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Four orthopedic surgeries no better than placebo


Tags: surgery, counter-intuitive, harms, mind, bad news, scientific medicine, treatment, pain problems

Eighteen articles on PainSci cite Louw 2016: (1) A Guide to Sciatica Treatment for Patients(2) The Complete Guide to IT Band Syndrome(3) Complete Guide to Low Back Pain(4) The Complete Guide to Patellofemoral Pain Syndrome(5) Complete Guide to Plantar Fasciitis(6) The Complete Guide to Neck Pain & Cricks(7) Alternative Medicine’s Choice: Alternative to What?(8) A Historical Perspective On Aches ‘n’ Pains(9) Should You Get A Lube Job for Your Arthritic Knee?(10) Do Nerve Blocks Work for Neck Pain and Low Back Pain?(11) Repetitive Strain Injuries Tutorial(12) Spinal Fracture Bracing(13) Medical Errors in Perspective(14) Knee Surgery Sure is Useless!(15) Does Cartilage Regeneration Work?(16) Complete Guide to Frozen Shoulder(17) Knee Replacement Surgery Doubts(18) Achilles Tendinitis Treatment Science

PainSci summary of Louw 2016: ?This page is one of thousands in the bibliography. It is not a general article: it is focused on a single scientific paper, and it may provide only just enough context for the summary to make sense. Links to other papers and more general information are provided at the bottom of the page, as often as possible.

This review of a half dozen good quality tests of four popular orthopedic (“carpentry”) surgeries found that none of them were more effective than a placebo. It’s an eyebrow-raiser that Louw et al could find only six good (controlled) trials of orthopedic surgeries, and all of them were bad news.

Surgeries have always been surprisingly based on tradition, authority, and educated guessing rather than good scientific trials; as they are tested properly, compared to a placebo (a sham surgery), many are failing the test. This review introduction is excellent, and does a great job of explaining the problem. As of 2016, this is the best academic citation to support the claim that “sham surgery has shown to be just as effective as actual surgery in reducing pain and disability.” The need for placebo-controlled trials of surgeries (and the damning results) is explored in much greater detail — and more readably — in the excellent book, Surgery: The ultimate placebo, by Ian Harris.

The surgeries that failed their tests were:

~ Paul Ingraham

original abstract Abstracts here may not perfectly match originals, for a variety of technical and practical reasons. Some abstacts are truncated for my purposes here, if they are particularly long-winded and unhelpful. I occasionally add clarifying notes. And I make some minor corrections.

OBJECTIVE: To evaluate the evidence for the effectiveness of sham surgery in orthopedics by conducting a systematic review of literature.

METHODS: Systematic searches were conducted on Biomed Central,, CINAHL, the Cochrane Library, NLM Central Gateway, OVID, ProQuest (Digital Dissertations), PsycInfo, PubMed/Medline, ScienceDirect and Web of Science. Secondary searching (PEARLing) was undertaken, whereby reference lists of the selected articles were reviewed for additional references not identified in the primary search. All randomized controlled trials comparing surgery versus sham surgery in orthopedics were included. «Shockingly few!» Data were extracted and methodological quality was assessed by two reviewers using the Critical Review Form-Quantitative Studies. Levels of scientific evidence, based on the direction of outcomes of the trials, were established following the Australian National Health and Medical Research Council (NHMRC) Hierarchy of Evidence (Australian National Health and Medical Research Council, 1999).

RESULTS: This review includes six randomized controlled trials (RCTs) involving 277 subjects. All six studies were rated as very good on methodological quality. Heterogeneity across the studies, with respect to participants, interventions evaluated, and outcome measures used, prevented meta-analyses. Narrative synthesis of results, based on effect size, demonstrated that sham surgery in orthopedics was as effective as actual surgery in reducing pain and improving disability.

CONCLUSIONS: This review suggests that sham surgery has shown to be just as effective as actual surgery in reducing pain and disability; however, care should be taken to generalize findings because of the limited number of studies.

related content

This page is part of the PainScience BIBLIOGRAPHY, which contains plain language summaries of thousands of scientific papers & others sources. It’s like a highly specialized blog. A few highlights: