Expectations and positive emotional feelings accompany reductions in ongoing and evoked neuropathic pain following placebo interventions |
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| Affiliation: | 1. Department of Psychology and Behavioural Sciences, School of Business and Social Sciences, Aarhus University, Aarhus, Denmark;2. Danish Pain Research Center, Aarhus University Hospital, Aarhus, Denmark;3. Department of Cardiothoracic and Vascular Surgery, Aarhus University Hospital, Skejby, Denmark;4. Centre for Functional Magnetic Resonance Imaging of the Brain (FMRIB), Nuffield Department of Clinical Neurosciences, University of Oxford, John Radcliffe Hospital, UK;5. Department of Neuroscience, Clinical and Applied Physiology Program, University of Turin Medical School, Turin, Italy;6. Division of Neuroscience, Department of Oral and Maxillofacial Surgery, University of Florida, Gainesville, FL, USA;1. GlaxoSmithKline Clinical Unit Cambridge, Addenbrooke’s Centre for Clinical Investigation, Addenbrooke’s Hospital, Cambridge, UK;2. GlaxoSmithKline, Brentford, UK;3. GlaxoSmithKline, Stevenage, UK;4. GlaxoSmithKline, Verona, Italy;1. Department of Psychiatry and Behavioral Sciences, University of Washington, Seattle, WA, USA;2. RTI International, Research Triangle Park, North Carolina, USA;3. Center for Mental Healthcare and Outcomes Research, Central Arkansas Veterans Healthcare System, Little Rock, AR, USA;4. Behavioral Health Services, St. Luke’s Health System, Twin Falls, ID, USA;5. Division of Pharmaceutical Evaluation and Policy, University of Arkansas for Medical Sciences, Little Rock, AR, USA;6. South Central Mental Illness Education and Clinical Center, Central Arkansas Veterans Healthcare System, Little Rock, AR, USA;7. Department of Psychiatry, University of Arkansas for Medical Sciences, Little Rock, AR, USA;1. Department of Emergency Medicine, Icahn School of Medicine at Mount Sinai, New York, NY, USA;2. Brookdale Department of Geriatrics and Palliative Medicine, Icahn School of Medicine at Mount Sinai, New York, NY, USA;3. Geriatric Research, Education and Clinical Center, James J. Peters VAMC, Bronx, NY, USA;4. Medical University of South Carolina, Charleston, SC, USA;5. Department of Emergency Medicine, Oregon Health & Science University, Portland, SC, USA;6. Department of Emergency Medicine, George Washington University Medical Center, Washington, DC, USA;7. Department of Emergency Medicine, University of Colorado, Aurora, CO, USA;8. Oncological Sciences, Icahn School of Medicine at Mount Sinai, New York, NY, USA;9. Department of Emergency Medicine, The University of Texas MD Anderson Cancer Center, Houston, TX, USA;1. Department of General Practice, Institute of Health and Society, University of Oslo, Oslo, Norway;2. Department of Community Medicine, Institute of Health and Society, University of Oslo, Norway;3. Division of Epidemiology, Norwegian Institute of Public Health, Oslo, Norway;1. Department of Anesthesiology, University of Rochester School of Medicine and Dentistry, Rochester, NY, USA;2. Departments of Biostatistics and Computational Biology and Neurology, University of Rochester School of Medicine and Dentistry, Rochester, NY, USA;3. Depomed, Inc., Newark, CA, USA;4. University of Pennsylvania, Philadelphia, PA, USA;5. Queen’s University, Kingston, Ontario, Canada;6. Analgesic Solutions, Natick, MA, USA;7. Tufts University, Boston, MA, USA;8. California Pacific Medical Center, San Francisco, CA, USA;9. Department of Anesthesiology and Pain Medicine, University of Washington, Seattle, WA, USA |
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| Abstract: | Research on placebo analgesia and nocebo hyperalgesia has primarily included healthy subjects or acute pain patients, and it is unknown whether these effects can be obtained in ongoing pain in patients with chronic pain caused by an identifiable nerve injury. Eighteen patients with postthoracotomy neuropathic pain were exposed to placebo and nocebo manipulations, in which they received open and hidden administrations of pain-relieving (lidocaine) or pain-inducing (capsaicin) treatment controlled for the natural history of pain. Immediately after the open administration, patients rated their expected pain levels on a mechanical visual analogue scale (M-VAS). They also reported their emotional feelings via a quantitative/qualitative experiential method. Subsequently, patients rated their ongoing pain levels on the M-VAS and underwent quantitative sensory testing of evoked pain (brush, pinprick, area of hyperalgesia, wind-up-like pain). There was a significant placebo effect on both ongoing (P = .009 to .019) and evoked neuropathic pain (P = .0005 to .053). Expected pain levels accounted for significant amounts of the variance in ongoing (53.4%) and evoked pain (up to 34.5%) after the open lidocaine administration. Furthermore, patients reported high levels of positive and low levels of negative emotional feelings in the placebo condition compared with the nocebo condition (P ⩽ .001). Pain increases during nocebo were nonsignificant (P = .394 to 1.000). To our knowledge, this is the first study to demonstrate placebo effects in ongoing neuropathic pain. It provides further evidence for placebo-induced reduction in hyperalgesia and suggests that patients’ expectations coexist with emotional feelings about treatments. |
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| Keywords: | Emotional feelings Expectation Neuropathic pain Nocebo hyperalgesia Placebo analgesia |
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