Found a new prolotherapist WOW

Discussion in 'Injuries and Prevention' started by yannick35, Aug 19, 2010.

  1. Late for dinner

    Late for dinner Valued Member

    clarification

    You have confused the study in 1960 with the study that was carried out recently. I know what you are saying regarding the vigour of the study but I think that this you need look at the results of the sacro-illiac study and not make comments re the effects of whiplash.

    Most things have an effect (at the least placebo) but considering the diagnostic criteria of the condition and the results of past attempts to treat patients at that particular stage then the results might seem more impressive to you.

    I deal with whiplash patients on a daily basis for both the NHS and private insurance companies. Most get better quickly but some do take a long time for a number of reasons. That may be why people have 3 years to submit a legal claim as to their status after a motor vehicle accident as there is a percentage of the patient population that does not heal quickly/well.

    I understand your scepticism. My point was only to show that there have been recent studies that support the use of this treatment that was first reported in the literature in the 1960's.

    Here is the conclusion of the Mayo Clinic on prolotherapy:

    Prolotherapy: An effective treatment for low back pain?
    Is prolotherapy an effective treatment for chronic low back pain?
    Answer
    from David P. Martin, M.D., Ph.D.

    Prolotherapy involves injecting sugar solutions into painful ligaments and tendons to stimulate production of connective tissue. The theory is that prolotherapy can strengthen these ligaments and tendons and reduce pain. Studies of prolotherapy have reported conflicting evidence regarding its effectiveness in treating chronic low back pain.

    A review of five well-designed studies concluded that prolotherapy alone is ineffective in treating chronic low back pain. However, when combined with other treatments — such as spinal manipulation and exercise — prolotherapy may improve chronic low back pain. More research is needed to clarify what role, if any, prolotherapy plays in the treatment of chronic low back pain.
    References

    1. Handout on health: Back pain. National Institute of Arthritis and Musculoskeletal and Skin Diseases. http://www.niams.nih.gov/Health_Info/Back_Pain/default.asp. Accessed Feb. 19, 2010.
    2. Dagenais S, et al. Prolotherapy injections for chronic low-back pain. Cochrane Database of Systematic Reviews. 2007:CD004059.

    http://www.mayoclinic.com/health/prolotherapy/AN01330
     
  2. Suhosthe

    Suhosthe A dwarf! A dwarf!

    You're right. I overlooked it when I wrote the post. It's not a good excuse, but while I'm at work I'm working to pretty tight targets, and get frequently interrupted. I apologise for not paying greater attention to your point. :)

    I appreciate that. There are also several controlled randomised double-blind clinical trials underway right now. None of them is studying the efficacy of prolotherapy with regards to lower back pain.

    I'm not saying that's necessarily significant; I just find that interesting.

    Exactly. Prolotherapy has not been shown to be effective on its own and may produce some kind of beneficial effect when combined with something else. That's no kind of reassurance if poking someone with a stick (or any other kind of convincing placebo) for free could potentially achieve the same results as injecting them with simple syrup for hundreds of dollars.

    I am being deliberately facetious. I know it's not really simple syrup. :D
     
  3. holyheadjch

    holyheadjch Valued Member

    I wonder, has there ever been a study that considered the relationship between the cost of a treatment and its efficacy?

    The placebo effect relies on the patient believing that the treatment is going to work and so would the placebo effect be greater if the treatment was very expensive - I'd argue yes, because as humans we tend to consider things that are more expensive to be better.
     
  4. Late for dinner

    Late for dinner Valued Member

    holyheadjch you are correct that expectations etc will give patients a certain level of improvement. I actually think that the study you are suggesting has been done. Perhaps this is why people are followed up at regular intervals for a number of years to see if the long term effect of a treatment is any better than the long term effect of any other treatment. Many, if not most, treatments act as short term first aid. This is not necessarily a bad thing as if the patient feels somewhat better for any reason then they can be moved onto active self-management, strengthening etc so that they were able to get control of their bodies themselves.

    There are so many complicating factors but even if there are not perfect studies patients need to be given some sort of help. Usually the least invasive and safest would be the most likely choice. Pain is a factor of how sensitive a tissue is as much as how damaged it is. Lepers don't feel pain which is why they tend to lose bits of their bodies without even noticing it. People with tic douloureux have severe pain and little obvious damage. You have pain from tissue damage as well as the potential for both peripheral and central sensitization (nerves fire too easily or the brain responds too fully to stimuli). There is a huge amount to consider when looking at a patient let alone performing a randomised double blind study. As well as the problem being studied you have to consider the ethics of what you are doing. To do a double blind study one group must be given a sham treatment (and not everyone wants to stay if they think they are not getting something effective which causes people to leave the study).

    Work needs to be done to find out what are the best methods for treatment but just because the research has not been done does not mean that we should do nothing (as doing nothing might not be the best thing either).

    One professor said to us that lack of evidence is not the same as evidence that a treatment is not effective. I am sure that with a bit of effort it is possible to nay say anything that has been attempted.

    I guess my only question to you would be what would YOU think could be done that would be better, how would you implement it and what would it cost? If you only have criticisms and not suggestions then you aren't helping much.

    powchoy
     
  5. Late for dinner

    Late for dinner Valued Member

    Exactly. Prolotherapy has not been shown to be effective on its own and may produce some kind of beneficial effect when combined with something else. That's no kind of reassurance if poking someone with a stick (or any other kind of convincing placebo) for free could potentially achieve the same results as injecting them with simple syrup for hundreds of dollars.

    I am being deliberately facetious. I know it's not really simple syrup. :D[/QUOTE]

    I think that your comparison is a red herring. Little has been shown to be effective on its own in the treatment of back complaints. Many studies look at whether a combination of treatments work rather than whether just one thing is effective by itself. If you are in too much pain then you can't exercise easily so the study might compare the effects of exercise and medications versus medicine alone to see if the exercise can be effective when otherwise the patient would be unable to exercise. This is not to say that either the exercise or the medications are effective by themselves at a particular stage of an injury but the synnergy of using them together might be better than you could achieve with either alone at that time

    I don't think that poking someone with a stick has ever been shown to have a positive effect so the arguement that it is as good as prolotherapy would be acceptable. This is purely just an attempt to distract one from the arguement at hand. You mention effective placebos A placebo is supposed to be something that the patient expects would improve their condition. This is one of the difficulties in teasing out the placebo from the treatment. Ice packs might help because of physiological changes or it might be just because the patient expects it to work. The difference , at least for some treatments over placebos, should be the length and amount of improvement over time. Even if a placebo is effective it often just amounts to temporary relief of a complaint. Doctors used to tie off the mammilary artery on the external chest wall to treat heart conditions with a good placebo effect but you would not expect that the underlying hear condition would go away in the long term because of this (and it did not).

    Lots of treatments have potential risks. We had a lady die a few years ago during a disc operation but she asked that it be done in spite of the risks because she could not stand her sufferng any longer. For the patient population that might benefit from prolotherapy some might prefer to try it because there is some evidence that in certain circumstances it could be helpful. Saying it might not work any better than a placebo is a cop out. You could not do studies to evaluate any treatment unless you were willing to have people try things that might not work in the first place any better than a placebo. And as I said in a previous post just because something has not been studied satisfactorily does not mean that under certain circumstances it might not be effective.

    Sorry for the rant but I think you are not fully considering the possible benefits as opposed to the potential risks.

    powchoy
     
  6. CKava

    CKava Just one more thing... Supporter

    Administering expensive and invasive treatments before you have proven that they actually produce an effect beyond the placebo I would say is much more ethically dicey than conducting studies with a placebo group. I also imagine that with back pain it would not be impossible to find enough people who would be willing to 'risk' receiving a placebo to receive additional treatment. If it was really a big concern you could also simply compare NEW EXPENSIVE TREATMENT A against CHEAPEST PROVEN TREATMENT B instead of a true placebo.

    Who is saying do nothing? There are a whole heap of treatments available for chronic back pain. It is one of the most nebulous recurring problems that people face so there is no shortage of available treatments and/or folk/alternative remedies on offer. We should not however promote expensive invasive treatments before there is good evidence they actually work beyond a placebo!

    No study is perfect but studies exist on a spectrum from very well to very poorly designed. Multiple well designed studies showing a strong effect are hard to 'nay say' whereas a few poor designed studies showing mixed effects deserve to be looked at skeptically since they are showing what you would expect to find from a placebo treatment. Asking for better studies for treatments isn't being mean, it is being prudent. Otherwise we would end up with a lot of treatments that don't actually do anything.

    Simple really put proper controls in place, include a placebo arm, blind as many people as feasible and if possible compare the treatment against an established treatment. It's the same formula to improve all treatment studies. I also suspect that the cost of running a trial would be a very minute in comparison to the profit being made by clinics that already offer and promote the treatment.
     
  7. CKava

    CKava Just one more thing... Supporter

    Actually it has been shown. Take a look at this study where 'sham acupuncture' whereby people were poked with tooth*****s provided the same benefit as 'real' acupuncture.

    http://www.nhs.uk/news/2009/05May/Pages/Acupuncturerelievesbackpain.aspx

    N.B. Rather amazingly a number of sites and the study authors tried to promote this result as proving that acupuncture was effective.

    Having a deep belief in the placebo is not a requirement to get a placebo effect. And as for ice packs and whatnot of course they will activate the placebo effect... all treatments do, but the difference is that a treatment proven to be effective will have an effect beyond the placebo, if the effect is indistinguishable from the placebo well then... all you have is a placebo! That's not denying that people get benefit from placebos but it shouldn't be what modern evidence based medicine aims for.

    You can get quite far on the placebo effect and while I agree with you that it usually offers only temporary relief (see yannick's past threads on his other therapies) I also think there are numerous examples of how placebo induced relief can last for significant periods especially if part of the pain/condition is psychosomatic.
     
  8. Suhosthe

    Suhosthe A dwarf! A dwarf!

    I have a suggestion. Everyone should read this excellent explanation before espousing the virtues of an unproven technique or therapy.

    You may think me rude to say so, but there is no substitute for cold, hard evidence.
     
  9. Suhosthe

    Suhosthe A dwarf! A dwarf!

    A red herring.

    You cited a study specifically dealing with back complaints.

    Prolotherapy is used for more than just back complaints.

    Admittedly, the back complaints thing is interesting because there is no proof and no-one appears to be interested in getting it, perhaps for the difficulties you cite.

    If prolotherapy had hitherto been clinically proven on something other than the lower back in the 50 years in which it has been used on paying patients then its use might be considered acceptable under the circumstances. Oddly, it hasn't been proven to work at all.

    Argue all you like about how difficult it is to prove what helps relieve back pain, but prolotherapy is not used exclusively for that purpose.

    No, it was just a comical example. It was making my point.

    Some people think that comedy can be used didactically. It is supposed to be fairly effective in making an argument memorable.

    I don't find humour detracts or distracts from making a valid point, but if it will make you feel better, I'll try and cut it out for the rest of the debate.

    How can you identify a placebo if you don't test it? I recommend not charging people hundreds of dollars (starting at $5 a minute for a consultation) in case the treatment you offer is not a placebo.

    A dear friend of mine has undergone 2 terrifyingly risky spinal surgeries to deal with his back problems.

    For him, the pain relief totally outweighed the risks and, fortunately, he survived the surgery both times.

    I would not have recommended prolotherapy or any other untested treatment to him, either, even knowing that the surgery he was undergoing could kill him, because there was actual evidence that if the operation was a success, he would be in less pain.

    Um. No.

    Would they try electro-shock therapy for the pain if some doctor posited 50 years ago that it might help, no actual proper research had been carried out, but a few people who'd undergone the treatment said it had made them feel better and the doctors who treated them wrote up what they said?

    I know I wouldn't.

    Umm. Yeah. That's why they pay people to take part in studies. That's why people who are desperate take part in studies.

    The possible benefits that I see include at least 2 sports doctors making money out of Yannick and his insurance company for an unproven and untested treatment.

    I genuinely hope, for Yannick's sake, that when the clinical studies are complete, they indicate that prolotherapy is a worthwhile and valuable treatment. I just don't expect it.
     
  10. yannick35

    yannick35 Banned Banned

    Well you guys keep having fun with your little debate on prolotherapy even if none of you ever got pocked, and received a treatment ever in your life.

