Prior Therapeutic Experiences, Not Expectation Ratings, Predict Placebo Effects: An Experimental Study in Chronic Pain and Healthy Participants.
Prior Therapeutic Experiences, Not Expectation Ratings, Predict Placebo Effects: An Experimental Study in Chronic Pain and Healthy Participants.
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DOI：
10.1159/000507400
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发表时间：
2020
影响因子：
22.8
通讯作者：
Wang Y
中科院分区：
文献类型：
--
作者：
Colloca L;Akintola T;Haycock NR;Blasini M;Thomas S;Phillips J;Corsi N;Schenk LA;Wang Y
许多临床试验失败是因为安慰剂反应。先前的治疗经验和患者的期望可能会影响慢性疾病对安慰剂的反应能力。本研究的范围包括763名慢性口面部疼痛和健康的研究参与者，目的是比较安慰剂效应的程度和患病率，并确定既往治疗经验与预期的假定作用。我们在实验室环境中通过使用两种不同水平的个性化疼痛刺激（高疼痛和低疼痛）来加强期望并提供痛觉减退体验（条件反射阶段）来测试安慰剂倾向。之后，两种疼痛水平都被秘密地设置在中度疼痛水平，以测试安慰剂效应（测试阶段）。使用视觉模拟量表将疼痛和期望评级作为主要结局进行评估。在慢性疼痛和健康参与者中，安慰剂效应的大小相似，健康参与者中应答者的患病率更高。尽管慢性疼痛参与者报告了更大的疼痛缓解期望，但期望并不能解释安慰剂效应的发生。相反，先前的经验，通过调节强度介导的安慰剂效应在疼痛和健康的参与者。这些发现表明，患有慢性疼痛的参与者显示出强大的安慰剂效应，这种效应不是由预期介导的，而是与先前的治疗经验直接相关。这证实了评估治疗史的重要性，同时提出了关于期望评级效用的问题。未来的研究需要加强对安慰剂反应的预测，这将最终改善临床试验设计。
Many clinical trials fail because of placebo responses. Prior therapeutic experiences and patients’ expectations may affect the capacity to respond to placebos in chronic disorders. The scope of this study in 763 chronic orofacial pain and healthy study participants was to compare the magnitude and prevalence of placebo effects and determine the putative role of prior therapeutic experiences versus expectations. We tested placebo propensity in a laboratory setting by using two distinct levels of individually-tailored painful stimulations (high pain and low pain) to reinforce expectations and provide a hypoalgesic experience (conditioning phase). Afterwards, both levels of pain were surreptitiously set at a moderate pain level to test for placebo effects (testing phase). Pain and expectation ratings were assessed as primary outcomes using visual analogue scales. In both chronic pain and healthy participants, placebo effects were similar in magnitude, with the larger prevalence of responders in the healthy participants. Although chronic pain participants reported larger pain-relief expectations, expectations did not account for the occurrence of placebo effects. Rather, prior experience via conditioning strength was mediated placebo effects in both pain and healthy participants. These findings indicate that participants with chronic pain conditions display robust placebo effects that are not mediated by expectations but are instead directly linked to prior therapeutic experiences. This confirms the importance of assessing therapeutic history while raising questions about the utility of expectation ratings. Future research is needed to enhance prediction of responses to placebos, which will ultimately improve clinical trial designs.
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影响因子：
17.1
作者：
Kam-Hansen S;Jakubowski M;Kelley JM;Kirsch I;Hoaglin DC;Kaptchuk TJ;Burstein R
通讯作者：
Burstein R
影响因子：
6.9
作者：
Colloca, Luana;Miller, Franklin G.
通讯作者：
Miller, Franklin G.
影响因子：
7.4
作者：
Dixon, Diane;Pollard, Beth;Johnston, Marie
通讯作者：
Johnston, Marie
DOI：
10.14219/jada.archive.1990.0043
发表时间：
1990-03-01
影响因子：
3.9
作者：
DWORKIN, SF;HUGGINS, KH;SOMMERS, E
通讯作者：
SOMMERS, E
影响因子：
--
作者：
Colloca, Luana
通讯作者：
Colloca, Luana