Understanding Placebo Effect without Distortion of the Truth
Placebo effect is fascinating, yet totally misunderstood and biased. A placebo is a substance or treatment, which is designed to have no therapeutic value. Essentially, it means an inert substance is injected into an inert structure through injection other than by mouth or sham surgery. The use of placebos in clinical medicine raises ethical concerns, especially if they are disguised as an active treatment, as this introduces dishonesty into the doctor-patient relationship and bypasses informed consent.
Overenthusiastic academicians have started converting active controlled trials with local anesthetic alone compared to local anesthetic steroids into placebo controlled trials with local anesthetic being placebo. This is met with high levels of bias due to academic eagerness and other financial interests constituting deviation from the truth. By no means this is not an error caused by chance. Bias represents a systematic distortion of the truth. The number of instances of these types of biases are large, starting from Cochrane reviews and AHRQ funded studies, extending to wide-spread academics. The present manuscript on epidural injection of sodium chloride solution shows that sodium chloride solution when injected into epidural space is equally effective as steroids alone or a combination. Multiple other manuscripts show that steroids have some effect when combined with local anesthetic, which is not significant.
Knezevic N, Manchikanti L, Urits I, et al. Lack of superiority of epidural injections with lidocaine with steroids compared to without steroids in spinal pain: A systematic review and meta-analysis. Pain Physician 2020; 23:S239-S270.
Manchikanti L, Knezevic NN, Parr A, Kaye AD, Sanapati M, Hirsch JA. Does epidural bupivacaine with or without steroids provide long-term relief? A systematic review and meta-analysis. Curr Pain Headache Rep 2020; 24:26.
Shanthanna H, Busse J, Wang L, et al. Addition of corticosteroids to local anesthetics for chronic non-cancer pain injections: A systematic review and meta-analysis of randomized controlled trials. Br J Anaesth 2020; 125:779-801.
Authors of multiple manuscripts by converting local anesthetic into placebo or committing systematic distortion of the literature and essentially accusing the physicians who use local anesthetic only when steroids are needed as fraudulent. Hopefully, this manuscript and other manuscripts will provide light to these distortions.
Read the manuscript on PubMed