Tuesday, September 27, 2016

Where Do You Go For Sound Medical Information?

Do you search the internet in earnest to look up medical information?  Do you try to find out the best treatment for your condition, only to come across pages and pages of information that you cannot make sense of?  Or pages of useless or conflicting documents?  Well me too!  And I’m a physician! 

I spend hours and hours trying to research the newest and best treatments for my patients, only to be frustrated with the misinformation out there.  It is trying and tiring sorting out good medical information, from bad.  This is why you need Treatment Scores! 

Treatment Scores aims to acquire the vast amount of medical information there is on the web, in journals, in magazines, etc, whether true or false, and put it into a single place.  One location for all medical claims (disease, diagnoses, and treatments).  How great would that be?  Patients and physicians, alike, will be able to understand true versus false medical information.  Not only will we be able to do that, we will be able to see what the statistics say for one treatment and compare it to other treatments for similar conditions.  

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You must consult your own licensed physician, or other licensed medical professional, for diagnosis, treatment, and for the interpretation of all medical statistics including Treatment Scores. Treatment Scores are for educational purposes only. Treatment Scores may be incomplete, inaccurate, harmful, or even cause death if used for treatment instead of consulting a licensed medical professional. No medical advice is being given. We DO NOT CLAIM to cure, treat, or prevent any illness or condition. Nor do our services provide medical advice or constitute a physician patient relationship. Contact a physician or other medical professional if you suspect that you are ill. Call emergency services (call 911 if available) or go to the nearest emergency room if an emergency is suspected. We are not responsible for any delays in care from using our website, our services, or for any other reason. We are not responsible for any consequential damages of any nature whatsoever. We make no warranties of any kind in connection with our writings or the use of TreatmentScoresBlog.com or TreatmentScores.com. Treatment Scores are about what happened to patients studied in the past; they do not predict the future.

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Copyright © 2016 Treatment Scores, Inc.

Monday, September 26, 2016

Natural versus Pharmaceutical Treatment for Knee Osteoarthritis

Many physicians and patients, alike, are searching for new and emerging treatments for chronic pain. One of the most debilitating areas of chronic pain can be due to knee arthritis.  Knee arthritis affects one's ability to maneuver throughout society without pain.  Depending on the degree of pain the patient is in, it will affect their ability to maintain function, exercise, and thus affect other areas of health as well.

Due to the fact that we do not know the exact cause of arthritis, it makes it difficult to treat.  We do know that with osteoarthritis, people have degeneration of their protective layers of cartilage in their joints.  Though we do not know how this happens (and just assume that it is predominately due to wear and tear over time), pharmaceutical companies have come up with ways to try to emulate the job of cartilage in the joints.  Of of those medications is called hyaluronic acid (HA).  It has been used for many years.  It works to provide increased joint lubrication, and thus decrease the friction between two bones that may be rubbing together, thereby decreasing pain.  HA is one of the most common treatments for osteoarthritis of the knee. However, it's effects only tend to last about 6 months, and multiple injections are required.

Platelet-rich plasma (PRP) is made from the patient's own blood.  It has healing properties and can be used in a variety of conditions.  It actually serves to stimulated the body's natural ability to regenerate tissues.  It is the hope of physicians presently using PRP and other regenerative forms of medicine, that they can recreate the body's natural ability to heal and grow, without the use of pharmaceuticals.

In the article that I researched, I was able to compare the use of HA, PRP and HA in combination with PRP for knee osteoarthritis.  I regularly perform PRP injections in my clinic.  PRP injections are not covered by insurance, and I wanted to make sure that the added cost of the injection, to the patient, was the best medical treatment I could offer them.  I was actually surprised to find out how effective all 3 treatments are!



Even though the HA treatment group ended up with a Treatment Grade of "D", a 37.5% improvement in physical ability a year after treatment is a good number.  However, it is pretty notable that both PRP groups still had a significantly better score than the HA group alone.

Through Treatment Scores, we can compare different treatments for a variety of diseases in a more organized manner.  In this way, we can place values on treatments.

Our goal is to make the process of treatment scores transparent so that every step can be verified and validated, and that the "rules" can be assessed as well. We are still in the early stages, and do not claim accuracy for our reviews at this time. (See the disclaimers below).

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DISCLAIMERS:
You must consult your own licensed physician, or other licensed medical professional, for diagnosis, treatment, and for the interpretation of all medical statistics including Treatment Scores. Treatment Scores are for educational purposes only. Treatment Scores may be incomplete, inaccurate, harmful, or even cause death if used for treatment instead of consulting a licensed medical professional. No medical advice is being given. We DO NOT CLAIM to cure, treat, or prevent any illness or condition. Nor do our services provide medical advice or constitute a physician patient relationship. Contact a physician or other medical professional if you suspect that you are ill. Call emergency services (call 911 if available) or go to the nearest emergency room if an emergency is suspected. We are not responsible for any delays in care from using our website, our services, or for any other reason. We are not responsible for any consequential damages of any nature whatsoever. We make no warranties of any kind in connection with our writings or the use of TreatmentScoresBlog.com or TreatmentScores.com. Treatment Scores are about what happened to patients studied in the past; they do not predict the future.

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Copyright © 2016 Treatment Scores, Inc.

