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Are Invasive Procedures Effective for Chronic Pain? A Systematic Review.
Wayne B Jonas1, Cindy Crawford2, Luana Colloca3
1Integrative Health Programs, H&S Ventures, Alexandria, Virginia.
Pain Medicine (Malden, Mass.)
|September 12, 2018
Summary
Invasive procedures show little evidence of efficacy beyond sham treatments for chronic pain. Higher adverse event rates and cost concerns suggest more research is needed before routine use.
Area of Science:
- Pain Management
- Interventional Procedures
- Evidence-Based Medicine
Background:
- Chronic pain affects millions globally, impacting function and quality of life.
- Invasive procedures are increasingly used, but their efficacy compared to placebo is debated.
- Systematic reviews are crucial for synthesizing evidence on treatment effectiveness.
Purpose of the Study:
- To evaluate the safety and efficacy of invasive procedures for chronic pain relief.
- To compare invasive procedures against sham (placebo) interventions.
- To assess improvements in pain, function, and quality of life.
Main Methods:
- Systematic review and meta-analysis of randomized controlled trials (RCTs).
- Searched multiple databases and included RCTs comparing invasive procedures with sham procedures for chronic pain.
- Extracted data on study characteristics, risk of bias, adverse events, and outcomes; meta-analysis performed on back and knee pain subsets.
Main Results:
- Twenty-five trials (2,000 participants) were included across various chronic pain conditions.
- Invasive procedures had a significantly higher risk of adverse events (12%) versus sham (4%).
- No significant difference in pain reduction was found for low back pain (SMD 0.18) or knee pain (SMD 0.04) compared to sham. Improvement in sham groups accounted for 87% of the observed effect.
Conclusions:
- Limited evidence supports the specific efficacy of invasive procedures beyond sham interventions for chronic pain.
- Moderate evidence does not support using invasive procedures over sham for chronic back or knee pain.
- High costs and safety concerns necessitate rigorous studies before routine adoption for chronic pain management.
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