Background & Aims
Experimental and clincial studies suggest that positive expectation – as induced by placebo treatments – can have clinically relevant effects on pain and the response to analgesic treatments. Humans can acquire behavior through the observation of others’ responses, and this also applies to pain behavior. Obviously, the observation of other patients’ pain behavior associated with pain treatments can affect patient’s treatment expectation and their subsequent pain experience. It is reasonable to examine the implications of the observation of others, especially in patients with chronic low back pain (CLBP). Due to a long history of failed therapy, CLBP patients seek for novel treatment options. Our aim was, to examine the role of observing others in CLBP patients’ expectations and treatment responses to two types of treatment, a usual analgesic (Novaminsulfon; “ANA”) and an open-label placebo treatment (OLP).
Methods
In our clinical trial (2×2 factorial design, with an additional natural history group without an intervention, NH) we randomized chronic low back pain patients to either a 3-week treatment with an analgesic, novamine sulfone, or to a 3-week treatment with open-label placebos. The effects of the two treatments and their potential interaction with positive treatment expectancy was compared to NH. We built treatment expectations through social observation and assessed their impact on these two treatments. To this end, patients watched a positive or a neutral video. We assessed patient’s treatment expectations pre and post of their 3-week treatment and after 3 months. We tested effects of these expectation on subjective and objective outcome measures. This allowed us to test, whether social observation enhances positive treatment expectations; whether positive expectations improve treatment outcome. The planned sample of this study is N=120.
Results
An initial analysis with two-sided t-testing of 94 patients showed a significant decline in pain ratings (pre-post assessment) in the OLP-group with social observational learning compared to the NH group (MD -1,29; SEM 0,55; p=.021) and an significant decrease in pain ratings pre to post intervention of the ANA-group without social observation compared to NH(MD -1,22; SEM 0,56; p=.033). The ANA group with social learning and the OLP-group without social learning showed a pain reduction in the post intervention compared to the pre intervention assessment, however, no significant reduction compared the NH group.
Conclusions
These preliminary findings are of limited interpretive significance. They may suggest that social observation has impact on clinical treatment, however, this psychological mechanism has a better effect in the OLP group than in the ANA group. An OLP can be perceived as an unconditional stimulus with a high novelty value and is expected to have more positive effects on patients than conventional medical, drug-based measures (ANA) with and without social observation .
References
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Presenting Author
Regine Klinger
Poster Authors
Regine Klinger
PD Dr
Universitätsklinikum Hamburg Eppendorf
Lead Author
Marie Schwartz
University Medical Center Hamburg-Eppendorf (UKE)
Lead Author
Johannes Wessels
University Medical Center Hamburg-Eppendorf (UKE)
Lead Author
Antonia Borcherding
University Medical Center Hamburg-Eppendorf (UKE)
Lead Author
Julia Stuhlreyer
University Medical Center Hamburg-Eppendorf (UKE)
Lead Author
Topics
- Placebo