    That one got me laughing prolotherapy is dangerous mouahahah have you read the studies on chiropractor and the arm it can do to your back, people get paralyzed from adjustments and some have had hernia in the back.

    Time for me to leave this board its filled with <people who like to express their opinions, allegedly unintelligent people and wannabee scientist>, please close my account ban me and lets get it over with. Bunch of <people whose opinions I don't agree with>
     
    Last edited by a moderator: Aug 21, 2010
  11. slipthejab

    slipthejab Hark, a vagrant! Supporter

    I somehow don't think that anyone is going to be surprised at this. I can see his eyes watering up with rage as he wrote that. I'm not going to be the first one to say roid rage. :p
     
    Last edited by a moderator: Aug 21, 2010
  12. holyheadjch

    holyheadjch Valued Member

    Yannick, not all of the scientists on here are wannabees, many of them are actual living breathing, know this shizzle backwards scientists.
     
  13. holyheadjch

    holyheadjch Valued Member

    Are there any studies exploring the relationship between prolotherapy and a person's tendency towards violent outbursts and tantrums? If not, perhaps there should be.
     
  14. Suhosthe

    Suhosthe A dwarf! A dwarf!

    Nice edit, Llama. :) If I'd pressed "quote" one minute earlier... :D

    Anyway, Yannick, it's probably pointless me posting this as you don't intend to come back, however, I find it remarkably ironic that only a few hours ago I was so concerned about the well-being both of your body and your bank account.

    I'm sure on multiple occasions within this thread I have sympathised with your condition and admitted that I can't relate specifically to your pain, and for that reason I'm not judging your decision to partake of alternative therapies. I'm sure that I have addressed any specific criticisms regarding specific posts to their specific poster, none of which included you. I'm sure I have not openly been rude to you.

    I realise I am donning a cap which may, or may not, fit, but I am surprised that you would take the debate around the subject which you have raised so personally, and am disappointed that you feel that in the face of this discussion, you want to leave.
     
  15. Late for dinner

    Late for dinner Valued Member

    Just out of interest I don't know how much you have looked at this information. I know that there is alot of controversy in the acupuncture research community as to what actually constitutes a placebo. Any physical intervention to an acupuncture point has the potential to stimulate the system whether a needle is used or not. In fact in chinese medicine anything that is tender is in effect a defacto acupuncture point and direct stimulation with any object would be considered as possibly having a therapeutic effect. Huge problem. Its not a placebo if it might work just as well. One study on knee pain suggested that the sensory stimulation to a sensitive area was more important than actually stimulating an acupuncture 'point' at all. Some practitioners use moxa (burning a herb), some use pressure with an implement or hand, some needles, some suction cups etc...

    To what level have you looked at this stuff? I remember the difficulties that we experienced in grad school with research design. Its easy to make comments about what one would do but have you any experience in the real world actually trying to set up the sort of stuff you have been mentioning?
    I know that there has been little well designed research that supports any of the treatments for chronic low back pain that you are suggesting would be a better choice than prolotherapy.

    Actually I am not promoting any treatment here. I was just trying to show there might be some support for what Yannick feels is helping him. You mention costs but here in the UK treatment is not necessarily going to cost anything in the NHS so its a moot point. As far as dangers of treatment go I think that reviews of treatment ie the Cochrane review do not show that these are likely with prolotherapy. I get the impression that you would be happier for Yannick to try treatments that have weak to moderate support but no strong evidence because they are non invasive and have been around longer. Is this the case?

    There are number of difficulties in testing any treatment. Have you ever tried to design a study with proper controls? You are supposed to use randomization to make the groups equal although simple things such as differences in socio-economic backgrounds may affect the success of a treatment. Do you have people travel to different clinics to make sure the populations are similar? You have now added increased load on these patients because of increasing the time they are travelling. Do you only use women? men? certain age groups? people who are not working?
    Each control limits the generalisability of your findings and makes any conclusions limited to the specific group of people you have looked at.
    If a treatment is new and you are trying to determine if it is effective then you have difficulties in making sure that the practitioners all perform the technique the same way. Should they ie all inject to the same level or should they go to the patients area of worst complaint? Does a failure of the first approach mean that the method is not any good or merely that the second approach should have been tried? At what point do you decide that something is not potentially effective? Research does not prove that something does not work but only shows the probability that the method in question may or may not have an effect in the circumstances cited.

