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Reader Remarks on:

Vertebroplasty Strikes Out

• Vertebroplasty
• Vertebroplasty
• Vertebroplasty
• Placebo

Vertebroplasty

Darol Joseff, Santa Barbara, 6 Aug 2009 12:20 AM EST

Competing interests: None declared

I've seen a number of very miserable, severely pained (to the point of being morbund) elders be functional and without pain the day after vertebroplasty (and I'm just the internist, not the surgeon). Apologies, but I don't believe the conclusions of this study.

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Vertebroplasty

Roman. B. Ruther, family office, 8 Aug 2009 1:20 PM EST

Competing interests: None declared

I agree with colleague Darol Joseff. I'm a general practitioner and have seen several older patients with spine fractures due to osteoporosis with heavy pain. After Vertebro-/Kyphoplastie they had significant lower pain within a few days . A problem is already to discuss about the disposition for further fractures of the proximal or distal of the stabilized vertebrae.

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Vertebroplasty

j harper, NHS Hospital, 27 Aug 2009 1:11 AM EST

Competing interests: Dislike of unproven high cost medicine

Re. previous remarks - consider the power of placebo (especially powerful in "hospital-based, high tech" interventions)

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Placebo

R. Luz Coelho, Family Physician, Curitiba - Brasil, 16 Jan 2010 6:45 AM EST

Competing interests: None declared

Placebo is a very powerfull entity in medicine, one wich many very good physicians and surgeons sometimes underestimate.

A procedure that leads to no benefit compared to no procedure in 2years time should not be seen as a "way out", specially considering pain management.

Pain is a very complex nosologic entity, back pain is even more complex. Pain is lesion, but also perceived lesion, by the cortex, witch makes a very good defense as why placebo therepies for pain work so well.

Anybody who studies pain and pain management knows that in the lumbar region, lesion does not correlate very good with pain (many lesion-free patients experience pain and many lesions do not cause pain or cause "away pain", pain in another site other than the lesion).

Just a comparison, look at the number of patients the pharmacological industry enrolls in a antibiotic drug study and the number of patients enrolled in a new analgesic, the power of placebo are of different magnitude in these 2 settings.

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