Clinical Use of Placebo Effects in Patients With Pain Disorders

Klinger, Regine; Stuhlreyer, Julia; Schwartz, Marie; Schmitz, Julia; Colloca, Luana

doi:10.1016/bs.irn.2018.07.015

Cited by 52 publications

(62 citation statements)

References 85 publications

(125 reference statements)

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“…Even though half of the included studies did not clarify the status of patients' analgesic response to medications, the neuromodulation effects seem to be higher on the intractable DPN population. It has been reported that patients with intractable pain disorders have less treatment expectancy and placebo effect 70 . Consequently, we can argue that our pooled estimated effect is less likely to be affected by the placebo effect of the sham intervention.…”

Section: Sources Of Heterogeneity and Potential Explanations Accordimentioning

confidence: 99%

Non-invasive neuromodulation effects on painful diabetic peripheral neuropathy: a systematic review and meta-analysis

Zeng¹,

Pacheco‐Barrios²,

Cao³

et al. 2020

Sci Rep

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Diabetic Peripheral Neuropathy (DPN) typically is accompanied by painful symptoms. Several therapeutic agents have been tried for symptomatic relief, but with varying results. The use of non-invasive neuromodulation (NINM) is a potential treatment option for DPN. The objective of our study is to evaluate NINM effects on pain rating and nerve conduction velocity in DPN patients. The search was carried out in seven databases until Aug 30th, 2019. Finally, twenty studies met the inclusion criteria. We found a significant reduction of pain scores by central NINMs (effect size [ES] = − 0.75, 95% CI = − 1.35 to − 0.14), but not by the overall peripheral techniques (electrical and electromagnetic) (ES = − 0.58, 95% CI = − 1.23 to 0.07). However, the subgroup of peripheral electrical NINMs reported a significant higher effect (ES = − 0.84, 95% CI = − 1.57 to − 0.11) compared to electromagnetic techniques (ES = 0.21; 95% CI = − 1.00 to 1.42, I2 = 95.3%) . Other subgroup analysis results show that NINMs effects are higher with intensive protocols and in populations with resistant symptoms or intolerance to analgesic medications. Besides, NINMs can increase motor nerves velocity (ES = 1.82; 95% CI = 1.47 to 2.17), and there were no effects on sensory nerves velocity (ES = 0.01, 95% CI = − 0.79 to 0.80). The results suggest that central and peripheral electrical NINMs could reduce neuropathic pain among DPN patients, without reported adverse events. Well-powered studies are needed to confirm that NINM techniques as an alternative effective and safe treatment option.

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Section: Sources Of Heterogeneity and Potential Explanations Accordimentioning

confidence: 99%

Non-invasive neuromodulation effects on painful diabetic peripheral neuropathy: a systematic review and meta-analysis

Zeng¹,

Pacheco‐Barrios²,

Cao³

et al. 2020

Sci Rep

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“…These findings are among the first attempts to outline the clinical relevance of shaping patients’ expectancies (Darnall & Colloca, 2018; Klinger, Stuhlreyer, Schwartz, Schmitz, & Colloca, 2018) and to use dose-extending placebos along with pharmacological conditioning as a potential pain management tool to taper opioids (Colloca, Enck, & DeGrazia, 2016; Colloca & Howick, 2018). …”

mentioning

confidence: 91%

“…There is increasing consensus that clinicians can actively set positive patients’ expectations (Darnall & Colloca, 2018; Glare, Fridman, & Ashton-James, 2018; Klinger et al, 2018). Educating patients about pain treatments and their effects can strengthen their overall pain reduction, coping, and resilience skills.…”

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confidence: 99%

Preface

Colloca

2018

International Review of Neurobiology

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“…The analgesic placebo effect has been well documented. 12 In the area of placebo effects, expectations play a major role, triggering a cascade of endogenous opioids and non-opioids, and altering the experience of pain. 12 For this reason, the field of anaesthesiology and pain research is likely biased if blinding is not used adequately.…”

Section: Introductionmentioning

confidence: 99%

Definitions of blinding in randomised controlled trials of interventions published in high-impact anaesthesiology journals: a methodological study and survey of authors

Penić¹,

Begic

Balajić

et al. 2020

BMJ Open

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ObjectivesTo analyse the completeness of reporting of blinding in randomised controlled trials (RCTs) of interventions in anaesthesiology, the actual blinding status of various persons associated with an RCT and trial authors’ interpretation of blinding terminology related to RCTs.MethodsThis was a methodological study and a cross-sectional survey. We analysed reporting related to blinding in published RCTs of interventions published in seven highly cited anaesthesiology journals from 2014 to 2016 and registered protocols in ClinicalTrials.gov. We surveyed corresponding authors of included RCTs about their definitions of blinding. The primary outcome was the number of RCTs that explicitly described who was blinded in a trial. Secondary outcomes were definitions of blinding terminology in the trials; trial authors’ interpretation of blinding terminology; discrepancies in the blinding description within registered protocols and between registered protocols and publications.ResultsOut of 622 analysed RCTs, 38% were not explicitly described as either open label or blinded studies and 10% did not report any information about blinding or lack of blinding. Only one manuscript fully reported the status of blinding for various individuals that may be involved with a trial. The most common descriptor was that a trial was double-blind. We found discrepant information regarding blinding in the majority of registered protocols. Even when there were no discrepancies in the registration, we found discrepancies in the reporting of blinding between the majority of registered protocols and published manuscripts. The survey of authors (40 responses from 231 eligible authors; 17% response rate) of analysed RCTs showed that they differed in how they defined different levels of blinding in trials.ConclusionsReporting of the blinding status of key individuals involved in analysed anaesthesiology RCTs was insufficient. For reporting guidelines, peer reviewers and editors should insist on clear information on who was blinded in a trial instead of using the term ‘double-blind’ for different blinding practices.

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Clinical Use of Placebo Effects in Patients With Pain Disorders

Cited by 52 publications

References 85 publications

Non-invasive neuromodulation effects on painful diabetic peripheral neuropathy: a systematic review and meta-analysis

Non-invasive neuromodulation effects on painful diabetic peripheral neuropathy: a systematic review and meta-analysis

Preface

Definitions of blinding in randomised controlled trials of interventions published in high-impact anaesthesiology journals: a methodological study and survey of authors

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