Peerdeman Kaya J, van Laarhoven Antoinette I M, Keij Sascha M, Vase Lene, Rovers Maroeska M, Peters Madelon L, Evers Andrea W M
Unit Health, Medical and Neuropsychology, Leiden University, Leiden, the Netherlands Leiden Institute for Brain and Cognition, Leiden University, Leiden, the Netherlands Department of Psychology and Behavioural Sciences, Aarhus University, Aarhus, Denmark Danish Pain Research Center, Aarhus University Hospital, Aarhus, Denmark Radboud Institute for Health Sciences, Radboud University Medical Center, Nijmegen, the Netherlands Department of Clinical Psychological Science, Maastricht University, Maastricht, the Netherlands Department of Medical Psychology, Radboud University Medical Center, Nijmegen, the Netherlands.
Pain. 2016 Jun;157(6):1179-1191. doi: 10.1097/j.pain.0000000000000540.
Patients' expectations are important predictors of the outcome of analgesic treatments, as demonstrated predominantly in research on placebo effects. Three commonly investigated interventions that have been found to induce expectations (verbal suggestion, conditioning, and mental imagery) entail promising, brief, and easy-to-implement adjunctive procedures for optimizing the effectiveness of analgesic treatments. However, evidence for their efficacy stems mostly from research on experimentally evoked pain in healthy samples, and these findings might not be directly transferable to clinical populations. The current meta-analysis investigated the effects of these expectation inductions on patients' pain relief. Five bibliographic databases were systematically searched for studies that assessed the effects of brief verbal suggestion, conditioning, or imagery interventions on pain in clinical populations, with patients experiencing experimental, acute procedural, or chronic pain, compared with no treatment or control treatment. Of the 15,955 studies retrieved, 30 met the inclusion criteria, of which 27 provided sufficient data for quantitative analyses. Overall, a medium-sized effect of the interventions on patients' pain relief was observed (Hedges g = 0.61, I = 73%), with varying effects of verbal suggestion (k = 18, g = 0.75), conditioning (always paired with verbal suggestion, k = 3, g = 0.65), and imagery (k = 6, g = 0.27). Subset analyses indicated medium to large effects on experimental and acute procedural pain and small effects on chronic pain. In conclusion, patients' pain can be relieved with expectation interventions; particularly, verbal suggestion for acute procedural pain was found to be effective.
患者的期望是镇痛治疗效果的重要预测指标，这在安慰剂效应的研究中得到了主要体现。已发现的三种常用于诱导期望的干预措施（言语暗示、条件作用和心理意象）是有前景的、简短且易于实施的辅助程序，可用于优化镇痛治疗的效果。然而，它们疗效的证据大多来自对健康样本中实验诱发疼痛的研究，而这些发现可能无法直接应用于临床人群。当前的荟萃分析研究了这些期望诱导措施对患者疼痛缓解的影响。系统检索了五个文献数据库，以查找评估简短言语暗示、条件作用或意象干预对临床人群疼痛影响的研究，这些患者经历的是实验性疼痛、急性程序性疼痛或慢性疼痛，并与未治疗或对照治疗进行比较。在检索到的15955项研究中，有30项符合纳入标准，其中27项提供了足够的数据用于定量分析。总体而言，观察到这些干预措施对患者疼痛缓解有中等程度的效果（Hedges g = 0.61，I² = 73%），言语暗示（k = 18，g = 0.75）、条件作用（总是与言语暗示配对，k = 3，g = 0.65）和意象（k = 6，g = 0.27）的效果各不相同。亚组分析表明，对实验性和急性程序性疼痛有中等至较大的效果，对慢性疼痛有较小的效果。总之，期望干预可以缓解患者的疼痛；特别是，发现言语暗示对急性程序性疼痛有效。
