Invasive procedures may not provide a substantial benefit over sham procedures for the management of chronic back or knee pain, according to a systematic review published in Pain Medicine.

Data from 25 randomized controlled trials that compared invasive vs sham procedures for the management of chronic knee or back pain, arthritis, angina, abdominal pain, endometriosis, biliary colic, and migraine were examined. Invasive procedures were defined as interventions that required the endoscopic or percutaneous insertion of an instrument into the body “for the purposes of manipulating tissue or changing anatomy.” Sham procedures involved interventions that used an identical invasive strategy and instruments, but without tissue modification. Two subsets of data on knee and back pain were pooled, using meta-analysis.

Invasive vs sham procedures were associated with a higher rate of adverse events (14 studies; 12% vs 4%, respectively; risk difference, 0.05; 95% CI, 0.01-0.09; P =.01). The standardized mean difference for low back pain reduction was 0.18 (7 studies; n=445; 95% CI, −0.14 to 0.51; P =.26), and the standardized mean difference for knee pain was 0.04 (3 studies; n=496; 95% CI, −0.11 to 0.19; P =.63).

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The lack of double-blind studies available for analysis and the lack of a sham control in several studies represent the main limitations of the review.

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“The implications of continuing to use these procedures without knowing whether they provide specific benefit are in urgent need of further research and discussion,” the researchers wrote. “In the meantime, it seems prudent that invasive procedures for chronic pain be avoided unless done as part of a clinical research study.”

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Jonas WB, Crawford C, Colloca L, et al. Are invasive procedures effective for chronic pain? A systematic review [published online September 10, 2018]. Pain Med. doi: 10.1093/pm/pny154