Why placebo and sham surgeries work

Posted on September 19, 2019

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(Last Updated On: September 19, 2019)

For a number of years research has been coming out on sham surgeries.

Background: We long ago discovered our thoughts can influence our biology. Thus, with drugs we always want to give placebo pills so we can figure out how much of the benefit is from that mysterious mind of ours. With surgery a placebo is rarely done, as you can’t exactly give someone a sugar pill. What can be done instead is a sham surgery. Something like you dress someone for surgery, go through anesthesia, make the same incisions, but you don’t perform the inside-the-body aspect of the procedure.

Some articles about this:

And then Doctor Skeptic has, albeit briefly, gone over quite a few surgeries. The theme of the sham research is the shams are doing as well as the real operations. Fairly concerning considering how much money and risk goes into surgery!

-> The shams do as well on average. As one article above hits on, that does not mean these surgeries are useless for everybody. But, on average, we are wasting money, time, increasing the amount of people who get infections…probably unnecessarily killing people…

How can this be?

There is first the mental argument. Where people get some benefit whether it’s from tricking their brain into thinking something productive was done, misunderstanding what was causing their pain to begin with ala “I just needed to get my joint cleaned up.” In some way the brain gets told “You’re ok now,” so the surgery, sham or not, works.

This is where many pain science aficionados -the “PAIN IS IN YOUR BRAIN!!!” crowd- start getting erections. “See! See! It’s all a mirage. People are deluding themselves! The medical industrial complex has fooled us!”

Yeah, sure, the brain matters, but there’s more to it than that.

One of the hardest things to accomplish when someone is dealing with a chronic issue, like a long-lasting knee, lower back, or shoulder, is getting the area to calm down, getting the person to give the area a breather.

One scenario I routinely see people have a hard time with is driving a car. A car seat can only be manipulated to a point. There is only so much room in there, the seat can only lean back so far when you have to drive, you can’t simply replace your car seat like other seats, you can only avoid the stress of traffic so much. There is a lot less flexibility to manipulate the environment than when sitting at a work desk. Nowadays you can even avoid sitting at work i.e. standing desks. But it’s tough to not drive to work.

Another aspect is changing behavior is damn hard. Say you’re someone who has right shoulder issues, often brought on by mousing at your computer. It can be very hard to change this behavior-

  1. Old habits do die hard
  2. Changing the habit makes the work take slower

To change how you use a mouse, or how you type, is going to make you, initially, mouse or type slower. What was once automatic is now conscious, and conscious thought takes longer than automatic. That can be a tough tradeoff. Whether it’s having to stay at work later, possible repercussions from your boss for working slower, sheer frustration, etc.

Sleep is another common one for the shoulder(s). Have right shoulder pain? You probably shouldn’t be sleeping on your right side.

  1. “But I always sleep that way”
  2. “I can’t fall asleep if I’m on my back”

Now think if a person like one of the above goes on vacation. Often many of the issues bothering a person calm down. Yes, we have to consider vacation is relaxing, and being less stressed tends to make everything feel better, but it’s also when a person all but assuredly changes their behavior due to such a drastic change in environment. You might not be driving at all, or if you are, it’s often in a rental car, so the stress of how you sit has been changed since you’re in a different car. You might be walking more site seeing opposed to sitting in front of a computer all day. Any sitting you are doing is, to at least some degree, going to be different than how you normally sit. You don’t have to mouse like you were. Everything changes.

But vacation is only perhaps a week long. Not a whole lot fully heals in a week. While injuries can calm down a lot, you’re back into the routine before fully calming down, and invariably that shoulder starts barking again. But if you get surgery…

Musculoskeletal surgery pretty much always forces a person to take an extended break from their daily routine. Even a basic orthopedic procedure will, for your everyday person, cause a minimum of 4-5 days off work. And it’s not like work is normal the moment you’re back. Someone else may drive you around for a bit. Then say it’s your right shoulder which was operated on. You’re probably going to be mousing with your left hand for a while, if any mousing at all. Probably a month minimum to where your mousing is significantly different. Oh, and you sure as hell won’t be sleeping on that arm! A rotator cuff surgery and your arm can be in a sling for months. You couldn’t have gotten away with that earlier, but now, after having a procedure done, you (probably) don’t have to worry about being fired.

-> More about changing how you sleep

If it’s a knee, and you haven’t already, you’re going to absolutely find a different way of driving. And sitting. And walking. The pain is too much otherwise. You may even decide screw it, time to buy a different car.

-> Sitting and knee pain

You may be using crutches for a couple weeks, and then once getting rid of them, walking extra slow to be sure you don’t mess the surgery up.

-> I’ve had people who I absolutely could not get them to change their walking. I can see them come into the gym half sprinting, but favoring a leg. “WALK SLOWER!” I yell, so they don’t have to limp. Get a knee surgery though? You will be walking differently.

If it’s a back, you may essentially lay down for multiple weeks until you’re good to start moving around again. When else would you have been able to pull this off? Try to do this under routine life and your significant other will scowl at you to the point you feel an imaginary Mack truck hitting your face. “Dad’s lower back is tight” doesn’t get much sympathy from your young children. “Dad just got out of surgery and looks half dead”, ok, still, probably little sympathy, but you’re less likely to have to pick up the kids and throw them in the air.

Due to the pain getting ratcheted up a notch, you very mindfully go through all your activities, changing them one by one to not irritate the area. Likely even more so after the surgeon has told you to really be careful for an extended period of time, and, now realizing how painful surgery is, or now you realize how terrible the nausea of anesthesia can be, you accept you do not want to do this process again, ever. This provides even more incentive to actually do the physical therapy exercises you’ve been given, and maybe even lose some weight as you’ve acknowledged “I really need to get my health in order now.”

A surgery can provide a giant kick in the ass for people in a variety of ways. Many having nothing to do with what was done in the surgery. Even if what was done was nothing.

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