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Is surgery best way to stop back pain?

Rating

3 Star

Is surgery best way to stop back pain?

Our Review Summary

This story reports on the results of a large clinical trial published in the Journal of the American Medical Association evaluating surgery compared to non-operative care for herniated disc. This trial represents the first randomized clinical trial of surgery in the US since 1983 and greatly improves our understanding of the benefits of surgery. This story does a good job of explaining the strength of the existing evidence and rightly highlights some of the controversies. The story also does a good job of focusing on why patients need to be informed and take a lead role in decision making.

The story does a decent job of describing the new study and explaining the controversy over the large numbers of cross-overs, or people in the study who were initially designated to non-operative care who opted to have surgery (or vice versa). The also story mentions various kinds of non-operative care, including physical therapy, medications and steroid injections, as the alternative to surgery.

The story only quotes the study's lead author. The story should have quoted other clinicians/researchers who could have provided other perspectives. The story does not quantify the benefits of treatment and although harms of surgery are rare, the story should have mentioned the possible complications such as wound infection or need for reoperation. There was no discussion of costs of surgery or of any of the non-operative options.

Unfortunately, the story crosses the line into disease mongering in the beginning of the story by stating that back pain is "almost as common as the common cold." Although back pain is common, this story is really about herniated disc, a specific back condition that is relatively uncommon. The story does not clearly differentiate between the average patient with low back pain and the patients enrolled in this study who had sciatica due to a herniated disc. The study goes on to describe what a herniated disc is, but the first paragraph implies that 4 out of 5 of us will have the condition described in the story.

Criteria

Does the story adequately discuss the costs of the intervention?

Not Satisfactory

The story does not mention costs of surgery or any of the non-operative options.

Does the story adequately quantify the benefits of the treatment/test/product/procedure?

Not Satisfactory

The story does not quantify the benefits of treatment and presents qualitative results only.

Does the story adequately explain/quantify the harms of the intervention?

Not Satisfactory

Although harms of surgery are rare, the story should have mentioned the possible complications such as wound infection or need for reoperation. The story also does not address potential harms of non-operative treatment, such as permanent nerve damage from cauda equina syndrome.

Does the story seem to grasp the quality of the evidence?

Satisfactory

The story at least attempts to describe the study and to explain the controversy over the large numbers of cross-overs, or people in the study who were initially designated to non-operative care who opted to have surgery (or vice versa). We'll give it the benefit of the doubt on this criterion.

Does the story commit disease-mongering?

Not Satisfactory

The story crosses the line into disease mongering in the beginning of the story by stating that back pain is "almost as common as the common cold." Although back pain is common, this story is really about herniated disc, a specific back condition that is relatively uncommon. The story does not clearly differentiate between the average patient with low back pain and the patients enrolled in this study who had sciatica due to a herniated disc. The study goes on to describe what a herniated disc is, but the first paragraph implies that 4 out of 5 of us will have the condition described in the story.

Does the story use independent sources and identify conflicts of interest?

Not Satisfactory

The story only quotes the study's lead author. The story should have quoted other clinicians/researchers who could have provided other perspectives.

Does the story compare the new approach with existing alternatives?

Satisfactory

The story mentions various kinds of non-operative care, including physical therapy, medications and steroid injections, as the alternative to surgery.

Does the story establish the availability of the treatment/test/product/procedure?

Satisfactory

It's clear from the storyt that surgery for herniated disc is widely available.

Does the story establish the true novelty of the approach?

Satisfactory

It's clear from the story that surgery is not a new idea.

Does the story appear to rely solely or largely on a news release?

Not Applicable

There is no way to know if the story relied on a press release as the sole source of information, although it did only interview the study's lead author.

Total Score: 4 of 9 Satisfactory

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