Four orthopedic surgeries no better than placebo
Seventeen articles on PainSci cite Louw 2016: 1. How to Treat Sciatic Nerve Pain 2. The Complete Guide to IT Band Syndrome 3. The 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 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. Knee Surgery Sure is Useless! 14. Does Cartilage Regeneration Work? 15. Complete Guide to Frozen Shoulder 16. Knee Replacement Surgery Doubts 17. Achilles Tendinitis Treatment Science
PainSci commentary on Louw 2016: ?This page is one of thousands in the PainScience.com 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 wherever 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 at all — there should have been more — and all of them were bad news.
The surgeries that failed their tests were:
- vertebroplasty for osteoporotic compression fractures (stabilizing crushed verebtrae)
- intradiscal electrothermal therapy (burninating nerve fibres)
- arthroscopic debridement for osteoarthritis (“polishing” rough arthritic joint surfaces)
- open debridement of common extensor tendons for tennis elbow (scraping the tendon)
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. This review of the trend does a great job of explaining the problem. This is one of the best academic citations 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 very readably — in the excellent book, Surgery: The ultimate placebo, by Ian Harris.
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, BMJ.com, 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
- Surgery: The ultimate placebo (book), by Ian Harris (book review).
- “The Right to Know That an Operation Is ‘Next to Useless’,” Gina Kolata, www.nytimes.com.
- “The sexy scalpel: unnecessary shoulder surgery on the rise,” Jørgen Jevne, Blogs.BMJ.com.
- “Use of placebo controls in the evaluation of surgery: systematic review,” Wartolowska et al, British Medical Journal, 2014.
- “The evidence on surgical interventions for low back disorders, an overview of systematic reviews,” Jacobs et al, European Spine Journal, 2013.
- “Arthroscopic surgery for degenerative knee: systematic review and meta-analysis of benefits and harms,” Thorlund et al, British Medical Journal, 2015.
- “To what extent are surgery and invasive procedures effective beyond a placebo response? A systematic review with meta-analysis of randomised, sham controlled trials,” Jonas et al, BMJ Open, 2015.
- “A controlled trial of arthroscopic surgery for osteoarthritis of the knee,” Moseley et al, New England Journal of Medicine, 2002.
- “Arthroscopic surgery for degenerative knee arthritis and meniscal tears: a clinical practice guideline,” Siemieniuk et al, British Medical Journal, 2017.
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:
- Inciting events associated with lumbar disc herniation. Suri 2010 Spine J.
- Prediction of an extruded fragment in lumbar disc patients from clinical presentations. Pople 1994 Spine (Phila Pa 1976).
- Characteristics of patients with low back and leg pain seeking treatment in primary care: baseline results from the ATLAS cohort study. Konstantinou 2015 BMC Musculoskelet Disord.
- Effectiveness and cost-effectiveness of universal school-based mindfulness training compared with normal school provision in reducing risk of mental health problems and promoting well-being in adolescence: the MYRIAD cluster randomised controlled trial. Kuyken 2022 Evid Based Ment Health.
- No long-term effects after a three-week open-label placebo treatment for chronic low back pain: a three-year follow-up of a randomized controlled trial. Kleine-Borgmann 2022 Pain.