may worsen bouts of diarrhea.)

Regular exercise may also have a positive influence on the nervous and hormonal systems that act on the digestive tract.

None of the participants in the new study, reported in the American Journal of Gastroenterology, were regularly active at the outset. The researchers randomly asked about half to begin exercising over a 12-week period, with advice from a physical therapist. The rest stuck with their normal lifestyle habits.

At the end of the study, the exercise group reported greater improvements on a standard questionnaire on IBS symptoms. They were also less likely to show worsening symptoms.

Of the exercise group, 8 percent had a clinically significant increase in IBS symptoms, versus 23 percent of the comparison group.

hat, according to Sadik, suggests that for a considerable number of people remaining sedentary may only worsen IBS.

"If you have IBS, then you can increase your physical activity to improve your symptoms," Sadik said. "If you stay inactive, you should expect more symptoms."

SOURCE: bit.ly/fMadZy American Journal of Gastroenterology, online January 4, 2011.

http://www.reuters.com/article/idUSTRE70B70R20110112

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Mindful Meditation Might Ease Irritable Bowel Syndrome new
      #364667 - 05/09/11 11:47 AM
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Mindful Meditation Might Ease Irritable Bowel Syndrome
Related Health News

By Ellin Holohan
HealthDay Reporter

MONDAY, May 9 (HealthDay News) -- A simple meditation technique can help ease the torment suffered by people with a chronic bowel disease, a new study has found.

The research, done at the University of North Carolina at Chapel Hill, found that women with irritable bowel syndrome who practiced "mindful meditation" had more than a 38 percent reduction in symptoms, far surpassing a nearly 12 percent reduction for women who participated in a traditional support group.

Moreover, meditation helped reduce psychological distress and improved quality of life, the study found.

One of the study authors said the practice, based on a Buddhist meditative technique, "empowers" patients to deal with an illness that is difficult to treat.

"It's not easy to treat IBS [irritable bowel syndrome], even with the best standard medical approaches," said study co-author Olafur Palsson, an associate professor, clinical psychologist and research in the gastroenterolgoy department at the university. "It's chronic and, over time, it's hard to treat because it is complicated."

Mindful meditation helps practitioners relax by focusing on the moment, paying attention to breathing, the body and thoughts as they occur, without judgment.

"It's a different way of using the mind and being aware," said Palsson. He noted that more than 200 hospitals around the country offer the mindfulness meditation training program.

The technique takes discipline to learn, but "becomes second nature after a while," said Palsson, adding, "this is not a clinical treatment, it's more educational."

The findings were to be presented Saturday at Digestive Disease Week meeting in Chicago. Research presented at medical meetings should be viewed as preliminary because it has not been subjected to the scrutiny that typically accompanies publication in medical journals. In addition, the number of participants in the new study was small, and the findings need to be confirmed in larger studies.

Irritable bowel syndrome is a common chronic illness that can start as early as adolescence and become a lifelong condition. Symptoms include abdominal pain, cramps, diarrhea and constipation. Cases range from mild to severe. It differs from inflammatory bowel disease, a more serious condition with a similar name.

In the United States, the disease is more common in women and about one in six people has the condition, according to the National Institutes of Health. The condition is believed to stem from a genetic predisposition and is triggered by stress, a gastrointestinal infection or gastrointestinal surgery.

Treatments include anti-spasmodic medications to relax the colon, and drugs to reduce constipation and diarrhea. Patients are advised to avoid drinks and foods that stimulate the intestines, such as alcohol, caffeinated beverages, some grains, chocolate and milk.

But the disease varies from one person to another, and one regimen does not help everyone, according to health officials.

For the study, 75 women between 19 and 71 years old, with an average age of nearly 43 years, were randomly divided into two groups. One group participated in a mindfulness meditation training session and the other in a traditional support group, both for eight weeks.

Ahead of time, the groups rated the treatments' potential benefit, or "credibility," about the same, the study said.

But at the end of eight weeks, the meditation group had a 26.4 percent reduction in "overall severity of symptoms" compared to a 6.2 percent reduction in the support group. By the end of three months, the disparity persisted as improvement increased to a 38.2 percent reduction in symptoms for the meditation group vs. a 11.8 percent reduction for the therapy group, the study found.

The study authors also noted that mindful meditation was inexpensive and widely available.

One expert praised the research results as original and powerful.

"It's a small sample, but I'm impressed. It's not so easy to do this with treatments that are not well-defined," said Dr. Albena Halpert, a gastroenterologist and assistant professor of medicine at Boston University Medical School. "There have been other studies that looked at psychological treatment options, but this is the first looking at mindfulness, and the results are robust."

Halpert said she was surprised that both groups rated the potential benefit of the treatment option they were to receive equally.

"You can call it the placebo effect or whatever you want, but you have to believe in a treatment for it to work," said Halpert. "It's interesting that people would think it [mindfulness training] would have the same benefit as a support group."

More information

To learn more about mediation, visit the U.S. National Institutes of Health.
SOURCES: Olafur Palsson, Psy.D., clinical psychologist, research and associate professor, Division of Gastroenterology, University of North Carolina School of Medicine, Chapel Hill, N.C.; Albena Halpert, gastroenterologist, assistant professor, Boston University Medical School, Boston; May 7, 2011, presentation, Digestive Disease Week, Chicago
Copyright © 2011 HealthDay. All rights reserved.
This is a story from HealthDay, a service of ScoutNews, LLC.

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Mixed Evidence on Acupuncture for Irritable Bowel new
      #367362 - 05/02/12 10:37 AM
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From Reuters Health Information
Mixed Evidence on Acupuncture for Irritable Bowel

By Amy Norton

NEW YORK (Reuters Health) Apr 25 - The research on whether acupuncture helps ease irritable bowel syndrome (IBS) has so far yielded mixed results, according to a new meta-analysis.

The review, published April 10th in the American Journal of Gastroenterology, found that in some trials, acupuncture seemed to work better than certain medications for IBS. In others, acupuncture was no better than a sham procedure.

"It's difficult to interpret the results of the review," said lead researcher Eric Manheimer, of the Center for Integrative Medicine at the University of Maryland School of Medicine.

For now, he told Reuters Health, "I think the evidence is equivocal."

In many cases, IBS can be managed with diet changes, along with anti-diarrheal medication or, for constipation, laxatives or fiber supplements. There are also a few drugs for the condition -- including alosetron (Lotronex) and lubiprostone (Amitiza). Doctors sometimes also prescribe low-dose antidepressants, anti-anxiety medications, or antispasmodics. But drugs are often limited in their effectiveness, and can have side effects.

Two non-drug options -- cognitive behavioral therapy and hypnosis -- have proven effective for some people in clinical trials. A fairly small number of studies have begun looking at acupuncture.

In their review, the researchers found five clinical trials that tested acupuncture against a sham procedure. None of the five showed that real acupuncture was superior at improving patients' ratings of their symptoms or quality of life.

On the other hand, five trials done in China did find that patients reported bigger gains from acupuncture when it was tested against certain medications -- which included certain anti-diarrheal, antispasmodic and anti-inflammatory drugs.

But there are limitations to both types of studies, Manheimer said.

With the trials that pitted acupuncture against drugs, the patients were recruited at hospitals for traditional Chinese medicine.

"So it's possible that patients' expectations played a role" in acupuncture's higher success odds, Manheimer explained.

With the sham-controlled trials, the study groups tended to be small, which may have limited their ability to pick up small benefits of true acupuncture, the researchers say.

There's also debate over what makes for a good sham version of acupuncture. In some studies, it may involve inserting needles in the skin at sites that are not considered acupuncture points according to traditional Chinese medicine. In others, it means using a dull needle that doesn't penetrate the skin.

"It's not clear that they (shams) are all inert," Manheimer said. Some sham acupuncture tactics may have biological effects that are close to the real thing. No one is sure how acupuncture works, but some research suggests the needle stimulation triggers the release of pain- and inflammation-fighting chemicals in the body -- even if the acupuncture doesn't strictly follow traditional principles.

In the future, Manheimer said it might be helpful to do trials that compare acupuncture against other treatments, but do it with a more general population of IBS sufferers than the Chinese studies used.

It would also be a good idea, he said, to measure patients' expectations going into the study. That way, researchers can look at whether people who expected to improve were more likely to report benefits from acupuncture.

