Li Xiaotong, Baser Raymond E, Bryl Karolina, Amann Lindsay, Chimonas Susan, Mao Jun J
Integrative Medicine Service, Department of Medicine, Memorial Sloan Kettering Cancer Center, New York, NY, United States.
Department of Epidemiology and Biostatistics, Memorial Sloan Kettering Cancer Center, New York, New York, United States.
Integr Med Res. 2024 Jun;13(2):101040. doi: 10.1016/j.imr.2024.101040. Epub 2024 Mar 26.
Outcome expectancy is an important component of non-specific effect that may play an important role in pain research and clinical care. We sought to evaluate whether pretreatment expectancy predicts pain reduction in cancer survivors receiving electroacupuncture (EA) or battlefield acupuncture (BFA).
We analyzed data from a randomized clinical trial that compared EA and BFA versus wait list control (WLC) for chronic musculoskeletal pain in cancer survivors. Expectancy was measured by the Acupuncture Expectancy Scale (AES) at baseline. Pain severity was assessed using the Brief Pain Inventory (BPI) at baseline and week 12. For each treatment arm, multivariable regression models were used to evaluate the association between pretreatment expectancy and week 12 pain severity, controlling for baseline pain severity, age, sex, race, and education.
Among 360 participants enrolled, the mean age was 62.1 years (SD 12.7), with 251 (69.7 %) women and 88 (24.4 %) non-white survivors. Pretreatment expectancy was similar for all groups at baseline (EA: 13.9 ± 3.6; BFA: 13.2 ± 3.7, WLC:12.8 ± 3.3, = 0.14). Greater pretreatment expectancy was not significantly associated with greater pain reduction in any group, after adjusting for co-variates (EA: Coef. = -0.05, 95 % CI = -0.14 - 0.04, = 0.28; BFA: Coef. = -0.07, 95 % CI = -0.16 - 0.02, = 0.15; WLC: Coef. = -0.09, 95 % CI = -0.25 - 0.06, = 0.23).
Pretreatment expectancy did not predict pain reduction for either EA or BFA in cancer survivors. Our study contributes to the interpretation of analgesic effects of EA or BFA, beyond the notion of a mere 'placebo effect'.
结果期望是非特异性效应的一个重要组成部分，可能在疼痛研究和临床护理中发挥重要作用。我们试图评估治疗前的期望是否能预测接受电针（EA）或战场针刺（BFA）的癌症幸存者的疼痛减轻情况。
我们分析了一项随机临床试验的数据，该试验比较了EA和BFA与等待列表对照（WLC）对癌症幸存者慢性肌肉骨骼疼痛的疗效。在基线时使用针刺期望量表（AES）测量期望。在基线和第12周使用简明疼痛量表（BPI）评估疼痛严重程度。对于每个治疗组，使用多变量回归模型评估治疗前期望与第12周疼痛严重程度之间的关联，并控制基线疼痛严重程度、年龄、性别、种族和教育程度。
在360名入组参与者中，平均年龄为62.1岁（标准差12.7），其中251名（69.7%）为女性，88名（24.4%）为非白人幸存者。基线时所有组的治疗前期望相似（EA：13.9±3.6；BFA：13.2±3.7，WLC：12.8±3.3，P = 0.14）。在调整协变量后，任何组中更高的治疗前期望与更大的疼痛减轻均无显著关联（EA：系数=-0.05，95%置信区间=-0.14 - 0.04，P = 0.28；BFA：系数=-0.07，95%置信区间=-0.16 - 0.02，P = 0.15；WLC：系数=-0.09，95%置信区间=-0.25 - 0.06，P = 0.23）。
治疗前期望不能预测癌症幸存者接受EA或BFA后的疼痛减轻情况。我们的研究有助于解释EA或BFA的镇痛效果，超越了单纯“安慰剂效应”的概念。
