Journal article

A test of positive suggestions about side effects as a way of enhancing the analgesic response to NSAIDs

  • Fernandez, Aurore Pain Center, Department of Anesthesiology, Lausanne University Hospital, Switzerland - Faculty of Biology and Medicine (FBM), University of Lausanne, Switzerland
  • Kirsch, Irving Program in Placebo Studies, Harvard Medical School, Boston, USA
  • Noël, Louis Pain Center, Department of Anesthesiology, Lausanne University Hospital, Switzerland - Faculty of Biology and Medicine (FBM), University of Lausanne, Switzerland
  • Rodondi, Pierre-Yves Faculty of Biology and Medicine (FBM), University of Lausanne, Switzerland - Institute of Social and Preventive Medicine, Lausanne, Switzerland - Institute of Family Medicine, University of Fribourg, Switzerland
  • Kaptchuk, Ted J. Program in Placebo Studies, Harvard Medical School, Boston, USA
  • Suter, Marc R. Pain Center, Department of Anesthesiology, Lausanne University Hospital, Switzerland - Faculty of Biology and Medicine (FBM), University of Lausanne, Switzerland
  • Décosterd, Isabelle Pain Center, Department of Anesthesiology, Lausanne University Hospital, Switzerland - Faculty of Biology and Medicine (FBM), University of Lausanne, Switzerland
  • Berna, Chantal Pain Center, Department of Anesthesiology, Lausanne University Hospital, Switzerland - Faculty of Biology and Medicine (FBM), University of Lausanne, Switzerland - Program in Placebo Studies, Harvard Medical School, Boston, USA
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    03.01.2019
Published in:
  • PLOS ONE. - 2019, vol. 14, no. 1, p. e0209851
English Side effects are frequent in pharmacological pain management, potentially preceding analgesia and limiting drug tolerability. Discussing side effects is part of informed consent, yet can favor nocebo effects. This study aimed to test whether a positive suggestion regarding side effects, which could act as reminders of the medication having been absorbed, might favor analgesia in a clinical interaction model. Sixty-six healthy males participated in a study “to validate pupillometry as an objective measure of analgesia”. Participants were unknowingly randomized double-blind to positive vs control information about side effects embedded in a video regarding the study drugs. Sequences of moderately painful heat stimuli applied before and after treatment with diclofenac and atropine served to evaluate analgesia. Atropine was deceptively presented as a co-analgesic, but used to induce side effects. Adverse events (AE) were collected with the General Assessment of Side Effects (GASE) questionnaire prior to the second induced pain sequence. Debriefing fully informed participants regarding the purpose of the study and showed them the two videos.The combination of medication led to significant analgesia, without a between-group difference. Positive information about side effects increased the attribution of AE to the treatment compared to the control information. The total GASE score was correlated with analgesia, i.e., the more AEs reported, the stronger the analgesia. Interestingly, there was a significant between-groups difference on this correlation: the GASE score and analgesia correlated only in the positive information group. This provides evidence for a selective link between AEs and pain relief in the group who received the suggestion that AEs could be taken as a sign “that help was on the way”. During debriefing, 65% of participants said they would prefer to receive the positive message in a clinical context. Although the present results cannot be translated immediately to clinical pain conditions, they do indicate the importance of testing this type of modulation in a clinical context.
Faculty
Faculté des sciences et de médecine
Department
Master en médecine
Language
  • English
Classification
Medicine
License
License undefined
Identifiers
Persistent URL
https://folia.unifr.ch/unifr/documents/307589
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