"This is an interesting study," said Dr. Jeffrey M. Lackner of the University at Buffalo School of Medicine in New York, who was not involved in the work.

In the U.S., he noted, acupuncture would not be considered a "go-to" IBS treatment. As far as non-drug options, cognitive behavioral therapy (CBT) seems to have the best research evidence to back it up, according to Dr. Lackner.

The problem with CBT, though, is availability. "We really need to start developing IBS treatments that are more easily disseminated," he said. That could mean "self-help materials," like books or CDs, that teach people CBT principles.

As for acupuncture, Manheimer said that if patients do want to try it, safety and cost would be the other considerations. Acupuncture is generally considered safe, with side effects like bruising at the needle site. The cost can vary widely, but a session would typically start at around $100.

And many patients, Manheimer noted, may have to pay out of pocket.

SOURCE: http://bit.ly/IoaQnA

Am J Gastroenterol 2012.

http://www.medscape.com/viewarticle/762722

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Therapeutic heat and IBS new
      #370978 - 03/11/14 02:11 PM
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Therapeutic heat and IBS

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Acupuncture Soothes Irritable Bowel Syndrome (IBS) new
      #371720 - 12/15/14 03:15 PM
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Acupuncture Soothes Irritable Bowel Syndrome (IBS)

on 10 December 2014.

Acupuncture and moxibustion alleviate irritable bowel syndrome (IBS). Research confirms that acupuncture and moxibustion significantly reduce abdominal pain, diarrhea, and the ratio of abnormal stools. The research was conducted on patients with IBS-D, a type of irritable bowel syndrome characterized by insidious attacks of diarrhea. The total effective rate was 96.7% with many patients experiencing a complete recovery with no relapses. The positive patient outcomes for IBS-D patients suggest that additional research on IBS-C (constipation IBS) and IBS-A (alternating stool IBS) is warranted. Lower abdominal acupoints with four needles inserted.

Over 65% of patients in the study demonstrated "marked effect." The study's criteria for marked effect are: completely asymptomatic, normal frequency of bowel movements, normal stools, no relapse after three months. An additional 30% of patients experienced improvements. The criteria for "improvements" are significant reductions in symptoms and relapse within three months but only with mild symptom intensity.

As a standalone procedure, acupuncture demonstrated a 76.7% total effective rate including reductions in abdominal pain, diarrhea, and frequency of bowel movements. Acupuncture combined with moxibustion increased the total effective rate to 96.7%. The researchers note that "acupuncture combined with ginger and salt-partitioned moxibustion can obtain a remarkable effect for IBS-D. This integrative therapy is simple and convenient."

Biomedicine
The researchers note that the biomedical definition of IBS includes abdominal pain or discomfort with 2 out of 3 of the following symptoms: relief by defecation, changes in frequency of stools, changes in the form of stools (hard, loose, lumpy or watery). IBS may be further differentiated by greater than 3 bowel movements per day and urgent bowel movements. The symptoms occur for 12 weeks during a 12 month period but are not necessarily consecutive.

Traditional Chinese Medicine
The researchers note that IBS-D is differentiated into 3 patterns within Traditional Chinese Medicine (TCM) according to the Diagnosis and Treatment Protocol of Integrative Chinese and Western Medicine for Irritable Bowel Syndrome by Chen, et. al. Type 1 is liver qi stagnation with spleen deficiency. Symptoms may be triggered by emotional disturbances and include: diarrhea, abdominal pain, alleviation by defecation, and lower abdominal cramping. Secondary symptoms of type 1 IBS-D are: borborygmus, flatulence, mucus in stools, depression, sighing, irritability, poor appetite, and abdominal distention. Signs include a thin-white tongue coating and a wiry pulse.

Type 2 IBS-D is due to spleen and stomach deficiency. Diarrhea, especially after food intake, is a primary symptom along with loose stools, watery stools, mucus in stool, poor appetite, and abdominal distention after eating, gastric fullness and general digestive organ discomfort. Secondary symptoms include abdominal pain relieved by pressure, borborygmus, mental and physical fatigue, abdominal bloating, and reluctance to speak. Signs include a sallow complexion, a pale tongue with teethmarks, a white tongue coating, and a thready-weak pulse.

