Health information is plentiful on the Internet and many Web surfers consider medical advice they find online to be a cheaper alternative to visiting a doctor, according to some studies. However, the risk of obtaining useless or even harmful medical information from some websites is high for patients with postherpetic neuralgia, a common complication of shingles, according to new research reported in The Journal of Pain, published by the American Pain Society, www.ampainsoc.org.
Researchers from the University of Vermont evaluated the quality of information provided on the Internet about postherpetic neuralgia and its treatments using three validated measurement tools - JAMA benchmarks for evaluating medical websites, the Health on the Net seal and the DISCERN rating tool from medical professionals. Google and Yahoo searches were conducted for the term 'postherpetic neuralgia treatments,' and the first 50 sites identified from each search engine were examined.
Fifty-two unique sites were selected. The websites were classified according to affiliation, such as non-profit organization, medical center, government, university or commercial organization. Sites sponsored by pharmaceutical companies that covered only one treatment option were excluded.
JAMA benchmarks include displays of authorship of medical content, attribution of references, dates of updates, and disclosures of sponsorship, advertising and conflicts of interest.
The Health on the Net seal certifies medical websites based on an "ethical standard aimed at offering quality health information in compliance with criteria such as ability to back claims, attribution of sources, transparency, financial separation and clear distinctions between advertising and editorial content."
DISCERN is a validated rating tool used primarily by physicians and poses 16 questions intended to gauge the reliability of the publication and accuracy of treatment recommendations.
Therapies advocated by each website were evaluated according to a list of treatments that are peer reviewed or have consensus for use or exclusion. Three treatments (antidepressants, anticonvulsants and topical lidocaine) were classified as first-line therapies, two options were labeled as second line treatments (opioids and tramadol), and several other treatments were listed as third-line options for which the evidence is insufficient to recommend or is considered ineffective.
The analysis showed that 15 websites identified by Google (41%) met all criteria of the JAMA benchmarks and nine (25 %) displayed the HON seal. From the Yahoo search, 15 sites (45%) met all the JAMA benchmarks and 11 (33%) displayed the HON seal. The DISCERN Instruments showed that just one website from both the Google and Yahoo searches achieved the maximum quality score. The median overall DISCERN quality score for the non-commercial websites was 4 of 5 and 3 of 5 for the commercial sites. The authors noted that most of the websites suggested 2 of 3 recommended treatments and some advocated all three. For example, acupuncture and surgery were commonly recommended, but the evidence shows neither option is helpful.
The authors concluded that the quality of website content related to postherpetic neuralgia is not always high and their treatment recommendations often are inconsistent with expert advice. Many websites suggested treatments that do not have much, if any, evidence to support their use for treating postherpetic neuralgia patients or have been proven to be non-beneficial. They wrote: "On average, a third to half of the sites visited will recommend a treatment that could be potentially harmful, since the risk of treatment outweighs the benefit."
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