Invasive Procedures no better than Sham for Chronic Pain

[drusso]

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...raise your hand if you know the problem with this study...


Are Invasive Procedures Effective for Chronic Pain? A Systematic Review
Are Invasive Procedures Effective for Chronic Pain? A Systematic Review | Pain Medicine | Oxford Academic
Published:

10 September 2018
Abstract
Objective
To assess the evidence for the safety and efficacy of invasive procedures for reducing chronic pain and improving function and health-related quality of life compared with sham (placebo) procedures.

Design
Systematic review with meta-analysis.

Methods
Studies were identified by searching multiple electronic databases, examining reference lists, and communicating with experts. Randomized controlled trials comparing invasive procedures with identical but otherwise sham procedures for chronic pain conditions were selected. Three authors independently extracted and described study characteristics and assessed Cochrane risk of bias. Two subsets of data on back and knee pain, respectively, were pooled using random-effects meta-analysis. Overall quality of the literature was assessed through Grading of Recommendations, Assessment, Development, and Evaluation.

Results
Twenty-five trials (2,000 participants) were included in the review assessing the effect of invasive procedures over sham. Conditions included low back (N = 7 trials), arthritis (4), angina (4), abdominal pain (3), endometriosis (3), biliary colic (2), and migraine (2). Thirteen trials (52%) reported an adequate concealment of allocation. Fourteen studies (56%) reported on adverse events. Of these, the risk of any adverse event was significantly higher for invasive procedures (12%) than sham procedures (4%; risk difference = 0.05, 95% confidence interval [CI] = 0.01 to 0.09, P = 0.01, I2 = 65%). In the two meta-analysis subsets, the standardized mean difference for reduction of low back pain in seven studies (N = 445) was 0.18 (95% CI = –0.14 to 0.51, P = 0.26, I2 = 62%), and for knee pain in three studies (N = 496) it was 0.04 (95% CI = –0.11 to 0.19, P = 0.63, I2 = 36%). The relative contribution of within-group improvement in sham treatments accounted for 87% of the effect compared with active treatment across all conditions.

Conclusions
There is little evidence for the specific efficacy beyond sham for invasive procedures in chronic pain. A moderate amount of evidence does not support the use of invasive procedures as compared with sham procedures for patients with chronic back or knee pain. Given their high cost and safety concerns, more rigorous studies are required before invasive procedures are routinely used for patients with chronic pain.

 

[knoxdoc]

"A moderate amount of evidence does not support the use of invasive procedures as compared with sham procedures for patients with chronic back or knee pain."

Can anyone hook me up with a reputable physician performing sham procedures for discogenic pain in the upper midwest? There seems to be a lot of studies out there about them and with all the new technology these days (lasers and whatnot), I'm sure the success rate is pretty high. I'd even be willing to buy some sham stock if the price is right.

 

[painfree23]

What is the point in studies like this? I hate when things get published just for the sake of publishing. Everyone on this forum wouldn’t have a job if we were doing sham procedures nor would we have returning patients.

 

[Biohazard685]

What's the phrase? GIGO?

 

[Ducttape]

yes, GIGO.

 

[Ferrismonk]

This makes my eyes want to bleed.

My pet peeve: What "interventional pain procedures" are people doing for "low back, arthritis, angina, abdominal pain, endometriosis, biliary colic, and migraine" These are largely garbage diagnoses and nowhere near specific enough to lead to an effective interventional treatment, if one even exists.

 

[Biohazard685]

Can someone do a quick background in the authors? I'm sure they have absolutely no agenda or bias at all.

 

[DOctorJay]

who were the editors that allowed this crap to be published???

 

[Ducttape]

from the get go, grouping different procedures for different pain conditions leads to inadequate results.

in addition, the lead author actually supports therapies that have shown no benefit in better controlled studies. I doubt he stops performing his treatments based on "research".

Wayne B. Jonas, MD
President and CEO
Wayne B. Jonas, MD, is the President and Chief Executive Officer of Samueli Institute. He is a widely published scientific investigator, a practicing family physician, Professor of Family Medicine at Georgetown University, and Adjunct Professor at Uniformed Services University of Health Sciences. Additionally, Dr. Jonas is a retired Lieutenant Colonel in the Medical Corps of the United States Army.

Dr. Jonas was the director of the Office of Alternative Medicine at the National Institute of Health from 1995-1998, and prior to that served as the Director of the Medical Research Fellowship at the Walter Reed Army Institute of Research. He is a Fellow of the American Academy of Family Physicians.

In addition to his conventional medical practice, Dr. Jonas has long-been interested in various alternative medicine approaches, and has conducted research on homeopathy, electro-acupuncture, and nutritional supplements. His research has appeared in peer-reviewed journals such as the Journal of the American Medical Association, Natural Medicine, the Journal of Family Practice, the Annals of Internal Medicine, and The Lancet. His many book publications include Mosby’s Dictionary of Complementary and Alternative Medicine, Lippincott’s Essentials of Complementary and Alternative Medicine, and Elsevier’s Healing, Intention and Energy Medicine and Clinical Research Methods in Complementary Medicine (2nd Edition).

Additionally, Dr. Jonas received the 2007 America’s Top Family Doctors Award, the 2003 Pioneer Award from the American Holistic Medical Association, the 2002 Physician Recognition Award of the American Medical Association, and the 2002 Meritorious Activity Prize from the International Society of Life Information Science in Chiba, Japan. His current research interests include projects on Information Biology™, the placebo effect, cancer, biological effects of low level exposures (hormesis), homeopathy, spirituality, methods for enhancing stress resilience in military personnel and the impact of optimal healing environments in health care.

Dr. Jonas earned his medical degree from Wake Forest University School of Medicine in Winston-Salem, NC and has held leadership positions with a number of organizations and councils such as the World Health Organization, the National Institute of Health, and the White House Commission for Complementary and Alternative Medicine Policy. He currently serves on the editorial boards of eight peer-reviewed journals and on the advisory or scientific boards of six national and international organizations.

 

[jimmy johnson123]

from the get go, grouping different procedures for different pain conditions leads to inadequate results.

in addition, the lead author actually supports therapies that have shown no benefit in better controlled studies. I doubt he stops performing his treatments based on "research".

https://sciencebasedmedicine.org/th...cine-crown-jewels-terminating-the-terminator/

This "integrative" stuff is never ending with is pseudoscience.

Guess the "powers that be" must love this stuff.