Type 3 IBS-D is due to spleen and kidney yang deficiency. Primary symptoms include early morning diarrhea, stools with undigested food, and abdominal pain with a cold sensation. Secondary symptoms include: coldness of the limbs, aching and weakness of the lower back and knees. Signs include a pale tongue with a greasy white coating and a deep-thready pulse.

Woman holding up copper handle acupuncture needles for display.

The study was conducted over a 4 year period. All participants in the study were screened for exclusion criteria. Patients with organic intestinal disorders were screened from participation using stool tests, fungal smear and colonoscopy.

Acupuncture
Acupuncture was applied to a set of primary and secondary points. Primary acupoints were:

Zhongwan (CV12)
Guanyuan (CV4)
Tianshu (ST25)
Zusanli (ST36)
Shangjuxu (ST37)
Pishu (BL20)
Dachangshu (BL25)

Secondary points were added for specific conditions:

Weishu (BL21) for weakness of the spleen and stomach
Ganshu (BL18), Xingjian (LR2) for liver qi stagnation with spleen deficiency
Shenshu (BL23) for yang deficiency of the spleen and kidney

The BL (bladder meridian of foot-taiyang) acupoints were needled with the patient in a prone position and the needles were removed upon the arrival of deqi. Next, patients assumed the supine position and the acupoints were inserted to 1 - 1.5 cun perpendicularly. Even reinforcing-reducing needle technique was applied using lifting and thrusting to achieve a deqi sensation of local soreness, distention, numbness, or a radiating sensation towards the abdomen. The needles were manipulated once every 10 minutes and were retained for a total of 30 minutes per session. In addition, the abdominal area was heated using a TDP heat lamp.

Moxibustion
Moxibustion was applied with patients in a supine position. A pillar of salt was poured onto acupoint Shenque (CV8). Next, ginger slices of 0.7 to 0.8 cm thickness and approximately 4 cm diameter were placed upon the salt pillar. Prior to placement, two toothpick sized holes were made through the ginger. Moxa cones of a 3 cm diameter and a 3 cm height were placed atop the ginger and were ignited. The moxa cone was replenished once during each session. Both acupuncture and moxibustion were performed once per day and 6 treatments made up one course of care. There was a 1 day interval between courses of care and all patients received 4 courses of care.

Additional Research
The results of the study indicate that combining acupuncture with moxibustion is significantly more effective for the treatment of IBS-D than acupuncture alone. Additional research confirms the efficacy of Traditional Chinese medicine. A meta-analysis published in the World Journal of Gastroenterology concludes, "Acupuncture exhibits clinically and statistically significant control of IBS symptoms." The study investigated all three types of IBS: diarrhea predominant (IBS-D), constipation predominant (IBS-C), and alternating (IBS-A). The researchers note "our meta-analysis of six randomized controlled trials suggests that acupuncture improves the symptoms of IBS, including abdominal pain and distention, sensation of incomplete defecation, times of defecation per day, and state of stool."

The researchers concluded that acupuncture is both safe and effective noting that, "No serious adverse events associated with acupuncture were reported in the articles." They aded that one study "showed that improvement in pain in IBS was positively associated with increased parasympathetic tone in the acupuncture group." This finding indicates that acupuncture regulates the parasympathetic nervous system.

One study in the meta-analysis was conducted at the University of York and was published in BMC Gastroenterology. This randomized controlled trial included 233 IBS patients who suffered from this condition for an average of 13 years. A total of 116 patients received acupuncture plus conventional care. This was compared with another group of 117 patients receiving only conventional medical care. The group receiving acupuncture plus conventional medical care demonstrated significantly superior clinical outcomes. The researchers concluded, "Acupuncture for irritable bowel syndrome provided an additional benefit over usual care alone. The magnitude of the effect was sustained over the longer term. Acupuncture should be considered as a treatment option to be offered in primary care alongside other evidenced based treatments."

Global Acceptance
Given the recent study of acupuncture combined with moxibustion and the meta-analysis published in the World Journal of Gastroenterology, it is reasonable to implement acupuncture in primary healthcare settings for the treatment of IBS. Dietetics ingredients for remedies. The are other sources supporting the use of acupuncture. The Mayo Clinic website notes, "Researchers have found that acupuncture may help improve symptoms for people with IBS." The IBS fact sheet from Johns Hopkins Medicine online notes, "Several small studies suggest acupuncture provides significant relief from chronic pain. In IBS patients, there are reports that acupuncture can relax muscle spasms and improve bowel function." IBS affects approximately 10 - 15% of the population. Scientifically based research now demonstrates that acupuncture may help patients with IBS.

