Over the next couple posts I’m going to discuss a case study that casts a helpful light upon our recent discussion of the so-called placebo type positive effect resulting from a treatment approach that privileges informing and empowering patients.
In this study on vertebroplasty and the relevance of patient disclosure, it was shown that patient disclosure does have an impact on results as it influences expectations. In the first study there was no patient disclosure and the results were attributed to the placebo effect. In the second study where there was disclosure, patients did not know whether they were receiving the “treatment” or were receiving a “sham treatment.” But there was too much uncertainty to align themselves with the positive expected results and clinically they did not do as well.
“To further illustrate the impact of information disclosure on treatment benefits, consider the widely-used treatment for painful vertebral fractures known as vertebroplasty (which involves injecting cement into the spine with the aim of relieving pain by stabilizing the fracture). In 2009, the New England Journal of Medicine published the results of two double-blind sham-controlled trials, which demonstrated no difference in pain relief between vertebroplasty and a fake invasive intervention without injecting cement.
“In contrast, a more recent unblinded randomized trial comparing vertebroplasty to conservative medical therapy demonstrated substantially greater improvement in pain. A reasonable interpretation of these two sets of trials is that vertebroplasty is effective in relieving pain, not as the result of injecting cement but by virtue of the placebo response.”
If you’ve been following this blog recently, though, these findings will not come as a surprise to you. I’ll have a little more to say to wrap up this topic in my next post.