As a clinical pain epidemiologist (albeit with an original specialty in ID), I think that these were well chosen studies. They do illustrate several things: 1) the difficulties of doing high quality RCTs in procedure- oriented interventions, including but not limited to surgery; 2) the questionable quality of evidence and study design in interventional pain procedures. It is so much more difficult to do these studies compared with studies of medication. Placebo effects are plentiful, or, as I prefer to call them, “nonspecific treatment effects.” As one of the speakers points put, this is a very large industry, and industry-sponsored studies have built in incentives that at least raise questions. I wish that fellowship programs would include far more on doing and interpreting this kind of research, with an emphasis on study design and clinical epidemiology. Too many spine surgery fellowships may look at radiographic measures of success, but not true patient outcome in terms of function as well as deeply informed quality of life outcomes. This was a fine session.
One additional comment: we should endeavor to eliminate the use of the word “narcotic” (as in the last presentation. It is a term that is rife with negative connotations. Rather, more scientifically meaningful terms such as “opioids” ought to be used. This is a specific term. So please, let’s not use “narcotic.”
Thank you 🙏
As a clinical pain epidemiologist (albeit with an original specialty in ID), I think that these were well chosen studies. They do illustrate several things: 1) the difficulties of doing high quality RCTs in procedure- oriented interventions, including but not limited to surgery; 2) the questionable quality of evidence and study design in interventional pain procedures. It is so much more difficult to do these studies compared with studies of medication. Placebo effects are plentiful, or, as I prefer to call them, “nonspecific treatment effects.” As one of the speakers points put, this is a very large industry, and industry-sponsored studies have built in incentives that at least raise questions. I wish that fellowship programs would include far more on doing and interpreting this kind of research, with an emphasis on study design and clinical epidemiology. Too many spine surgery fellowships may look at radiographic measures of success, but not true patient outcome in terms of function as well as deeply informed quality of life outcomes. This was a fine session.
One additional comment: we should endeavor to eliminate the use of the word “narcotic” (as in the last presentation. It is a term that is rife with negative connotations. Rather, more scientifically meaningful terms such as “opioids” ought to be used. This is a specific term. So please, let’s not use “narcotic.”
Have a small disagreement with dr nesser. So far