The Healthcare Medicine Institute (HealthCMi) offers continuing education courses on the treatment IBS and digestive disorders. Online acupuncture CEU courses are valid for NCCAOM® PDA (national Diplomate), California Acupuncture Board, Florida Board of Acupuncture, Texas CAE, CTCMA, CAAA, Massachusetts acupuncture continuing education credit and more. In addition to acupuncture and herbal medicine courses on digestive concerns, the course Chinese Medicine Dietetic Remedies covers the treatment of IBS with dietetic treatments. A special steamed bun (Ba Zhen Gao) that helps patients with IBS, diarrhea, chronic dysentery, and colitis is presented. The recipe contained in the course material is:

"Powder Shan Yao (the main ingredient), Fu Ling, Dang Shen, Yi Yi Ren, Qian Shi, Bai Bian Dou and Lian Zi. Mix the powder with rice or wheat flour and add water to make a dough. Optionally, add powdered Dang Shen and Fu Ling. Sugar may be added for flavor. Make a steamed bun, bread or pastry. Originally, this steamed bun was served to children suffering from malnutrition."

An additional congee recipe is also presented in the dietetics course material. The Shan Yao Lian Zi Zhu recipe presented in the course materials is as follows:

"Zhu, translated as congee, is nutritious and well tolerated by children. Make a powder with Shan Yao (Chinese yam), Lian Zi, Qian Shi, Bai Bian Dou and Yi Yi Ren. Combine the powder with rice (Geng Mi), oatmeal or wheat to make a congee. Optionally, add Dang Shen, Fu Ling or both."

Browse healthcmi.com to learn more about the IBS online course materials. At HealthCMi, we are dedicated to research and education to promote greater health and understanding.


References:
Liu, Xiao-xia. "Moxibustion on Shenque (CV 8) improves effect of acupuncture for diarrhea-predominant irritable bowel syndrome." Journal of Acupuncture and Tuina Science 12, no. 6 (2014): 362-365.

Thompson WG, Longstreth GF, Drossman DA, Heaton KW,Irvine EJ, Mu&#776;ller-Lissner SA. Functional bowel disorders and functional abdominal pain. Gut, 1999, 45 (Suppl 2): &#8545;43-47.

Chen ZS, Zhang WD, Wei BH. Diagnosis and treatmentprotocol of integrative Chinese and Western medicine forirritable bowel syndrome (IBS). Shijie Huaren Xiaohua Zazhi,2004, 12(11): 2704-2706.

Chen CY, Wang Y. Clinical effect of Trimebutine in treatment of irritable bowel syndrome. Zhongguo Xinyao Yu Linchuang Zazhi, 2003, 22(4): 199.

Voland C, Serre CM, Delmas P, Clézardin P. Plateletosteosarcoma cell interaction is mediated through a specific fibrinogen-binding sequence located within the N-terminal domain of thrombospondin 1. J Bone Miner Res, 2000, 15(2): 361-368.

Chao, Guan-Qun, and Shuo Zhang. "Effectiveness of acupuncture to treat irritable bowel syndrome: A meta-analysis." World Journal of Gastroenterology 20, 7 (2014): 1871-1877.

MacPherson H, et. al. Acupuncture for irritable bowel syndrome: primary care based pragmatic randomised controlled trial. BMC Gastroenterology 2012; 12: 150.
- See more at: http://www.healthcmi.com/Acupuncture-Continuing-Education-News/1405-acupuncture-soothes-irritable-bowel-syndrome-ibs#sthash.EIE2ESNr.dpuf

http://www.healthcmi.com/Acupuncture-Continuing-Education-News/1405-acupuncture-soothes-irritable-bowel-syndrome-ibs

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Ear Stimulation Eases IBS Pain in Teens new
      #373956 - 08/20/20 02:54 PM
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Ear Stimulation Eases IBS Pain in Teens

59% of users versus 26% of those given sham stimulation experienced a reduction in worst pain

by Diana Swift, Contributing Writer August 14, 2020

A noninvasive device (IB-Stim) delivering percutaneous electrical nerve field stimulation to the external ear safely reduced abdominal pain and improved quality of life in adolescents with irritable bowel syndrome (IBS), data from a prospective double-blind study indicated.

