Sham Surgery: Can Fake Procedures Be Just as Effective? | Podcast Ep. 218

Today's episode actually is a super important one because we are talking about a paper titled sham Surgical Procedures for Pain Intervention Result in Significant Improvements in Pain Systematic review and meta analyses. This is an interesting paper and you heard that correctly. Sham Surgical Procedures for Pain Result in Significant improvements. And we're gonna talk all about that and more on today's episode. They did a systematic review and meta analyses. This is brand new. It was just accepted as a manuscript and you can find a direct link also in the show notes. But the gist of it is this. These researchers found. We're gonna break it down, but I'm gonna give you the conclusion. To start, they found, quote, sham surgery is associated with large improvement in pain and other subjective patient reported outcomes, but with relatively small effect on objective outcomes. Sham surgeries are overwhelmingly safe. The magnitude of this effect should be used when planning future sham controlled surgical trials. So that's a lot to take in right there, right now. We've discussed on this specific podcast, earlier episodes, we've talked about the research showcasing manipulation versus microdiscectomy. And the fact is, a couple years post surgery or post intervention from manipulation, the results of a manipulation were at least, they said, just as good as getting a microdiscectomy surgical procedure. And furthermore, those individuals who did not in those trials who failed, quote, unquote, manipulation then actually had a very high likelihood of then having a great surgical outcome. There's other papers that touch on those things as well that say to me, there's not, there's very few people that don't have red flags that should not be at least visiting your office for a trial course of care before having surgery. We know half a million fusions are done each and every year, and that number's rising. And I'm going to estimate that double, double that is done in microdiscectomies, foraminotomies, laminotomies, et cetera, laminectomies. And that's a lot of individuals. How many of those individuals are experiencing chiropractic or being referred to a chiropractor before getting those surgeries? Probably not that high a percentage from what we see. Typically, they can, quote, unquote, exhaust conservative care with medications or physical therapy alone. Yet even though the research points to what we do with an adjustment or manipulation, chiropractic care as being something that not only has exceptionally high efficacy, but exceptionally low risk and low harms. And if they happen to fail, what we do, they're actually great surgical candidates based on the fact that they went through the course of care. A lot to dive into right there. But the gist of it is the placebo effect and other nonspecific effects complicate the interpretation of a surgically's therapeutic. Now, a lot of times we get this as chiropractors, right? Hey, you're placebo, it's just because you're touching the patient, which, by the way, there's nothing wrong with that. But that does not only extend to chiropractic. Placebo is a part of every healing process, and arguably, it's a real big part of the surgical process. They say, in other words, the clinical effect of the surgery may not be better than the sham placebo effect. That is a quote from this paper. That's powerful stuff, right when we start thinking about this. Now, I want to be clear. This paper is not spine surgery specific. Now, they did look at a majority of surgeries that were minimally invasive by nature. So those could be spine, those could be extremity and or other. But the gist of it is, gosh. Is surgery a permanent fix? Probably not. Do many patients come into your practice and then go into a surgeon's office hoping for a quote, unquote, permanent fix because chiropractic gave them some relief, but not 100% relief. Yeah, quite frankly, that happens all day, every day, which is why I'd encourage you. And what we do at the Emerson Space Chiropractor is to bridge the gap and build those relationships so you have fluid communication. Just in a group on Facebook earlier this week, there was a doc talking about, man, I have patients that come in, and then they go to, you know, the orthopedist or the primary care, and they kind of. I get railroaded out of taking care of my patient. And my response to that is, that is exactly the case on why you need to be bridging the gap and getting out there so that you can play offense and defense in your practice. You can help direct patients to the doctors that are actually doing the right thing. And coincidentally, those are gonna be people who are also friendly to who you are and what you do, and it's what's best for the patient. Why let them go out and find for themselves just a random doctor who might talk down about what you're doing, even though what you're doing is in the research, the best option for care for musculoskeletal issues, neuromusculoskeletal issues that don't have red flags. It's absolutely crazy. But you gotta take the effort and get out there and do it. So in this paper, they identified our articles and they were screened based on the fact that it had to be a randomized controlled clinical trial, and it was comparing surgery to a corresponding sham placebo group. So that was basically kind of what they were looking at. And what they found, again, was the gist of it is primary outcomes. In this meta analysis, they looked at what was the improvement in pain on a 0 to 10 analog scale. Number two, what was the improvement in any subjective outcome? And number three, the improvement in any objective outcome. Now, what they found was that specifically