AHRQ publishes evidence report showing “modest results” for CAM practices for neck and back pain “Review of CAM Practices for Back and Neck Pain Shows Modest Results” was the title of a November 2010 e news push from the NIH
“Review of CAM Practices for Back and Neck Pain Shows Modest Results” was the title of a November 2010 e-news push from the NIH National Center for Complementary and Alternative Medicine (NCCAM). NCCAM was highlighting a report published by the U.S. Agency for Healthcare Research and Quality based on work from researchers at the University of Ottawa who concluded from their review of 272 back/neck pain studies that:
“Evidence was of poor to moderate grade and most of it pertained to chronic nonspecific pain, making it difficult to draw more definitive conclusions regarding benefits and harms of CAM therapies in subjects with acute/subacute, mixed, or unknown duration of pain. The benefit of CAM treatments was mostly evident immediately or shortly after the end of the treatment and then faded with time. Very few studies reported long-term outcomes. There was insufficient data to explore subgroup effects. The trial results were inconsistent due probably to methodological and clinical diversity, thereby limiting the extent of quantitative synthesis and complicating interpretation of trial results. Strong efforts are warranted to improve the conduct methodology and reporting quality of primary studies of CAM therapies. Future well powered head to head comparisons of CAM treatments and trials comparing CAM to widely used active treatments that report on all clinically relevant outcomes are needed to draw better conclusions.” (bold added)
Comment: The review and the publication by AHRQ are especially notable given the increasing importance of pain strategies in the nation’s research agenda. Note the article in this Round-up on the new Institute of Medicine (IOM) Committee on Advancing Pain Research, Care and Education, and the importance of pain in the emerging 2011-2015 NCCAM strategic plan.
“Efforts to make hospitals safer for patients are falling short, researchers report in the first large study in a decade to analyze harm from medical care and to track it over time.” The November 24, 2010 New York Times article based on research in North Carolina is boldly head-lined Study Finds No Progress in Patient Safety in Hospitals. Authors of the study, published here in the New England Journal of Medicine:
” … examined 2,300 randomly selected patients’ records at 10 hospitals in North Carolina from 2002-2007 and found 588 instances of ‘patient harm,’ including surgical errors, hospital falls, misdiagnoses, medication errors, and hospital-acquired infections. Fifty of the incidents were considered life threatening, and 14 people died, according to the study.”
A follow-up article on December 3, 2010 from Health Leaders, titled Medical Errors Stubbornly Common, Studies Find, references both the NEJM report and an Office of the Inspector General report entitled Adverse Events in Hospitals: National Incidence Among Medicare Beneficiaries. The latter found similar outcomes.
Comment: It’s been 11 years since the IOM appropriated Alexander Pope’s poetic phrase To Err is Human as a title for their landmark, eye-opening study that concluded that at least 98,000 hospital deaths each year come via medical errors. Much effort was put into responding, particularly under the leadership of Don Berwick, MD, who led the 100,000 Lives Campaign through the Institute for Health Improvement. Berwick is now Center for Medicare and Medicaid Services administrator. (The findings are not likely to help Berwick with his vociferous opponents on the Hill since his efforts could be framed as failures.) Interestingly, Pope’s full phrase is that “to err is human, to forgive is divine.” When it comes to medical errors, I suspect that most of us remain located in different panels of the usual and customary triptych.
What do you do when research doesn’t come out the way you’d like? Massage research leader and oncology massage specialist Tracy Walton, LMT, MS provides an unusually candid commentary on the topic. Walton heard researchers at the American Massage Therapy Association conference report findings of a large, NIH-funded, controlled trial of massage and humor for children with stem cell transplant. Walton’s summary in a Massage Today article includes this statement: “The study reported that massage had no effect on any of the outcomes studied. Not one.” Walton offers a quality reflection on how she digested findings that surprised even the researchers.
Comment: Kudos to Walton for the unusually candid response. Interestingly however, she concludes with this: “I am not ready to abandon massage of stem cell therapy patients, nor do the investigators suggest that we should.”
Read other sections of the John Weeks Round-up: