MedicalResearch.com Interview with:
Wayne B. Jonas, MD
Clinical Professor of Family Medicine
Uniformed Services University and at
Georgetown University School of Medicine
MedicalResearch.com: What is the background for this study?
Response: The search for non-drug approaches to chronic pain is a major recommendation in many recent guidelines for both pain management and reduction in the use of opioids. Surgical and invasive procedures are non-drug approaches often used for pain conditions like back pain and arthritis, so good evidence is needed to determine the safety and efficacy of these procedures. Properly done randomized, placebo controlled trials are the best way (the gold standard) to get that evidence, so we did a thorough evaluation of such research, using standard systematic review and meta-analysis methods.
MedicalResearch.com: What are the main findings?
Response: There is not much rigorous research using gold standard methods of surgery and invasive procedures for chronic pain. The quality of the studies that have been done vary and the sample sizes are often small and not replicated. Sufficient research of reasonable quality have been done on invasive procedures for low back pain and knee arthritis.
But these studies do not show that the real surgeries are any better than placebo surgeries. In addition, the real surgeries produce more adverse side effects than the placebo surgeries.
MedicalResearch.com: What should readers take away from your report?
Response: Invasive procedures for chronic pain have not been proven to work and should only be done in the context of quality research.
MedicalResearch.com: What recommendations do you have for future research as a result of this work?
Response: More high-quality research is needed that examines at invasive procedures that compare active treatment to placebo controls or to no treatment or to other proven treatments such as medications, massage and acupuncture.
MedicalResearch.com: Is there anything else you would like to add?
Response: The Samueli Foundation is a non-profit charity without commercial ties to any of the technologies or specialties involved in these procedures. It also has extensive experience and used highly respected experts in the review and meta-analysis methods used.
Some difficulties in doing these studies rigorously are that it is not possible to blind the surgeons to the intervention. In addition, there are still debates about the ethical implications of both doing and not doing rigorous comparison studies that use sham surgery.
Wayne B Jonas, Cindy Crawford, Luana Colloca, Levente Kriston, Klaus Linde, Bruce Moseley, Karin Meissner; Are Invasive Procedures Effective for Chronic Pain? A Systematic Review, Pain Medicine, , pny154, https://doi.org/10.1093/pm/pny154
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