    Of course there needs to be better research etc but in the mean time people suffer and one does need to make some choices as to what might afford patients relief.

    powchoy
     
  16. Gary

    Gary Vs The Irresistible Farce Supporter

    This thread has nothing to do with World of Warcraft!
     
  17. Moi

    Moi Warriors live forever x

    He's done it again? I blame that painful back of his. He should get it sorted
     
  18. Suhosthe

    Suhosthe A dwarf! A dwarf!

    Pressure with an implement? What? Like a stick?

    Your argument seems to be inconsistent.

    Acupuncture did not hold up well under proper scientific scrutiny. I have a feeling that you're not looking as objectively at the data as you imagine.

    Gosh. If only there were real scientists that could actually study this stuff. If only there were people who would provide funding for scientific research. If only there were people to administrate such studies and ensure their viability as well as their validity. If only there were peer-reviewed journals in which these studies could be published. If only there could be more than one study so that we could compare the results and see if the findings were similar.

    What a shame we don't live in such a world and we have to rely on guess work and conjecture for all our medicine.

    Surely that's an argument for more research, not treating people on a wing and a prayer?

    Yes. Because the NHS is such a nice organisation, they don't need to pay for medicine, or staff, or buildings, or equipment. Everyone likes them so much that they volunteer all these things for free.

    To suggest that costs are not a factor in the NHS is laughable, especially as there are numerous, proven, effective treatments which the NHS will not pay for in much of the UK.

    I'd rather Yannick underwent an invasive therapy that had actual proof of efficacy.

    It's a good argument for not testing things that are likely to turn out to be ineffective, but it is a moot point.

    Of course there are difficulties. That hardly means that these things shouldn't be tested.

    Exactly. That's why a body of evidence needs to be collected; why multiple independant and properly carried out studies showing comparable results are needed before a treatment is used on a patient.
     
  19. CKava

    CKava Just one more thing... Supporter

    I've looked into the topic in quite some depth and I think most of the 'controversy' comes from the fact that advocates of acupuncture (who make up the majority of researchers investigating it) are unwilling to accept the implications of negative results because they are already heavily invested in the belief that it is an effective treatment. There are legitimate debates about how to make convincing placebo treatments and difficulties in regards blinding but by far the greatest source of 'controversy' about placebos in the acupuncture research community is that the good ones (i.e. the ones people can't recognise as being different) tend to produce an effect indistinguishable from the 'real' treatment'.

    In which case it seems odd that people train for years to learn the precise points in the meridan's and the exact combinations of points required to produce specific therapeutic effects. If you can produce the same effect by simply touching tender parts of the body with a toothpick then it seems like a lot of people are wasting a lot of time.

    If your therapeutic effect is indistinguishable from someone touching random points on the body with toothpicks then it's a fairly safe bet that you've got a placebo. There isn't a huge problem here unless you are already convinced that acupuncture must be effective. If there was a drug that was shown to produce no more benefit than someone eating a packet of fruit pastilles I doubt you would be arguing that this is a huge problem and that it means we cannot dismiss the drug's effectiveness and should instead be considering fruit pastilles as a valid potential treatment. So why the difference in how we interpret evidence for efficacy?

    The fact that Chinese medicine is complicated doesn't mean you can't examine the effectiveness of specific treatments. Moxibustion might be based on similar theories to acupuncture but the treatments are clearly different. Similarly, acupuncture involving penetration with needles is a different treatment than acupuncture involving penetration with needles and electric current applied. The fact that there is a variety of practices and little standardisation seems to me to be a pretty good argument for why more attention should be paid to evidence of efficacy. I assume you would agree that not all treatments will be equally effective for all conditions so shouldn't it be a goal to try and establish which ones (if any) are effective rather than recommending them all?

