Office of Health Promotion Research
NEJM Acupuncture Article Co-Authored by Langevin Draws Comment
Release Date: 10-29-2010
A July 29, 2010 "Clinical Therapeutics" article, titled "Acupuncture for Low Back Pain" and co-authored by Helene Langevin, M.D., University of Vermont research associate professor of neurology, drew attention and commentary from the traditionally conservative New England Journal of Medicine (NEJM) readership. The October 28 NEJM features some of those comments, as well as the authors' response, and can be viewed at NEJM "Correspondence".
Langevin, an internationally recognized leader in the field of acupuncture research, has been studying the biomechanical effect of acupuncture for more than 12 years. Since initiating this work, her focus has broadened to examine the effect of acupuncture, manual and movement therapies on connective tissue, and whether or not connective tissue plays a role in the therapeutic response.
In the July 29 NEJM paper, Langevin, lead author Brian Berman, M.D., of the University of Maryland, and co-authors Claudia Witt, M.D., M.B.A., of Charité University Medical Center in Berlin, Germany, and Ronald Dubner, D.D.S., Ph.D., of the University of Maryland, address the clinical problem of low back pain, which is estimated to effect more than 6 million U.S. adults. Their aim was to develop a clinical recommendation in response to a clinical vignette based on a review of major clinical studies, established clinical use of acupuncture and adverse effects.
According to Langevin, recent clinical trials of acupuncture's effects in patients with chronic low back pain, including two large studies conducted in Germany and a 2009 Archives of Internal Medicine article, show that "both acupuncture and sham acupuncture – the poking of tissue or shallow insertion of an acupuncture needle in non-acupuncture points – help low back pain." The question is, asks Langevin and other researchers, is it just a placebo effect?
"There are many factors that need to be taken into consideration," says Langevin. "Designing an inert sham procedure for acupuncture is more difficult than creating a placebo pill," she says. "In fact, studies have shown that sham acupuncture is more effective than placebo pills for pain," says Langevin. What Langevin and others in her field want to know is: Is sham acupuncture simply creating greater expectancy, or is sham acupuncture also having direct physiological effects?
"In a University of Michigan study using brain imaging during acupuncture and sham acupuncture in fibromyalgia patients, both regular and sham acupuncture produced relief, but the brain activation was different," says Langevin, who adds "there is a lot more that needs to be understood before we know if acupuncture is effective or not."
The "Correspondence" letters are taking a legitimate conservative perspective on the issue, claims Langevin, by asking whether or not it is ethical to recommend a treatment that may be a placebo, as Langevin and the other authors recommend in their "Clinical Therapeutics" article, since typical clinical guidelines are based on randomized, placebo-controlled trials.
"We need to understand the placebo mechanisms and find out whether or not there are self-healing responses that may be activated more efficiently by specific types of treatments," maintains Langevin. In particular, Langevin and her UVM colleagues are interested in learning more about needle and other forms of mechanical stimulation - including massage and stretching - on connective tissue and determining whether or not there is a connection between the stimulation and the therapeutic response.
"I believe that we need to have an open discussion about these issues/areas; a balanced viewpoint – not advocating, not rejecting – is useful," says Langevin.