Monday, March 8, 2010

Thankfully, a new placebo for knee pain. Electromagnetic pulses.

Thankfully, a new placebo for knee pain. Electromagnetic pulses.

"Electromagnetic Pulses May Stem Arthritic Knee Pain."
"New device could improve life quality without side effects, expert says"

After surgery got the ax (Mosely et al NEJM, 2002), knee pain sufferers have had to be satisfied with the chondrointin/glucosamine placebo effect (There are a lot of studies finding little to no benefit from this well-markted remedy; an example- Houpt JB, McMillan R, Wein C, Paget-Dellio SD. Effect of glucosamine hydrochloride in the treatment of pain of osteoarthritis of the knee. J Rheumatol. 1999 Nov;26(11):2423-30: "CONCLUSION: There was no significant difference in pain reduction between the glucosamine hydrochloride and placebo groups as measured by WOMAC. However, the secondary endpoints of cumulative pain reduction as measured by daily diary and knee examination were favorable, suggesting that glucosamine hydrochloride benefits some patients with knee OA.")
Seeming much less scientific-y, and not so mechanical, these pills just have not delivered the way some good ol blood and guts surgery would deliver. Not necessarily in measureable outcomes, but in patient satisfaction.
Thankfully, some one has come along to hitch some mechanical device up to your knee, and give you a placebo response that way.
Note how carefully the quote is crafted: the researchers are almost admitting the goal is patient satisfaction. The same as the neighborhood palm-reader. They (the researchers, not Marie Laveaux), say: ""We look at electromagnetic pulses as a potential way to improve quality of life and independence for those who suffer from osteoarthritis of the knee."
In the meantime, a continual parade of studies repeat the finding that you need to engage in regular physical activity to stave off knee arthritis itself, and to stave off knee pain. These medication and device studies rarely perform the study the proper way: use only exercisers, or get people up to some decent level of regular physical activity, THEN test their pet theory drug or gismo.
Here is an aexample of one of a parade of studies:

Gail D. Deyle, Nancy E. Henderson, PhD, Robert L. Matekel, Michael G. Ryder, Matthew B. Garber, Stephen C. Allison. Effectiveness of Manual Physical Therapy and Exercise in Osteoarthritis of the Knee. A Randomized, Controlled Trial. Annals of Internal Medicine 2000 v. 132, 173-181.
They conclude: "A combination of manual physical therapy and supervised exercise yields functional benefits for patients with osteoarthritis of the knee and may delay or prevent the need for surgical intervention."
Why am I commeting on this at a psych blog?
I see it as the same phenomenon: we want medical establishment-authorized cures for our maladies, even when the best answer is good old fashioned work: psychotherapy work, or physical rehab / physical activity work.

This preference for the easy way out, plus the placebo effect on a soft outcome such as "patient satisfaction" makes a big market for pill pushers. And device pushers.

Should you invest in this gizmo? I don't know. If it gets marekted the right way, millions will be sold.
Does it actually work? I doubt it. Also, I am kind of afraid of it: if it is moving around calcium in knee pain cells, where else is it affecting calcium in the vicinity? You stick it on your knee, which is close to the largest bones and muscles in your body. Bones make red blood cells. I am sure it is not a good idea to mess with calcium there in the bones as they make their red blood cells.

Hopefully the physiomechanical effect is just strong enough to evoke the placebo response, so we will all be satisfied and safe.

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