Risk Reward Analysis III

By | May 18, 2015

In the end the decision about whether or not to have surgery has more to do with the way you view risk and reward, than the likelihood of either.

In the end the decision about whether or not to have surgery has more to do with the way you view risk and reward, than the likelihood of either.

In this blog we will look at the last major variable, the personal response to either therapeutic success or failure. We will look at it in terms of risk tolerance and we will see that although it may be hard to quantify its effects can be huge.

Risk Tolerant

 

Treatment Outcome Pain Level Reward Risk 1 Average 1 Risk 2 Average 2
Surgery Success No Pain 1 84% 0.68 83% 0.66
Adjacent Segment Severe Pain -1 15% 15%
Post-Laminectomy Severe Pain -1 1% 2%
Intensive PT Success No Pain 1 10% 0.09 20% 0.19
Status Quo Moderate Pain 0 89% 79%
Disease Progression Severe Pain -1 1% 1%
Surgery + PT Success No Pain 1 94% 0.88 93% 0.86
Adjacent Segment Severe Pain -1 5% 5%
Post-Laminectomy Severe Pain -1 1% 2%

 

Risk Averse

 

Treatment Outcome Pain Level Reward Risk 1 Average 1 Risk 2 Average 2
Surgery Success No Pain 1 84% -0.76 83% -0.87
Adjacent Segment Severe Pain -10 15% 15%
Post-Laminectomy Severe Pain -10 1% 2%
Intensive PT Success No Pain 1 10% 0.00 20% 0.10
Status Quo Moderate Pain 0 89% 79%
Disease Progression Severe Pain -10 1% 1%
Surgery + PT Success No Pain 1 94% 0.34 93% 0.23
Adjacent Segment Severe Pain -10 5% 5%
Post-Laminectomy Severe Pain -10 1% 2%

 

 

Notice that the first table labeled Risk Tolerant is the same one that we used in the last blog and that the reward for a successful outcome are of the same magnitude as the penalty for an unsuccessful outcome. In the second table labeled Risk Averse, while the likelihood of success or failure are the same as in the first table, the perceived penalty for a failed therapy is now 10 times as great as the perceived benefit of success. We see that the perceived utility of surgery alone is negative, physical therapy alone either zero or very nearly zero and even surgery with intensive physical therapy barely positive. I have many patients like this at Schlesinger Pain Centers and they rarely attempt any therapy because they are convinced that that they would never be able to tolerate even a modest increase in pain should the therapy fail.


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