Department of Anesthesiology, Perioperative, and Pain Medicine, Brigham and Women's Hospital, 75 Francis Street, Boston, MA, 02015, USA.
Lewis Katz School of Medicine, Temple University, Philadelphia, USA.
Int J Behav Med. 2023 Aug;30(4):509-521. doi: 10.1007/s12529-022-10114-5. Epub 2022 Aug 1.
Pain after spine surgery is difficult to manage, often requiring the use of opioid analgesics. While traditional "deceptive" or concealed placebo has been studied in trials and laboratory experiments, the acceptability and patient experience of taking honestly prescribed placebos, such as "open-label" placebo (non-deceptive placebo), or conditioned placebo (pairing placebo with another active pharmaceutical) is relatively unexamined.
Qualitative thematic analysis was performed using semi-structured, post-treatment interviews with spine surgery patients (n = 18) who had received conditioned open-label placebo (COLP) during the first 2-3 weeks after surgery as part of a RCT. Interview transcripts were reviewed by 3 investigators using an immersion/crystallization approach, followed by iterative large-group discussions with additional investigators, to identify, refine, and codify emergent themes.
Patients' experiences and perceptions of COLP efficacy varied widely. Some emergent themes included the power of the mind over pain, how COLP might provide distraction from or agency over pain, bandwidth required and engagement with COLP, and its modulation of opioid tapering, as well as negative attitudes toward opioids and pill taking in general. Other themes included uncertainty about COLP efficacy, observations of how personality may relate to COLP efficacy, and a recognition of the greater impact of COLP on reduction of opioid use rather than on pain itself. Interestingly, participant uncertainty, disbelief, and skepticism were not necessarily associated with greater opioid consumption or worse pain.
Participants provided insights into the experience of COLP which may help to guide its future utilization to manage acute pain and tapering from opioids.
脊柱手术后的疼痛难以控制，往往需要使用阿片类镇痛药。虽然在试验和实验室实验中已经研究了传统的“欺骗性”或隐蔽安慰剂，但患者对服用诚实处方安慰剂（如“开放性标签”安慰剂（非欺骗性安慰剂）或条件性安慰剂（将安慰剂与另一种活性药物配对）的可接受性和体验相对较少研究。
使用半结构化的、治疗后访谈对脊柱手术患者（n=18）进行定性主题分析，这些患者在手术后的前 2-3 周内接受了条件开放性标签安慰剂（COLP），这是一项 RCT 的一部分。访谈记录由 3 名研究人员使用沉浸式/结晶方法进行审查，然后与其他研究人员进行迭代的大组讨论，以识别、精炼和编码新兴主题。
患者对 COLP 疗效的体验和看法差异很大。一些新兴主题包括思想对疼痛的力量、COLP 如何提供对疼痛的分散注意力或代理权、所需带宽和与 COLP 的参与、以及对阿片类药物减量的调节，以及对阿片类药物和一般药丸的一般负面态度。其他主题包括对 COLP 疗效的不确定性、观察人格可能与 COLP 疗效的关系、以及认识到 COLP 对减少阿片类药物使用的影响大于对疼痛本身的影响。有趣的是，参与者的不确定性、怀疑和怀疑并不一定与更大的阿片类药物消耗或更严重的疼痛相关。
参与者提供了有关 COLP 体验的见解，这可能有助于指导其未来用于管理急性疼痛和从阿片类药物减量。
