An increasingly common surgical procedure for repairing spinal fractures might not be all it’s cracked up to be–in fact, the surgery had the same effect on patient’s pain as a placebo, two studies report in the New England Journal of Medicine.
The technique, called vertebroplasty, involves injecting medical cement into a fractured spine bone to strengthen it. More than 38,000 such procedures are done in the United States every year and the number has been [increasing] rapidly, nearly doubling from 2001 to 2005 [Reuters]. But the new studies showed that the procedure alleviated pain about the same amount as a placebo “surgery,” in which the physicians tapped on the spine and piped in the smell of cement to make groggy volunteer subjects believe they were receiving the real thing.
Researchers found that 36 volunteers who received sham surgery did just as well as 35 who got the real operation. A separate test, of 131 people at 11 medical centers, … also found that sham surgery produced a comparable degree of pain reduction and movement [Reuters].
As both the real procedure and the decoy surgery provided pain relief among study subjects, it’s unlikely that the studies will spell the end of this low-risk procedure, which already is not the first remedy physicians try for treating pain due to a fractured spine. But why investigate the procedure when it’s already widely used? Two reasons: Several studies have found great benefit from the procedure, but none of those were placebo-controlled. Experts also worry that there may be a downside, with the surgery putting patients at higher risk for future fractures [HealthDay News].
Researchers aren’t sure exactly why the placebo and the surgery reduced pain by the same amount. It could be the placebo effect or something as simple as the effect of the novocaine on the bone, breaking the cycle of pain [HealthDay News].
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Image: flickr / warrenski
August 7th, 2009 at 10:36 am
Now it will be interesting to see what happens with kyphoplasty, a related but more invasive and more expensive procedure frequently compared to vertebroplasty.
And maybe the sham procedure, involving sticking a percutaneous needle into the lamina and injecting the periosteum with local anesthetic, can be developed into an effective treatment (given that percutaneous injections of joints is already done for a variety of indications)?
August 8th, 2009 at 10:55 am
Kyphoplasty is more invasive but also more precise and without the risks of polymethylmethacralate emboli (because the cement is injected as a liquid in vertebroplasty). It is also done more for compression fractures as compared to simply “strengthening” the vertebral body.
Kyphoplasty can restore bone height as well; the sham would not address the mechanical disruption that was requiring the procedure in the first place.
The sham surgery is still the same procedure; only the injectate is changed.
How is that of significance?
November 2nd, 2009 at 4:14 pm
If the fake surgery really manages to heal patients, I think these people are lucky, as they will have no “intruders” in their bodies. But imagine them finding out one day… wouldn´t they feel terribly deceived?
April 15th, 2010 at 8:52 pm
The placebo effect is such a confounding and quite a remarkable reaction of our senses. It makes you wonder how many prescription out there are genuinely effective in treating a patient’s ailments or if it’s always a mixture of both mental expectations and actual effectivity.