Four orthopedic surgeries no better than placebo
Seventeen 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 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,” Karolina Wartolowska, Andrew Judge, Sally Hopewell, Gary S Collins, Benjamin J F Dean, Ines Rombach, David Brindley, Julian Savulescu, David J Beard, and Andrew J Carr, British Medical Journal, 2014.
- “The evidence on surgical interventions for low back disorders, an overview of systematic reviews,” Wilco C H Jacobs, Sidney M Rubinstein, Paul C Willems, Wouter A Moojen, Ferran Pellisé, Cumhur F Oner, Wilco C Peul, and Maurits W van Tulder, European Spine Journal, 2013.
- “Arthroscopic surgery for degenerative knee: systematic review and meta-analysis of benefits and harms,” J B Thorlund, C B Juhl, E M Roos, and L S Lohmander, 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,” Wayne B Jonas, Cindy Crawford, Luana Colloca, Ted J Kaptchuk, Bruce Moseley, Franklin G Miller, Levente Kriston, Klaus Linde, and Karin Meissner, BMJ Open, 2015.
- “A controlled trial of arthroscopic surgery for osteoarthritis of the knee,” JB Moseley, K O’Malley, NJ Petersen, and others, New England Journal of Medicine, 2002.
- “Arthroscopic surgery for degenerative knee arthritis and meniscal tears: a clinical practice guideline,” Reed A C Siemieniuk, Ian A Harris, Thomas Agoritsas, Rudolf W Poolman, Romina Brignardello-Petersen, Stijn Van de Velde, Rachelle Buchbinder, Martin Englund, Lyubov Lytvyn, Casey Quinlan, Lise Helsingen, Gunnar Knutsen, Nina Rydland Olsen, Helen Macdonald, Louise Hailey, Hazel M Wilson, Anne Lydiatt, and Annette Kristiansen, 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:
- Photobiomodulation therapy is not better than placebo in patients with chronic nonspecific low back pain: a randomised placebo-controlled trial. Guimarães 2021 Pain.
- No effect of creatine monohydrate supplementation on inflammatory and cartilage degradation biomarkers in individuals with knee osteoarthritis. Cornish 2018 Nutr Res.
- The CANBACK trial: a randomised, controlled clinical trial of oral cannabidiol for people presenting to the emergency department with acute low back pain. Bebee 2021 Med J Aust.
- Relationships Between Sleep Quality and Pain-Related Factors for People with Chronic Low Back Pain: Tests of Reciprocal and Time of Day Effects. Gerhart 2017 Ann Behav Med.
- Modulation in the elastic properties of gastrocnemius muscle heads in individuals with plantar fasciitis and its relationship with pain. Zhou 2020 Sci Rep.