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Anybody have this article full text? Saw this glimpse of it on Doximity, curious how they came to their conclusions about pain procedures.
JAMA Management of Chronic Low Back Pain
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D
deleted131481
Just looked now, attached.
It's not even an article. Just a rehash of some random systematic reviews.
It's not even an article. Just a rehash of some random systematic reviews.
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It was written by insurance company hacks and therapeutic nihilism KOL's.
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I also like how they suggest that the only things that work are multidisciplinary rehab, which no insurance pays for.
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Written by a psychiatrist who works at Optum Center for Research and Innovation. its like a standard peer to peer except on paper. summary: nothing works for low back pain and insurance should stop covering it.
In other news, I, pain management physician, made a word document that cites hand selected studies that show no antipsychotics work but lobotomies have always worked for mental disorders since surgery is a cure.
conflict of interest disclosure: none (how about the fact that you work for the ****ing insurance companies?!)
this concludes today's session of old man yells at cloud. thank you.
In other news, I, pain management physician, made a word document that cites hand selected studies that show no antipsychotics work but lobotomies have always worked for mental disorders since surgery is a cure.
conflict of interest disclosure: none (how about the fact that you work for the ****ing insurance companies?!)
this concludes today's session of old man yells at cloud. thank you.
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It’s cash pay. You hand them the bill post-lobotomy. No worries about surprise billing as the patient has lost the ability to be surprised.
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By the logic you see in these studies, no chronic disease treatment should ever be covered because the benefits are "temporary". Why pay for asthma inhalers? They only work for a little while. Then the disease comes back. Insulin? Please... Anti-hypertensives? No way. ESI gave you three months of pain relief? Then it came back? Fuggedabowdit!
Multi-level PLIF for $75000, step right this way Mr. ForeverBackPain. You'll be cured and we won't have to pay for your back pain treatment ever again.
Multi-level PLIF for $75000, step right this way Mr. ForeverBackPain. You'll be cured and we won't have to pay for your back pain treatment ever again.
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deleted875186
I can’t believe stuff like this gets published.
Outcomes for low back pain are always poor. Saying no benefit from facet interventions is very misleading.
I also take issue with grouping all low back pain into one clinical entity. How can you say no benefit from kyphoplasty in compression fractures, simply insane.
Outcomes for low back pain are always poor. Saying no benefit from facet interventions is very misleading.
I also take issue with grouping all low back pain into one clinical entity. How can you say no benefit from kyphoplasty in compression fractures, simply insane.
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#AMA
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What does JAMA get out of publishing this stuff? The thousands of pain docs in the US would not all be working , making patients lives better if our procedures didn’t work.
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Our own specialty is partially at fault for that. Shoot, do a search on this forum. Half of the people here argue that very thing. If we can’t even convince our own that our procedures work, how the hell can we ever convince anyone else? That’s the real problem.
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A 1.5 page article that rehashes some GIGO-esque studies (1/3 of which is from the same author) covering all of low back pain. K.
A "study" looking at the benefit of anything interventional for lbp is useless. Need a targetable dx.
If I did a review of lisinopril for all-causes of "heart problems" I could churn out a negative study too.
A "study" looking at the benefit of anything interventional for lbp is useless. Need a targetable dx.
If I did a review of lisinopril for all-causes of "heart problems" I could churn out a negative study too.
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we all can complain but the reason why there has been and always will be negative studies regarding what we do is that we rely almost exclusively on subjective outcome measures.
also, we dont cure people or prevent them from worsening illness. your asthma example - inhalers/insulin/anti-hypertensives prevent hospitalizations and death. we dont...
the only other field like this is psychiatry
(fyi for hypertensives, literature suggests that ACE inhibitors are one of the few classes of drugs that have shown to reduce "all cause death"...)
also, we dont cure people or prevent them from worsening illness. your asthma example - inhalers/insulin/anti-hypertensives prevent hospitalizations and death. we dont...
the only other field like this is psychiatry
(fyi for hypertensives, literature suggests that ACE inhibitors are one of the few classes of drugs that have shown to reduce "all cause death"...)
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If you told me that my back pain was all in my head I'd be pissed.
How does that make you feel?
And Spell world backwards
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you've said that before.
so what unresolved psychological conflict is leading to your perception of severe pain?
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My 6 y.o. was tested for ADHD a year ago. He will randomly bust out “cat, apple, table are the three things I’m supposed to remember” before grinning like he memorized the answer key to to MCAT😆
Considering Bone or Joint Surgery? You May Not Need It. (Published 2022)
For many common problems of the knee, hip, shoulder, spine and wrist, nonsurgical options may be just as good.
First they came for my needles...
But honestly, most fields are struggling with showing value for their efforts
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I don’t have a subscription because the NYT went full left wing propaganda machine in 2017.Considering Bone or Joint Surgery? You May Not Need It. (Published 2022)
For many common problems of the knee, hip, shoulder, spine and wrist, nonsurgical options may be just as good.www.nytimes.com
First they came for my needles...
But honestly, most fields are struggling with showing value for their efforts
Can you post a transcript?
Rehash of this paper:
Common elective orthopaedic procedures and their clinical effectiveness: umbrella review of level 1 evidence
Objective To determine the clinical effectiveness of common elective orthopaedic procedures compared with no treatment, placebo, or non-operative care and assess the impact on clinical guidelines. Design Umbrella review of meta-analyses of randomised controlled trials or other study designs in...
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Data sources Ten of the most common elective orthopaedic procedures—arthroscopic anterior cruciate ligament reconstruction, arthroscopic meniscal repair of the knee, arthroscopic partial meniscectomy of the knee, arthroscopic rotator cuff repair, arthroscopic subacromial decompression, carpal tunnel decompression, lumbar spine decompression, lumbar spine fusion, total hip replacement, and total knee replacement—were studied.
....
Results Randomised controlled trial evidence supports the superiority of carpal tunnel decompression and total knee replacement over non-operative care. No randomised controlled trials specifically compared total hip replacement or meniscal repair with non-operative care. Trial evidence for the other six procedures showed no benefit over non-operative care.
....
Conclusions Although they may be effective overall or in certain subgroups, no strong, high quality evidence base shows that many commonly performed elective orthopaedic procedures are more effective than non-operative alternatives. Despite the lack of strong evidence, some of these procedures are still recommended by national guidelines in certain situations.
"