    Pretty deep I'd say. I've been following this kind of research for a good few years now and I've spent more time than I care to admit reading studies and looking into the various debates surrounding the area. My studies for the past six years have been based around East Asian cultures and in particular spiritual and religious beliefs so Chinese medicine and the underlying philosophies are extremely familiar to me. On top of that I am a rationalist, a skeptic and I am an advocate for evidence based medicine and good scientific research in general. I've also found that the arguments employed to support most alternative medical treatments often have very little to do with studies and evidence and much more to do with the psychology of beliefs and intuitions.

    I'm not a medical researcher so I haven't conducted clinical trials because I'm not qualified to do so, I don't have the resources to do so and there are already much more qualified people doing that. I do not believe however that you are required to have conducted a medical trial in order to recognise basic issues such as lack of suitable placebo arms or more complicated things such as fudging the statistics. I am studying Cognitive & Evolutionary Anthropology at Oxford so I have some experience with designing psychological studies and a lot more experience with being required to critically evaluate other researchers studies. And for all good studies be it in psychology or medicine the basic principles remain the same: Reduce the potential impact of researcher bias, include controls, blind subjects and so on.

    Which treatment in particular that I mentioned are you referring to?

    Huh? If a treatment is more expensive then it will cost the NHS more money. We pay for the NHS in our taxes therefore the cost is not an irrelevant concern. Why would we want the NHS to spend more money on treatments that have not been proven to be any more effective than cheaper conventional treatments?

    As Suhoste says what yannick does is his choice but I don't think it is reasonable to promote an invasive treatment which has not yet been established as effective on the basis of personal experience. If yannick's benefit was coming from the placebo effect wouldn't he be reporting the exact same benefit? That's why individual testimonies aren't enough and we need to get better evidence from controlled studies.

    In terms of what I would personally advocate. Yes I would suggest that people should work from the evidence and should start with the least invasive treatments possible.

    Yes I have designed a study and it was a cross cultural study looking at psychological responses to religious concepts and so I am well aware of the difficulties with creating good controls. The problems you mention are real but they are the kind of difficulties that every good medical researcher knows about, they are also the kind of difficulties that are routinely ignored in alternative medicine research. By pointing out how easy it is to influence outcomes you are essentially supporting my argument that prolotherapy is in need of better designed before it can be regarded as an effective treatment.

    Again this is all true but it doesn't mean we should give up on doing good studies and getting good evidence it just means that it we have to work hard to implement studies with good controls.

    So what is your actual position? Are you saying that doctors should promote treatments that lack strong evidence of efficacy if there is anecdotal evidence for effect and/or a treatment is popular? If so I disagree.
     
  20. Late for dinner

    Late for dinner Valued Member

    Suhosthe:

    Pressure with an implement? What? Like a stick?

    Your argument seems to be inconsistent.

    Acupuncture did not hold up well under proper scientific scrutiny. I have a feeling that you're not looking as objectively at the data as you imagine.

    Well this depends on how you read things LOL. I don't equate poking people with a stick to applying a sham or otherwise treatment with a blunt object. While there is potential for an effect in the first case your comment was taken as being a non-specific application when you presented it.
    If I misunderstood you then I was incorrect in my assumptions as to what you were meaning.


    Quote:
    Originally Posted by powchoy
    To what level have you looked at this stuff? I remember the difficulties that we experienced in grad school with research design. Its easy to make comments about what one would do but have you any experience in the real world actually trying to set up the sort of stuff you have been mentioning?
    Gosh. If only there were real scientists that could actually study this stuff. If only there were people who would provide funding for scientific research. If only there were people to administrate such studies and ensure their viability as well as their validity. If only there were peer-reviewed journals in which these studies could be published. If only there could be more than one study so that we could compare the results and see if the findings were similar.

    What a shame we don't live in such a world and we have to rely on guess work and conjecture for all our medicine.

    You might want to look at some of the research and the organisations that are about . A pub-med search on acupuncture and back pain lists 368 papers on acupuncture and low back pain.


    Quote:
    Originally Posted by powchoy
    I know that there has been little well designed research that supports any of the treatments for chronic low back pain that you are suggesting would be a better choice than prolotherapy.

    Surely that's an argument for more research, not treating people on a wing and a prayer?


    I agree with you. There needs to be better research on all treatment methods. Since there is not strong support in the literature for any one method would you then not offer any treatment that has been shown to have some reasonable level of efficacy until better research was performed?


