An extensive review of 25 randomized clinical trials found “little evidence” that invasive surgery was more effective than sham or placebo procedures in reducing chronic pain. The study was published in the journal "Pain Medicine".

An estimated 100 million Americans suffer from chronic pain, with costs estimated at more than $500 billion annually. With the development of new minimally invasive procedures, Americans spent an estimated $45 billion on surgery for chronic low back pain. Non-opioid treatments, like surgery, are being increasingly used.

But researchers concluded that: “evidence does not support the use of invasive procedures as compared with sham procedures for patients with chronic back pain. Given their high costs and safety concerns, more rigorous studies are required before invasive procedures are routinely used for patients with chronic pain.” The findings are based on a systematic review of studies from 28 publications between 1959 and 2013 involving surgeries on 2,000 patients.

In each study, researchers had also performed sham procedures on a control group where they faked the invasive procedure by omitting the step believed to be therapeutically necessary. They then compared reduction in pain intensity, disability, health-related quality of life, use of medication, adverse events, and other factors at various time periods after the procedures. Patients did not know which intervention (real or sham) they had and in most cases, evaluators were also blind to which procedure a patient received.

Overall, the reduction in disability post-procedure did not differ between the two groups at three months or at six months. A meta-analysis on outcomes in seven studies of low back pain showed no difference in pain at six months compared with sham procedures.

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