on the subjective side of things, individuals with sham procedures did exceptionally well. Now, the other interesting part of this is the complication rate. We know that from a spine surgery perspective, the complication rate, which can be tallied in a few different ways, to be fair, complications depending upon the hospital system, depending upon the state, depending upon even the country at times can be classified one way or the other. Was it a complication or was it a side effect? Was it a minor adverse event or was it a major complication? There are some definitives, but there's a lot of gray in that. And we've seen in surgical procedures specifically around spine, that there can be a complication rate up to 20% or more. Now, in this study, they found the minor complication rate for Sham surgeries was 3.8% and the major complication rate was 0.2% with no fatalities in the sham group. That's really important as well. Now, think about the 3.8 from a minor complication or from a major complication, the 0.2%. We don't put it exactly in terms like that for what we do within chiropractic, but I can tell you we're a heck of a lot lower now. Now, if you wanna classify some transient achar pain as a minor complication, yeah, Maybe we're above 3.8%, but I know that our major complication rate is definitely below 0.2%. So important to keep in mind, even with the surgery, the sham surgeries doing well, it's obviously still a surgery and there's still complications and challenges well beyond what we do in our practices. Now, they also cite another paper that found, quote, improvement in the placebo arm, which was seen in 75% of the sham trials, and that in about 50% of the trials, there was no difference in the outcomes between the sham arm and the surgical arm. Think about that. They're citing a paper that says half the time, 50% of the time, there's no difference in the outcomes between if somebody has a sham surgery or has an actual surgery, that's insane. And think about the fact that they found 75% of the time in the these placebo randomized controlled trials, there was improvement in the placebo arm. So again, when somebody's saying about chiropractic, well, it's all placebo. Hey, I'll take all the placebo credit in the world, but quite frankly, we're probably lower on the placebo effect scale than surgeries in many cases. And that makes sense, right? You think about the financial toll, the time toll, the mental stress and energy that goes into a surgical procedure. And yeah, people are really hell bent on making sure that they have a great outcome. So that amount of belief in the surgery being the fix absolutely can contribute to the placebo effect. Now, again, they noted that most of the studies and procedures in this were minimally invasive. And the bottom line is they said, quote, in conclusion, sham surgery is associated with a large improvement in pain and other subjective patient reported outcomes and a markedly lower effect on measurable objective outcomes. So objective outcomes, sham surgery doesn't do too much. That's to be expected if there is. Specifically in the spine, if there's a structural issue. Right. I'm going to give away throwback here, a limitation of matter. There is a disc herniation that is far beyond what we can do naturally. The body's unable to heal itself. With conservative care, it's unable to get over the hump. Well, then, yeah, if that is cut out, chopped off, so to speak, that can result. It's a structural issue. If you have severe spinal cord stenosis, a huge disc present in that spinal cord, those people respond exceptionally well. But that's rare. So many people have surgeries done, microdiscs, laminectomies, foraminotomies, et cetera, that are on minor disc bulges or minor herniations that might still heal. If somebody only has a course of NSAIDs and some physical therapy, they that is enough to check the boxes that they've quote, unquote, failed conservative care, even if they've never visited a chiropractic clinic. I don't think that should be the case. But I know that if we're gonna wait around for the legislature to change that, we're gonna be waiting a long time. So that is where it breaks down to you getting out there, bridging the gap and building relationships. We know what we do has such high efficacy, it has such low risk, it's cost effective. There's unbelievably high patient satisfaction and basically what we do with manipulation adjustments are recommended across multiple university platforms, organizations, et cetera. And we have seen in the literature that we can perform just as well as surgical intervention and those that happen to fail what we do are actually great surgical candidates. All that comes together to say you need to be reaching out. If you want help doing that, visit us@the evidencebasedchiropractor.com we've had a ton of new members. Come on. I think that's people getting motivated in 2020 to bridge the gap and build relationships. You can see that there is opportunity there and that opportunity is going to go away over time as more docs in your community start reaching out to the other MDs in your community. If you want to be one of the first, if you want to get in, bridge the gap, build a relationship, start talking the truth about healthcare in your community and getting other people to do what's right and guide and direct them. It is all about relationships. So visit us@the evidencebasedchiropractor.com I hope you have a fantastic week in practice and I will talk to you soon.

Thank you for joining us on this episode of the Evidence Based Chiropractor. If you want to grow your practice, come back for next week's episode. If you want to grow faster, visit the evidencebasedchiropractor.com and join our MD Marketing membership today.