Jun 05, 2024 12:30:00

Experts say that not only placebo but also 'fake surgery' can reduce pain and symptoms

The placebo effect is a phenomenon in which symptoms improve when a person takes a fake drug that has no physiological effect. Jeremy Howick , a professor of empathic health care at the University of Leicester in the UK, says that not only placebos but also 'sham surgery' that does not actually treat the patient can have the same effect as real surgery, such as reducing pain in the affected area.

'Placebo' or 'sham' surgery is not a cruel trick – it can be very effective
https://theconversation.com/placebo-or-sham-surgery-is-not-a-cruel-trick-it-can-be-very-effective-229896

In the 1990s, a study randomly assigned 180 patients with knee pain so severe that it was difficult for them to get up from a chair to either undergo real or sham knee arthroscopy .

The patients who underwent real surgery were given painkillers and had a small metal tube (arthroscope) inserted into their knee to repair damaged cartilage and remove bone fragments that were causing pain. The patients who underwent sham surgery were given painkillers and had a small incision made in their knee to fit the metal tube, but no real procedures were performed, such as inserting the tube, repairing cartilage, or removing bone fragments. During the sham surgery, the surgeon and nurses made the same noises as in a real operation, so the patients believed they were undergoing a real operation.

The researchers then followed the patients for two years, periodically surveying them to see how much pain and functional problems they reported, and also administering tests such as 'how many flights of stairs they could climb before pain got in the way,' to see how the real and sham surgeries affected them.

The results showed that patients who underwent sham surgery experienced similar results to those who underwent real surgery in terms of pain relief and improved function, and these results have been replicated in subsequent experiments, suggesting that sham surgery may be effective.

Furthermore,

a study reviewing 53 trials examining the effects of sham surgery found that sham surgery improved patients' symptoms in 39 of the 53 trials (74%), and in 27 trials (51%), sham surgery improved patients' symptoms to the same extent as real surgery. The sham surgeries reviewed in the study included medical bone cement injections to treat back pain, brain implants to reduce migraine attacks, laser surgery to stop bleeding in the digestive tract, and surgery to improve the function of the sphincter that opens and closes the anus.

However, these research results have not led to a widespread replacement of sham surgery with real surgery, and more than one million knee arthroscopy procedures are still performed in the U.S. every year. Howick cites several reasons for this, including the misconception that sham surgery is risky, the misconception that sham surgery requires patients to believe they are having real surgery, and the negative connotation of the term sham surgery.

In fact, sham surgery has the advantage of being less invasive and less risky for adverse events such as infections, since unlike real surgery, sham surgery does not involve direct contact with the affected area. In addition, many studies have accurately informed patients that they will be undergoing sham surgery, and have shown that it is still effective.

Howick claims that the mechanism by which sham surgery improves symptoms is that it activates a process called the 'wound-healing cascade,' which allows the body to regenerate wounds.

The human body has the ability to heal itself from a variety of injuries, and even an incision by a surgeon's scalpel initiates the wound-healing cascade, in which blood clots stop bleeding, white blood cells remove harmful bacteria, and new tissue and blood vessels form to nourish the injured area and seal the wound.

These processes may change the structure of the affected area, such as the knee, shoulder, or back, resulting in reduced pain and improved function. It is also possible that the administration of painkillers during sham surgery may make it easier to move the affected area, thereby reducing pain.

'So-called placebo or sham surgeries could be better described as 'minimally invasive surgeries.' For patients for whom the placebo procedure would be as effective as a more invasive, expensive and risky procedure, this could be another option. Patients are told exactly what minimally invasive surgery involves,' said Dr. Howick.

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