Confirming efficacy for improving abdominal pain in functional gastrointestinal disorders observed in an earlier study, the current IBS-focused analysis of trial data found that the percutaneous electrical nerve field stimulation (PENFS) device, worn behind the ear, led to reductions of 30% or more in worst abdominal pain in 59% of young patients compared with 26% of patients who received sham stimulation (P=0.024), reported Katja Kovacic, MD, of the division of pediatric gastroenterology, hepatology and nutrition at Medical College of Wisconsin in Milwaukee, and colleagues.

PENFS recipients had a composite pain median score of 7.5 (interquartile range [IQR] 3.6-14.4) versus 14.4 for the sham group (IQR 4.5-39.2; P=0.026) and a usual pain median score of 3.0 (IQR 3.0-5.0) versus 5.0 in the sham group (IQR 3.0-7.0; P=0.029), they noted in Clinical Gastroenterology and Hepatology.

Furthermore, a symptom response scale score of 2 or more was observed in 82% of patients receiving PENFS versus 26% of sham stimulation recipients (P≤0.001), and no significant side effects were reported.

"This study confirms that auricular neurostimulation via PENFS significantly improves abdominal pain and global symptoms in affected adolescents," wrote Kovacic and colleagues.

They noted that the results from this first prospective trial of PENFS in IBS are clinically relevant in light of the poor efficacy of pharmacological therapies for children with functional abdominal pain disorders and the dearth of safer treatment options. They argued that the device, recently approved by the FDA for IBS pain in children ages 11 to 18, should also be considered for use in adults, noting that peripheral neurostimulation has gained attention for its noninvasive modulation of central pain pathways via stimulation of peripheral cranial neurovascular bundles in the external ear.

Gastroenterologist William Chey, MD, of the University of Michigan at Ann Arbor, called neurostimulation an exciting new treatment modality for patients with functional gastrointestinal disorders.

"We've been engaging in neuromodulation for many years using drugs like tricyclics, selective serotonin reuptake inhibitors, and selective norepinephrine reuptake inhibitors, as well as via behavioral techniques like cognitive behavioral therapy and self-directed hypnosis," he told MedPage Today. "Thus, the concept of neuromodulation is not new and, indeed, has already been validated using these medications and psychological therapies."

"We also know that neurostimulation works for a number of somatic pain disorders," said Chey, who was not involved in the study.

In his view, the study adds "persuasive evidence" to a growing body of literature supporting a role of neurostimulation for the treatment of visceral pain. "I agree with the authors that studies in adults with painful conditions like IBS are warranted," he added, noting that his colleague Jiande Chen, PhD, had recently obtained funding from the National Institutes of Health for such testing. "We will be starting a series of studies to better understand the benefits of neurostimulation as a treatment for pain and other symptoms in adults with IBS."


A noninvasive device (IB-Stim) delivering percutaneous electrical nerve field stimulation to the external ear safely reduced abdominal pain and improved quality of life in adolescents with irritable bowel syndrome (IBS), data from a prospective double-blind study indicated.

Confirming efficacy for improving abdominal pain in functional gastrointestinal disorders observed in an earlier study, the current IBS-focused analysis of trial data found that the percutaneous electrical nerve field stimulation (PENFS) device, worn behind the ear, led to reductions of 30% or more in worst abdominal pain in 59% of young patients compared with 26% of patients who received sham stimulation (P=0.024), reported Katja Kovacic, MD, of the division of pediatric gastroenterology, hepatology and nutrition at Medical College of Wisconsin in Milwaukee, and colleagues.

PENFS recipients had a composite pain median score of 7.5 (interquartile range [IQR] 3.6-14.4) versus 14.4 for the sham group (IQR 4.5-39.2; P=0.026) and a usual pain median score of 3.0 (IQR 3.0-5.0) versus 5.0 in the sham group (IQR 3.0-7.0; P=0.029), they noted in Clinical Gastroenterology and Hepatology.

