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Improved outcome after lumbar microdiscectomy in patients shown their excised disc fragments: a prospective, double blind, randomised, controlled trial

PainSci » bibliography » Tait et al 2009
Tags: treatment, sciatica, mind, counter-intuitive, fun, back pain, pain problems, spine, butt, hip

PainSci notes on Tait 2009:

Patients undergoing lumbar discectomy who were shown the excised disc fragment get better results from the procedure. Tait et al suggest that this dramatic flourish was helpful because it gave them “visual confirmation” that the surgery had actually achieved something concrete. Not only does this suggest that “confidence” is an active ingredient in surgery as a treatment, but that confidence based on tangible evidence is better than faith.

Louw et al cite this study to make the point that sham surgeries get results comparable to the real thing because they “likely altered the patient’s perception of the health of their tissues.” This is a direct reference to the hypothesis that perception directly modulates pain.

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.

BACKGROUND: Lumbar microdiscectomy (LMD) is a commonly performed neurosurgical procedure. We set up a prospective, double blind, randomised, controlled trial to test the hypothesis that presenting the removed disc material to patients after LMD improves patient outcome.

METHODS: Adult patients undergoing LMD for radiculopathy caused by a prolapsed intervertebral disc were randomised into one of two groups, termed experimental and control. Patients in the experimental group were given their removed disc fragments whereas patients in the control group were not. Patients were unaware of the trial hypothesis and investigators were blinded to patient group allocation. Outcome was assessed between 3 and 6 months after LMD. Primary outcome measures were the degree of improvement in sciatica and back pain reported by the patients. Secondary outcome measures were the degree of improvement in leg weakness, paraesthesia, numbness, walking distance and use of analgesia reported by the patients.

RESULTS: Data from 38 patients in the experimental group and 36 patients in the control group were analysed. The two groups were matched for age, sex and preoperative symptoms. More patients in the experimental compared with the control group reported improvements in leg pain (91.5 vs 80.4%; p<0.05), back pain (86.1 vs 75.0%; p<0.05), limb weakness (90.5 vs 56.3%; p<0.02), paraesthesia (88 vs 61.9%; p<0.05) and reduced analgesic use (92.1 vs 69.4%; p<0.02) than preoperatively.

CONCLUSION: Presentation of excised disc fragments is a cheap and effective way to improve outcome after LMD.

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