Are Invasive Procedures Effective for Chronic Pain Relief? A Systematic Review What are the main findings?

Response: There is not much rigorous research using gold standard methods of surgery and invasive procedures for chronic pain. The quality of the studies that have been done vary and the sample sizes are often small and not replicated. However, sufficient research of reasonable quality have been done on invasive procedures for low back pain and knee arthritis.

These studies do not show that the real surgeries are any better than placebo surgeries. In addition, the real surgeries produce more adverse side effects than the placebo surgeries. In other words, current evidence for invasive procedures for back and knee pain indicate that they do not have specific benefit beyond the ritual (placebo) effect of surgery. What should readers take away from your report?

Response:.Invasive procedures for chronic pain have not been proven to work and should only be done in the context of quality research. What recommendations do you have for future research as a result of this work?

Response: More high-quality research is needed that examines invasive procedures that compare active treatment to placebo controls or to no treatment or to other proven treatments such as medications, massage and acupuncture Is there anything else you would like to add?

Response: The Samueli Foundation is a non-profit charity without commercial ties to any of the technologies or specialties involved in these procedures. It also has extensive experience in and used highly respected experts in the review and meta-analysis methods used.

Some difficulties in doing these studies rigorously are that it is not possible to blind the surgeons to the intervention. In addition, there are still debates about the ethical implications of both doing and not doing rigorous comparison studies that use sham surgery.


Wayne B Jonas, MD, Cindy Crawford, Luana Colloca, MD, PhD, Levente Kriston, PhD, Klaus Linde, MD, PhD, Bruce Moseley, MD, Karin Meissner, Are Invasive Procedures Effective for Chronic Pain? A Systematic Review, Pain Medicine, Volume 20, Issue 7, July 2019, Pages 1281–1293,

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