Surgery for chronic musculoskeletal pain: the question of evidence

Review written by Todd Hargrove info

Key Points

  1. There are few randomized controlled trials (RCTs) with adequate patient blinding that assess the efficacy of surgeries for chronic pain.
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BACKGROUND & OBJECTIVE

Surgeries for chronic musculoskeletal pain are premised on the assumption that pain can be improved by correcting objective changes seen on imaging. Such changes are only one of many factors, including psychosocial factors, that may affect pain. Thus, to establish reliable evidence that surgery is a good treatment option for chronic pain, randomized controlled trials (RCTs) with adequate patient blinding are required.

This study sought to assess the extent to which common surgeries for chronic pain are supported by RCTs that compare surgery to no surgery, and that involve patient blinding.

Changes seen on imaging are only one of many factors, including psychosocial factors, that may affect pain.
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Most of the RCTs on surgery for chronic pain suggest that surgery provides an insufficient benefit to justify its costs and risks.

METHODS

The authors first identified the most common surgical procedures for chronic musculoskeletal pain. The 14 most common were:

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