Julia Schmitz1, Maike Müller2, Jan Stork1, Iris Eichler1, Christian Zöllner1, Herta Flor3, Regine Klinger4. 1. Division of Pain Medicine and Pain Psychology, Department of Anesthesiology, University Medical Center Hamburg-Eppendorf, Hamburg, Germany. 2. Department of Anesthesiology, University Hospital of Würzburg, Würzburg, Germany. 3. Department of Cognitive and Clinical Neuroscience, Central Institute of Mental Health, Medical Faculty Mannheim, Heidelberg University, Mannheim, Germany. 4. Division of Pain Medicine and Pain Psychology, Department of Anesthesiology, University Medical Center Hamburg-Eppendorf, Hamburg, Germany, r.klinger@uke.de.
Abstract
BACKGROUND: Increasing evidence for the efficacy of analgesic placebo effects in laboratory studies with healthy persons raises the question whether placebos could be used to improve the treatment of pain patients. Expectancies play a central role in shaping analgesic placebo but also nocebo effects. OBJECTIVES: We investigated to what extent a sham opioid infusion (saline solution) produces sustained clinically relevant placebo and nocebo effects in chronic back pain patients. METHODS:Fifty-nine patients received the sham opioid infusion applied via a large drain dressing and were compared to 14 control patients without intervention (natural history, NH) while experimental pain stimuli were applied. All subjects were told that the infusion would decrease pain although in rare cases pain increase would be possible (induction of expectancy). In addition, conditioning was introduced where the participants either experienced a decrease in experimental pain (n = 17; placebo conditioning), an increase (n = 21; nocebo conditioning), or no change (n = 21, no conditioning). RESULTS: Compared to the NH group, all infusion groups showed positive treatment expectancies and significantly (p < 0.001) reduced clinical back pain (primary outcome) and pain-related disability (secondary outcome, assessed by self-reported functional capacity and perceived impairment of mobility). Even the nocebo conditioned group experiencing increased experimental pain developed positive treatment expectancies followed by reduced pain experience. Positive treatment expectancies and relief in clinical back pain were significantly positively correlated (r = 0.72, p < 0.01). CONCLUSIONS: These findings suggest that it may be beneficial to explicitly shape and integrate treatment expectancies into clinical pain management.
RCT Entities:
BACKGROUND: Increasing evidence for the efficacy of analgesic placebo effects in laboratory studies with healthy persons raises the question whether placebos could be used to improve the treatment of painpatients. Expectancies play a central role in shaping analgesic placebo but also nocebo effects. OBJECTIVES: We investigated to what extent a sham opioid infusion (saline solution) produces sustained clinically relevant placebo and nocebo effects in chronic back painpatients. METHODS: Fifty-nine patients received the sham opioid infusion applied via a large drain dressing and were compared to 14 control patients without intervention (natural history, NH) while experimental pain stimuli were applied. All subjects were told that the infusion would decrease pain although in rare cases pain increase would be possible (induction of expectancy). In addition, conditioning was introduced where the participants either experienced a decrease in experimental pain (n = 17; placebo conditioning), an increase (n = 21; nocebo conditioning), or no change (n = 21, no conditioning). RESULTS: Compared to the NH group, all infusion groups showed positive treatment expectancies and significantly (p < 0.001) reduced clinical back pain (primary outcome) and pain-related disability (secondary outcome, assessed by self-reported functional capacity and perceived impairment of mobility). Even the nocebo conditioned group experiencing increased experimental pain developed positive treatment expectancies followed by reduced pain experience. Positive treatment expectancies and relief in clinical back pain were significantly positively correlated (r = 0.72, p < 0.01). CONCLUSIONS: These findings suggest that it may be beneficial to explicitly shape and integrate treatment expectancies into clinical pain management.
Authors: Michael H Bernstein; Molly Magill; Arnold-Peter Weiss; Ted J Kaptchuk; Charlotte Blease; Irving Kirsch; Josiah D Rich; Sara J Becker; Steven Mach; Francesca L Beaudoin Journal: Psychother Psychosom Date: 2019-09-27 Impact factor: 17.659
Authors: Meike Shedden-Mora; Anne Toussaint; Bernd Löwe; Viola Andresen; Omer Van den Bergh; Tobias B Huber; Olaf von dem Knesebeck; Ansgar W Lohse; Yvonne Nestoriuc; Gudrun Schneider; Stefan W Schneider; Christoph Schramm; Sonja Ständer; Eik Vettorazzi; Antonia Zapf Journal: BMJ Open Date: 2022-01-21 Impact factor: 2.692