    Quote:
    Originally Posted by powchoy
    Actually I am not promoting any treatment here. I was just trying to show there might be some support for what Yannick feels is helping him. You mention costs but here in the UK treatment is not necessarily going to cost anything in the NHS so its a moot point.

    Yes. Because the NHS is such a nice organisation, they don't need to pay for medicine, or staff, or buildings, or equipment. Everyone likes them so much that they volunteer all these things for free.

    To suggest that costs are not a factor in the NHS is laughable, especially as there are numerous, proven, effective treatments which the NHS will not pay for in much of the UK.

    Ok so the methods available are not to your liking. SO what do you think is effective? In the NHS the NICE recommendations suggest mainly using acupuncture, manipulation or exercise possibly in combination and potentially with psychological treatments added as well. What do you see as being better? http://guidance.nice.org.uk/CG88/NICEGuidance/pdf/English


    Quote:
    Originally Posted by powchoy
    As far as dangers of treatment go I think that reviews of treatment ie the Cochrane review do not show that these are likely with prolotherapy. I get the impression that you would be happier for Yannick to try treatments that have weak to moderate support but no strong evidence because they are non invasive and have been around longer. Is this the case?
    I'd rather Yannick underwent an invasive therapy that had actual proof of efficacy.


    Surgery is not thought to be a primary option for most patients until they have already gone through the methods I mentioned already. Historically surgery has had both good and bad results that have made people question how much it should be offered outside of a very well defined group of patients. The American Pain Society does not give much of a recommendation for using surgery for chronic back pain and suggests that the majority of patients that seek surgical treatment do not have optimal outcomes (defined as no pain/return to high functional levels and being able to stop medications) . Http://site.fysio-live.workingpropeople.com/Upload/MTV/casper3.pdf


    Quote:
    Originally Posted by powchoy
    There are number of difficulties in testing any treatment.
    It's a good argument for not testing things that are likely to turn out to be ineffective, but it is a moot point.

    Of course there are difficulties. That hardly means that these things shouldn't be tested.

    Did I ever say that things should not be tested? I just wonder when you think people should be offered treatment and how you are supposed to see if treatment works or not experimentally if sufficient numbers or patients are not available. In order to show an effect from a treatment you need a large number of people involved or statistically the treatment will not show effectiveness irrespective of what it can do clinically. This is know as Type 2 error in statistics and is a real problem when dealing with small patient populations.


    Quote:
    Originally Posted by powchoy
    Have you ever tried to design a study with proper controls? You are supposed to use randomization to make the groups equal although simple things such as differences in socio-economic backgrounds may affect the success of a treatment. Do you have people travel to different clinics to make sure the populations are similar? You have now added increased load on these patients because of increasing the time they are travelling. Do you only use women? men? certain age groups? people who are not working?
    Each control limits the generalisability of your findings and makes any conclusions limited to the specific group of people you have looked at.
    If a treatment is new and you are trying to determine if it is effective then you have difficulties in making sure that the practitioners all perform the technique the same way. Should they ie all inject to the same level or should they go to the patients area of worst complaint? Does a failure of the first approach mean that the method is not any good or merely that the second approach should have been tried? At what point do you decide that something is not potentially effective? Research does not prove that something does not work but only shows the probability that the method in question may or may not have an effect in the circumstances cited.
    Exactly. That's why a body of evidence needs to be collected; why multiple independant and properly carried out studies showing comparable results are needed before a treatment is used on a patient.

    So as I said before: You need multiple studies with comparable problems and populations of a minimum size to find out whether something is likely to be effective. This is an ongoing process and as my note of 368 papers for acupuncture mentioned earlier shows it is being done. Yes there is more to be done with regards prolotherapy. You might also like to look at http://www.shareclevelandla.com/files/Research/Literature_reviews/The_Spine_Journal_Jan-Feb_2008.pdf
    This gives a fairly lengthy review of a number of treatments including prolotherapy and
    suggests some further research. They do say that the judgement on prolotherapy is not clear as there were three good studies with positive outcomes.

    I think that if we want to discuss this any further then you should pm me as I will not be responding further on this thread after I have finished replying to CKava. Thanks your your point of view.

    powchoy
     

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