Should You Go Under the Knife? A Review of Sham Surgery

image of man on hospital bed

Patients dealing with chronic pain and obesity have a difficult decision to make when facing surgery or minimally invasive procedures. With the help of their doctors, patients weigh the risks of the procedure including infection, cost, and the side effects, including those of anesthesia. However, a recent study by researchers showed that in some cases, surgery is no better than placebo, and in other cases that doctors and patients may not have all the information they need to make proper decisions.

Some Procedures No Better than Placebo

Researchers from Samueli Institute, National Institutes of Health, Harvard Medical School, Houston Methodist Hospital, the University of Maryland and the University of Munich, Germany systematically reviewed 55 studies comparing patient outcomes from actual surgical procedures to outcomes after “sham” procedures. Sham procedures mimic the ritual and process of surgery without actually performing the procedure.

The review encompassed more than 3,500 patients and showed that outcomes for surgery were about the same as placebo in the included procedures for pain, and marginally better in cases of obesity.

The results of the systematic review, which was published this month in the journal BMJ Open, have implications for clinical research and practice by arguing against the continued use of ineffective, invasive procedures—especially in the field of chronic pain – until more rigorous research is done on these procedures.

Limited Information Available for Decision-Making

Minimally invasive surgical procedures have expanded for treating conditions such as low-back pain, arthritis, endometriosis, Parkinson’s disease, gastro-oesophageal reflux and obesity, but rarely are these procedures evaluated using rigorous research designs using randomized, placebo-controlled trials, the gold standard of medical research.

This limits the ability of doctors and patients to make proper evidence-based decisions when deciding whether the risks outweigh the benefits.

Wayne B. Jonas, MD, President and CEO of Samueli Institute and an author of this review, has been studying the effects of placebo for more than a decade. His research works to uncover the role of placebo, meaning and context in the healing process.

“We need to uncover how much of the healing is due to the specific treatment and how much can be attributed to other factors like the ritual, the setting, and the communication style of the provider,” says Dr. Jonas. “This understanding will help us to maximize the effective factors and limit the risk of invasive treatments.”

Read the full study here.

BMJ Open 2015;5:e009655 doi:10.1136/bmjopen-2015-009655:  To what extent are surgery and invasive procedures effective beyond a placebo response? A systematic review with meta-analysis of randomised, sham controlled trials. View article.