Furthermore, a symptom response scale score of 2 or more was observed in 82% of patients receiving PENFS versus 26% of sham stimulation recipients (P≤0.001), and no significant side effects were reported.

"This study confirms that auricular neurostimulation via PENFS significantly improves abdominal pain and global symptoms in affected adolescents," wrote Kovacic and colleagues.

They noted that the results from this first prospective trial of PENFS in IBS are clinically relevant in light of the poor efficacy of pharmacological therapies for children with functional abdominal pain disorders and the dearth of safer treatment options. They argued that the device, recently approved by the FDA for IBS pain in children ages 11 to 18, should also be considered for use in adults, noting that peripheral neurostimulation has gained attention for its noninvasive modulation of central pain pathways via stimulation of peripheral cranial neurovascular bundles in the external ear.

Gastroenterologist William Chey, MD, of the University of Michigan at Ann Arbor, called neurostimulation an exciting new treatment modality for patients with functional gastrointestinal disorders.

"We've been engaging in neuromodulation for many years using drugs like tricyclics, selective serotonin reuptake inhibitors, and selective norepinephrine reuptake inhibitors, as well as via behavioral techniques like cognitive behavioral therapy and self-directed hypnosis," he told MedPage Today. "Thus, the concept of neuromodulation is not new and, indeed, has already been validated using these medications and psychological therapies."

"We also know that neurostimulation works for a number of somatic pain disorders," said Chey, who was not involved in the study.

In his view, the study adds "persuasive evidence" to a growing body of literature supporting a role of neurostimulation for the treatment of visceral pain. "I agree with the authors that studies in adults with painful conditions like IBS are warranted," he added, noting that his colleague Jiande Chen, PhD, had recently obtained funding from the National Institutes of Health for such testing. "We will be starting a series of studies to better understand the benefits of neurostimulation as a treatment for pain and other symptoms in adults with IBS."

For his part, pediatric gastroenterologist Marc Rhoads, MD, of McGovern Medical School at UTHealth in Houston, who was not involved in the research, noted that IBS and other chronic abdominal pain disorders affect about 10% of all children older than age 5, "so this is an important issue. If the cost of the device was less than $1,000, many middle-to-upper-class families would gladly pay for it, because the pain can become dominant and disabling. I doubt that insurance would pay for it."

Study Details

Data were extracted from a prospective study of 115 largely Caucasian adolescents recruited from a tertiary care pediatric gastroenterology clinic from June 2015 to November 2016.

The mean age in the PENFS arm (n=27) and the sham arm (n=23) was just over 15 years; 89% and 91%, respectively, were female. Mixed-type IBS subtype predominated in the intervention group (63%), while IBS-constipation was the most common subtype in the sham group (43%). The primary endpoint was the number of patients with >30% decrease in worst abdominal pain severity after 3 weeks of therapy.

The number needed to treat for one patient to reach the primary endpoint was three. At the extended follow-up 8 to 12 weeks after end of therapy, 32% of the treatment group continued to have improvement of at least 30% from baseline in worst pain compared with 18% of the sham group, but this difference was not significant (P=0.33).

According to the authors, future studies should focus on characterizing short- and long-term responses to PENFS in different IBS subtypes and other functional gastrointestinal disorders, identifying the optimal duration of therapy and also assessing changes in stool patterns. In addition, mechanistic studies are needed to help target this therapy to the most appropriate patient population, including adults.

Among the study's limitations, the investigators noted the relatively small sample size in the subanalysis and a design not intended to evaluate long-term efficacy. Another limitation was the incomplete assessment of stool frequency and consistency as prespecified outcomes in accordance with FDA and European Medicines Agency recommendations.

Furthermore, although stimulation parameters were below sensation threshold, some patients may still have been able to perceive the stimulation. Additionally, the findings may not be generalizable to less complex IBS patients than those in the study cohort.
Last Updated August 17, 2020



Primary Source

Clinical Gastroenterology and Hepatology

Source Reference: Krasaelap A, et al "Efficacy of auricular neurostimulation in adolescents with irritable bowel syndrome in a randomized, double-blind trial" Clin Gastroenterol Hepatol 2020; DOI: 10.1016/j.cgh.2019.10.012.


https://www.medpagetoday.com/gastroenterology/irritablebowelsyndrome/88088


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