Surgery Without Any Complications
20 Aug 2009
Would jump at the chance of back surgery that has zero risk of post-operative complications, is free of pain and provides relief of all your symptoms? Or do you choose a back operation that provides the same result, but has none of these guarantees? This first choice may sound like being sold swamp land in Florida. But a recent study shows this is not science fiction.
Dr. Rachelle Buchbinder of Monash University in Malvern, Australia, recently reported in The New England Journal of Medicine an operation called vertebroplasty. During this surgery medical "cement" was injected into a fractured spinal bone to provide extra strength to it. The surgeons hoped that this approach would relieve back pain as compression fractures of the spine occur frequently in the elderly.
36 other patients believed they were undergoing the same procedure. But in their case, to mimic the effect of the operation, surgeons just tapped against the spine making them believe the needle containing medical cement was being inserted into the spinal bone. To make it more authentic, they also made sure that the odour of the cement was present in the operating room.
Dr Buchbinder says that those patients who had the sham surgery reported that they experienced the same amount of pain relief as those who had the real operation.
This is not an isolated finding. Dr. David Kallmes of The Mayo Clinic, in Rochester, Minnesota, was the lead investigator of a study of 131 patients at several medical centers who underwent sham surgery for back pain. He also reported that one month after a supposed vertebroplasty had been done, patients had the same relief of pain as those who had the actual operation.
Several years ago the U.S. Department of Veterans Affairs and Baylor College of Medicine wanted to determine whether arthroscopic surgery, a common treatment for osteoarthritis of the knee was of value.
In this study 180 patients with knee pain were divided into three groups. One group
had a lighted instrument (arthroscope) inserted into the joint and worn, torn or loose cartilage removed from the knee joint.
A second group had bad cartilage flushed out. The last group just had two small skin incisions where the instruments were normally inserted and nothing else done.
During the next two years patients in all three groups reported moderate improvements in pain and their ability to function. However, those in the placebo group had the same relief of pain. In fact, at certain points in the follow up, subjects of the sham group surgery reported better outcomes than those who had material removed from the joint.
These results must keep knee surgeons awake at night. But this placebo effect has also been seen in patients suffering from medical problems. Researchers at the University of Denver implanted human embryonic tissue into the brains of patients suffering from Parkinson’s Disease. These patients develop tremor and other symptoms due to a lack of dopamine.
To insert the dopamine patients had small holes drilled into their skulls. One patient had not been physically active for many years before the operation. But in the year after surgery she resumed hiking and ice-skating. But she had only received dummy surgery!
In another study at the University of Oklahoma a patient suffering from anxiety was given a placebo. Fifteen minutes later her blood pressure dropped, his skin became clammy and he collapsed.
But how can this happen? It’s believed that the placebo result depends on multiple factors, one being what’s called, "Patient Expectant Effect". In effect, if a patient is convinced an operation is going to relieve the pain the result will be better than that of a patient who doesn’t think it will work.
The question is whether dummy treatment is heresy and should be relegated to the dark ages. Or should doctors use placebo therapy under certain circumstances? One may need the wisdom of Solomon to answer this question.
But let’s end on a positive note. We do know that real surgical operations and medicines can kill you. To my knowledge, no one has ever lost their life from placebo treatment.
