Breaking Bad (Tissue): Epidural Adhesiolysis and Its Outcomes
Medicine is at a crossroads as we approach the third decade of the 21st century. Intellectual and technologic advances have progressed at such a dramatic pace that much of what physicians learned only a decade ago is now obsolete. The dark side of this is that these innovations come at a cost, which includes unnecessary tests and procedures that exact a steep personal and financial toll on patients and society. For some conditions such as certain types of cancer, the benefits outweigh the financial costs. However, for low back pain, dramatic increases in the number, complexity, and costs of interventions have not been accompanied by corresponding decreases in prevalence or disability rates,1–3 and some research suggests that higher procedure rates may actually be associated with inferior outcomes.4 This augurs for publication of negative trials, which can help conserve resources and prevent unnecessary interventions, but which tend to be cited less frequently. The requirement for registration of clinical trials by many journals, including Anesthesia & Analgesia, and systematic reviews that now consider unpublished, negative data sets, has produced significant strides in remedying publication bias, although the problem still exists.