Conditioned open-label placebo for opioid reduction after spine surgery: a randomized controlled trial.
Conditioned open-label placebo for opioid reduction after spine surgery: a randomized controlled trial.
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脊柱手术后条件开放标签安慰剂减少阿片类药物：一项随机对照试验。
DOI：
10.1097/j.pain.0000000000002185
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发表时间：
2021-06-01
期刊：
影响因子：
7.4
通讯作者：
Schreiber KL
中科院分区：
文献类型：
--
作者：
Flowers KM;Patton ME;Hruschak VJ;Fields KG;Schwartz E;Zeballos J;Kang JD;Edwards RR;Kaptchuk TJ;Schreiber KL
传统上，安慰剂效应包括隐藏或欺骗。然而，最近的证据表明，安慰剂效应也可以被透明地规定为“开放标签安慰剂”(OLP)，并且无条件刺激(例如阿片类止痛剂)和条件刺激(例如安慰剂)配对可以单独导致条件刺激减轻疼痛。在这项随机对照试验中，我们调查了在脊柱手术后康复的患者中，是否在术后即刻将条件反射与OLP(COLP)相结合可以减少日常阿片类药物的使用和术后疼痛。患者随机接受COLP或照常治疗，两组均不受限制地接受典型的阿片类药物术后止痛方案。用广义估计方程方法评价COLP对术后第1~17天每日阿片类药物用量和疼痛的影响。在第1~17天，COLP组患者每天的吗啡毫克当量比常规治疗组患者减少约30%(−14.5日吗啡毫克当量；95%CI：[−26.8，−2.2])。COLP组每日最严重疼痛评分也较低(10分制，21.0分；95%CI：[−2.0，−0.1])，尽管两组患者的平均每日疼痛评分没有显著差异(−0.8分；95%CI：[−1.7，0.2])。这些发现表明，COLP可能是一种潜在的辅助止痛疗法，可以在不增加疼痛的情况下减少术后早期阿片类药物的消耗。
Placebo effects have traditionally involved concealment or deception. However, recent evidence suggests that placebo effects can also be elicited when prescribed transparently as “open-label placebos” (OLPs), and that the pairing of an unconditioned stimulus (eg, opioid analgesic) with a conditioned stimulus (eg, placebo pill) can lead to the conditioned stimulus alone reducing pain. In this randomized control trial, we investigated whether combining conditioning with an OLP (COLP) in the immediate postoperative period could reduce daily opioid use and postsurgical pain among patients recovering from spine surgery. Patients were randomized to COLP or treatment as usual, with both groups receiving unrestricted access to a typical opioid-based postoperative analgesic regimen. The generalized estimating equations method was used to assess the treatment effect of COLP on daily opioid consumption and pain during postoperative period from postoperative day (POD) 1 to POD 17. Patients in the COLP group consumed approximately 30% less daily morphine milligram equivalents compared with patients in the treatment as usual group during POD 1 to 17 (−14.5 daily morphine milligram equivalents; 95% CI: [−26.8, −2.2]). Daily worst pain scores were also lower in the COLP group (21.0 point on the 10-point scale; 95% CI: [−2.0, −0.1]), although a significant difference was not detected in average daily pain between the groups (−0.8 point; 95% CI: [−1.7, 0.2]). These findings suggest that COLP may serve as a potential adjuvant analgesic therapy to decrease opioid consumption in the early postoperative period, without increasing pain.
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影响因子：
7.4
作者：
Colloca L;Enck P;DeGrazia D
通讯作者：
DeGrazia D
影响因子：
7.4
作者：
De Pascalis, V;Chiaradia, C;Carotenuto, E
通讯作者：
Carotenuto, E
影响因子：
3.1
作者：
Bajcar, Elzbieta A.;Wiercioch-Kuzianik, Karolina;Babel, Przemyslaw
通讯作者：
Babel, Przemyslaw
影响因子：
3.3
作者：
Ader R;Mercurio MG;Walton J;James D;Davis M;Ojha V;Kimball AB;Fiorentino D
通讯作者：
Fiorentino D
影响因子：
13.3
作者：
Brummett, Chad M.;Urquhart, Andrew G.;Hassett, Afton L.;Tsodikov, Alex;Hallstrom, Brian R.;Wood, Nathan I.;Williams, David A.;Clauw, Daniel J.
通讯作者：
Clauw, Daniel J.