Systematic Review: Sham Surgery vs. Actual Surgery

Many in the PT world were excited this past week when the expected systematic review on sham surgeries was released. For the past decade or so, we have come to understand how significant a role the brain plays in the perception of pain and how little the biomechanical aspect actually plays. One of the basis for these pain science developments has been studies looking at placebo treatments and sham surgeries. Many of the recent ones have found that there is no difference between a "real" surgery and a sham surgery.  This specific systematic review found sham surgery to be just as beneficial as actual surgery in reducing pain and disability. So what does this mean?

First of all, we must be careful before apply these findings to all cases. The systematic review includes a low 6 studies, which is lower than ideal, especially with a total of 277 participants. We also must always remember that, in reality, there is no such thing as a true placebo. We all know a patient's expectations plays a significant role on the outcome of a treatment. If someone expects ultrasound will help them and you completely ignore that expectation, likely that patient will go elsewhere. With these patients, our job is to educate them on the lack of evidence for some treatments and the benefit of others. This part actually supports the findings of the sham surgery systematic review. On the other hand, an incision is not truly a placebo. Following an incision, an inflammatory (healing) response occurs in the region. Maybe the inflammatory process is the most significant factor for some surgeries? We don't know for sure. However, this study can serve as a foundation for further research in pain science and help us to educate our patients on the fact that pathological findings don't necessarily require a surgical intervention.

-Chris

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