Morales-Quezada Leon, Mesia-Toledo Ines, Estudillo-Guerra Anayali, O'Connor Kevin C, Schneider Jeffrey C, Sohn Douglas J, Crandell David M, Kaptchuk Ted, Zafonte Ross
Department of Physical Medicine and Rehabilitation, Spaulding Rehabilitation Hospital, Harvard Medical School, Boston, MA, USA.
Program in Placebo Studies and Therapeutic Encounter, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, MA, USA.
Pain Rep. 2020 Jul 20;5(4):e828. doi: 10.1097/PR9.0000000000000828. eCollection 2020 Jul-Aug.
Opioid consumption for those in comprehensive inpatient rehabilitation units is high because of the complexity of their injuries. Notably, pain in rehabilitation leads to worsened clinical outcomes because of maladaptive behaviors and poor engagement during therapies. It is critical to developing evidence-based pharmacobehavioral interventions. Based on principles of classical conditioning, conditioning open-label placebo (COLP) is a promising approach for reducing opioid use in comprehensive inpatient rehabilitation, and this technique takes advantage of the possibility of association learning and opioid pharmacology to promote evoked placebo-driven analgesia.
In this brief report, we evaluate the feasibility of COLP as a pharmacobehavioral intervention to decrease total opioid consumption in patients with pain hospitalized at Spaulding Rehabilitation Hospital.
Inpatients with spinal cord injury and polytrauma (n = 20) with moderate to severe pain were randomized to receive COLP (n = 10) or treatment-as-usual for 6 consecutive days. Opioid utilization was measured by morphine equivalents using the morphine equivalent dose conversion; pain severity was assessed using the numerical visual analog scale.
Conditioning open-label placebo significantly reduced total opioid consumption by the end of the intervention period ( ≤ 0.001). Pain reduction was also significant for the COLP group ( = 0.005), whereas the treatment-as-usual group demonstrated a trend towards pain reduction ( = 0.05).
This study presents the first data in the use of a pharmacobehavioral intervention that capitalize on the benefits of open-label placebo and classical drug conditioning for opioid dose reduction in a population with moderate to severe pain exposed to intensive inpatient rehabilitation.
由于综合住院康复单元患者损伤的复杂性，他们的阿片类药物消耗量很高。值得注意的是，康复过程中的疼痛会因适应不良行为和治疗期间参与度低而导致临床结果恶化。制定基于证据的药物行为干预措施至关重要。基于经典条件反射原理，条件性开放标签安慰剂（COLP）是一种在综合住院康复中减少阿片类药物使用的有前景的方法，该技术利用关联学习和阿片类药物药理学的可能性来促进诱发的安慰剂驱动的镇痛作用。
在本简要报告中，我们评估COLP作为一种药物行为干预措施在斯波尔丁康复医院住院的疼痛患者中减少阿片类药物总消耗量的可行性。
将患有中度至重度疼痛的脊髓损伤和多发伤住院患者（n = 20）随机分为接受COLP（n = 10）或常规治疗，连续6天。使用吗啡等效剂量转换通过吗啡当量来测量阿片类药物的使用情况；使用数字视觉模拟量表评估疼痛严重程度。
在干预期结束时，条件性开放标签安慰剂显著降低了阿片类药物的总消耗量（P≤0.001）。COLP组的疼痛减轻也很显著（P = 0.005），而常规治疗组则显示出疼痛减轻的趋势（P = 0.05）。
本研究提供了首个关于使用药物行为干预措施的数据，该措施利用开放标签安慰剂和经典药物条件反射的益处，在接受强化住院康复的中度至重度疼痛人群中减少阿片类药物剂量。