Saturday, September 3, 2016

My Aching Back: Spinal Fusion & Treatment Scores

There is controversy in the medical community about the usefulness of spinal fusion surgery for chronic low back pain. If you’re a patient in an area where there are a lot of spine surgeons, you’re much more likely to get surgery than if you live in area where there are fewer surgeons.  I’ve heard from surgeons about desperate patients who have tried everything else and they do get better with surgery, but there are several reviews out there questioning the efficacy of spinal fusion for treatment of chronic low back pain. It’s time to take a look at some Treatment Scores.

To be clear, we’re talking about patients with chronic low back pain, not patients with acute low back pain, nerve compressions, or spinal stenosis. Our outcome measure will be a decrease in disability, specifically the Oswestry disability index, as this was the outcome used in the studies I found.  We are not using pain since this was not the main outcome in the studies. In most cases, if the disability index decreases so does the pain level.

I found three randomized controlled trials that compared surgical intervention (specifically spinal fusion) to non-surgical intervention. The best study would be a comparison of surgical intervention vs. sham surgery vs. placebo. As we saw from the studies on vertebroplasties, sham surgeries can have a powerful placebo effect.  However, the only studies done were comparing surgical to non-surgical groups. It is difficult to do sham surgeries, although they have been done for some procedures.  Nevertheless, the purpose of Treatment Scores is to figure out what we know and what we don’t know about a particular topic so we’ll proceed on.

In all of the studies, there was a decrease in the Oswestry disability index (ODI) in the non-surgical group and in the surgical group. The decrease was greater in the surgical group in every case.  We’ll use the percent decrease in the ODI in the surgical group minus the percent decrease in the OSI in the non surgical group. The differences in the three studies were 19%, 8%, and 8%. The non-surgical groups were not the same. In one of the studies the patients had physical therapy. In two of the studies the patients had cognitive therapy along with physical therapy. The group that did not have cognitive therapy had the largest difference in the OSI.

It should also be noted that these were intention to treat studies meaning that some of the patients assigned to the non-surgical group ended up having surgery and this was a significant number in some of the studies. For example, in one study 28% of the patients assigned to the non-surgical group did have surgery within two years and 4% assigned to the surgical group did not have surgery.
Another issue that has to be considered is the MCIC or minimal clinically important change.  This is probably around 10 to 15 for the ODI. The differences in these studies are either below or at the border of clinical significance.

Also, there was another study which should be mentioned. It was a cohort study following groups of patients who had fusion vs those who did not. Since it is a cohort study, it cannot rank as high as randomized trials, but it was a well done cohort study. They found that patients who did not have surgery were 40% more likely to return to work than patients who did have surgery.

In this essay, I won’t go into all of the details of how I calculated my Treatment score. As mentioned in other blogs, the Treatment Score is the gross treatment benefit minus side effects plus side benefits. There is subjectivity in coming up with the final Treatment Score due to some of the uncertainties in the studies and side effects that have to be taken into account. (We will decrease subjectivity with mathematics and programming as we move forward). The side effects have to be rescaled, estimated, and subtracted from the gross treatment benefit. One study listed a complication rate of 18%. Others had lower complication rates. Complications included death, wound infections, deep venous thrombosis, pulmonary embolus, tears of the dura, need for re-operation and nerve injury. It does seem apparent, that with the current data, spinal fusion cannot have a high Treatment Score compared to non-surgical groups. My Treatment Score is 6 as shown in the Treatment Score Calculator™ below:


A Treatment Score of 6 has a letter grade of E.

To sum up, here is what we know. There is a decrease in disability with spinal fusion for the treatment of chronic low back pain. However, the Treatment Score is low compared to non-surgical groups. It appears to be lower than the MCIC ( minimal clinically important change). The groups who had cognitive therapy along with physical therapy tended to do better.

Here’s what we don’t know. There is still uncertainty since spinal fusion has never been compared to sham surgery. Some of the patients who were in the non-surgical group did have surgery. We don’t know if this would have changed the outcome more in favor of spinal fusion if they did not cross over.

This is what Treatment Scores is about. We know what we know, what we don’t know and what we need to find out. There is a simple Treatment Score for each treatment that patients and medical professionals can understand. (See the disclaimers below.)

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DISCLAIMERS:
You must consult your own licensed physician, or other licensed medical professional, for diagnosis, treatment, and for the interpretation of all medical statistics including Treatment Scores. Treatment Scores are for educational purposes only. Treatment Scores may be incomplete, inaccurate, harmful, or even cause death if used for treatment instead of consulting a licensed medical professional. No medical advice is being given. We DO NOT CLAIM to cure, treat, or prevent any illness or condition. Nor do our services provide medical advice or constitute a physician patient relationship. Contact a physician or other medical professional if you suspect that you are ill. Call emergency services (call 911 if available) or go to the nearest emergency room if an emergency is suspected. We are not responsible for any delays in care from using our website, our services, or for any other reason. We are not responsible for any consequential damages of any nature whatsoever. We make no warranties of any kind in connection with our writings or the use of TreatmentScoresBlog.com or TreatmentScores.com. Treatment Scores are about what happened to patients studied in the past; they do not predict the future.

COPYRIGHT:
Copyright © 2016 Treatment Scores, Inc.