ARE INVASIVE PROCEDURES EFFECTIVE FOR CHRONIC PAIN? A SYSTEMATIC REVIEW

BACKGROUND & OBJECTIVE

Chronic pain is a major worldwide problem, costing hundreds of billions of dollars per year. Surgery is increasingly being used by sufferers in an attempt to treat chronic pain. The purpose of this study was to evaluate the current evidence for invasive procedures compared with their identical sham procedures in the treatment of chronic pain, and assess the impact on reducing pain, medication use, disability, adverse events, and enhancing health-related quality of life for patients with various chronic pain conditions.

METHODS

The study design was a systematic review of randomized controlled trials (RCTs). RCTs that compared any invasive procedure, including classical surgery, with a parallel sham procedure for patients with chronic pain conditions were eligible to be included in the review. To be eligible, all procedures needed to be compared with an identical yet sham procedure that used the same invasive approach, instruments, and ritual but eliminated the hypothesized active component of tissue manipulation. For the purposes of this review, chronic pain conditions were defined as conditions in which pain had persisted for more than three months.

Studies were grouped according to chronic pain condition and the procedure reported in the examined study. Because of the variety of conditions and treatments, a meta-analysis was not done for the entire study sample.

RESULTS

25 studies involving a total of 2000 patients with specific chronic pain conditions met eligibility criteria for the systematic review. The procedures used included arthroscopic surgery or irrigation, heart catheterization with laser treatment or septal repair, endoscopic sphincterectomy, percutaneous or

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