Accurate pain reporting training diminishes the placebo response: Results from a randomised, double-blind, crossover trial

Roi Treister, Oluwadolapo D Lawal, Jonathan D Shecter, Nevil Khurana, John Bothmer, Mark Field, Steven E Harte, Grant H Kruger and Nathaniel P Katz

PLOS ONE, 2018, vol. 13, issue 5, 1-12

Abstract: Analgesic trials frequently fail to demonstrate efficacy of drugs known to be efficacious. Poor pain reporting accuracy is a possible source for this low essay-sensitivity. We report the effects of Accurate-Pain-Reporting-Training (APRT) on the placebo response in a trial of Pregabalin for painful-diabetic-neuropathy. The study was a two-stage randomized, double-blind trial: In Stage-1 (Training) subjects were randomized to APRT or No-Training. The APRT participants received feedback on the accuracy of their pain reports in response to mechanical stimuli, measured by R-square score. In Stage-2 (Evaluation) all subjects entered a placebo-controlled, cross-over trial. Primary (24-h average pain intensity) and secondary (current, 24-h worst, and 24-h walking pain intensity) outcome measures were reported. Fifty-one participants completed the study. APRT patients (n = 28) demonstrated significant (p = 0.036) increases in R-square scores. The APRT group demonstrated significantly (p = 0.018) lower placebo response (0.29 ± 1.21 vs. 1.48 ± 2.21, mean difference ± SD = -1.19±1.73). No relationships were found between the R-square scores and changes in pain intensity in the treatment arm. In summary, our training successfully increased pain reporting accuracy and resulted in a diminished placebo response. Theoretical and practical implications are discussed.

Date: 2018
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Persistent link: https://EconPapers.repec.org/RePEc:plo:pone00:0197844

DOI: 10.1371/journal.pone.0197844

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