SOME RECENT STUDIES ARE QUESTIONING the effectiveness of drug use for pain, while another looked at effectiveness of managing pain with herbal medicines. When I read these studies, I see questioning of the marketing juggernaut that is the pharmaceutical industry. I also see huge efforts to be scientific and remove the placebo effect, which are effects that are often significant themselves and can mask the clinical effect of a drug. This, in turn, makes me wonder why there isn’t more focus on harnessing the placebo effect as a tool to improve patient outcomes.
The recent studies:
• In a large, five-year study of patients with acute radiculopathy due to a herniated lumbar disc, “a short course of oral steroids, compared with placebo, resulted in modestly improved function and no improvement in pain [reduction].” [Goldberg H, Firtch W, Tyburski M, et al. Oral steroids for acute radiculopathy due to a herniated lumbar disk: a randomized clinical trial. JAMA. 2015;313(19):1915-1923. doi:10.1001/jama.2015.4468. Retrieved from http://jama.jamanetwork.com/article.aspx?articleid=2293294.]
• A large, multi-site study of lumbar spinal stenosis concluded, “epidural injection of glucocorticoids plus lidocaine offered minimal or no short-term benefit as compared with epidural injection of lidocaine alone.” Lidocaine is like a dentist’s novocaine; it numbs the pain for a short while. The (unachieved) goal of the glucocorticoid is reducing inflammation and promoting healing. [Friedly J, et al. A randomized trial of epidural glucocorticoid injections for spinal stenosis. N Engl J Med 2014; 371:11-21 July 3, 2014;DOI: 10.1056/NEJMoa1313265. Retrieved from www.nejm.org/doi/full/10.1056/NEJMx140040.]
• In a meta-study of herbal medicines for nonspecific low-back pain that looked at more than 2,000 people from 14 other studies, “Capsicum frutescens (cayenne) reduces pain more than placebo. Although Harpagophytum procumbens (devil’s claw), Salix alba (white willow bark), Symphytum officinale L. (comfrey), Solidago chilensis (Brazilian arnica) and lavender essential oil also seem to reduce pain more than placebo, evidence for these substances was of moderate quality at best. No significant adverse events were noted.” [Gagnier JJ, et al. Herbal medicine for low back pain – a Cochrane review Spine (Phila Pa. 1976). 2015 Nov 30. [Epub ahead of print]. Accessed at www.ncbi.nlm.nih.gov/pubmed/26630428.]
Office Face Time: Patients vs. Electronic Health Records
PATIENTS RATE THEIR CARE LOWER the more the doctor looks at a computer screen using an electronic health record (EHR) system, according to a new study in JAMA Internal Medicine.1 And, according to the study, on average, a third of a doctor’s visit time is spent using electronic health records.
Here are the new POISED guidelines* to help improve patient communications while using EHRs:
PREPARE: Review the electronic medical record before seeing the patient.
ORIENT: Briefly explain how the computer will be used during the appointment.
INFORMATION GATHERING: Enter data when with patients to show their concerns are being taken seriously.
SHARE: Show the computer screen so patients can see the information.
EDUCATE: Display a graphic representation of, say, the patient’s weight or blood pressure over time.
DEBRIEF: Make sure the patient understands what you said.
*Source: Richard Frankel, PhD, Regenstrief Institute and Indiana University School of Medicine. 1. Ratanawongsa N, et al. Association between clinician computer use and communication with patients in safety-net clinics. JAMA Intern Med. Published online Nov. 30, 2015. doi:10.1001/jamainternmed.2015.6186.
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