Oktay Cem, Eken Cenker, Goksu Erkan, Dora Babur
Department of Emergency Medicine, Akdeniz University School of Medicine, Turkey
Department of Emergency Medicine, Akdeniz University School of Medicine, Turkey.
Cephalalgia. 2015 Jun;35(7):579-84. doi: 10.1177/0333102414553821. Epub 2014 Oct 10.
The therapeutic response of a patient cannot purely be explained by the method of therapy or the efficacy of a drug. Clinician-patient interaction, psychosocial factors, patients' expectations, hopes, beliefs and fears are all related to the healing outcome. Malleability and suggestibility are also important in the placebo or nocebo effect. The purpose of this study was to evaluate whether adding brief verbal suggestions for pain relief could change the magnitude of an analgesic's efficacy.
This prospective study was performed in the emergency department of a university hospital. Patients who were ordered analgesia with diclofenac sodium for primary headache were divided into three groups. All groups were informed that they would be administered a pain killer by intramuscular injection. The second and third groups were given positive and reduced treatment expectations about the therapeutic efficacy, respectively. Patients were asked to rate their pain on a VAS at 0 and 45 minutes and if they needed any additional analgesic 45 minutes after the injection.
A total of 153 patients were included in the study. The paired univariate analyses showed significant differences for all groups between 0- and 45-minute VAS scores. However, there was no difference between the three groups according to the differences in VAS scores between 45 and 0 minutes and according to the administration of an additional drug.
Simple verbal suggestions did not alter the efficacy of an analgesic agent for headache in an emergency setting. The contributions of suggestibility, desire and expectation in acute primary headache patients should be further investigated.
患者的治疗反应不能单纯用治疗方法或药物疗效来解释。医患互动、心理社会因素、患者的期望、希望、信念和恐惧都与治疗结果相关。可塑性和暗示性在安慰剂或反安慰剂效应中也很重要。本研究的目的是评估添加简短的缓解疼痛的言语暗示是否会改变镇痛药疗效的程度。
这项前瞻性研究在一家大学医院的急诊科进行。因原发性头痛而被医嘱用双氯芬酸钠镇痛的患者被分为三组。所有组都被告知他们将接受肌肉注射止痛药。第二组和第三组分别对治疗效果给予积极和降低的治疗期望。要求患者在注射后0分钟和45分钟时用视觉模拟评分法（VAS）对疼痛进行评分，并询问他们在注射45分钟后是否需要额外的镇痛药。
共有153名患者纳入研究。配对单变量分析显示，所有组在0分钟和45分钟的VAS评分之间存在显著差异。然而，根据45分钟和0分钟之间VAS评分的差异以及额外药物的使用情况，三组之间没有差异。
在急诊环境中，简单的言语暗示不会改变镇痛药对头痛的疗效。应进一步研究急性原发性头痛患者中暗示性、欲望和期望的作用。
