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Conditioned open-label placebos to facilitate opioid reduction in patients with chronic non-cancer pain: study protocol of a randomised controlled trial.

作者信息

Carratta Katja, Bodonyi Kiara, Frey Nascimento Antje, Friis Daniel, von Känel Roland, Bircher Lukas, Koechlin Helen, Bernstein Michael, Streitberger Konrad, Arnet Isabelle, Roth Alfred Josef, Ronel Joram, Olliges Elisabeth, Locher Cosima

机构信息

Department of Consultation-Liaison Psychiatry and Psychosomatic Medicine, University Hospital Zurich, Zürich, Switzerland.

Division of Clinical Psychology and Psychotherapy, Faculty of Psychology, University of Basel, Basel, Switzerland.

出版信息

BMJ Open. 2025 May 24;15(5):e098253. doi: 10.1136/bmjopen-2024-098253.


DOI:10.1136/bmjopen-2024-098253
PMID:40413049
原文链接:https://pmc.ncbi.nlm.nih.gov/articles/PMC12104921/
Abstract

INTRODUCTION: Chronic non-cancer pain presents a global health problem, with a significant increase in opioid prescriptions over recent decades. However, opioid therapy poses risks of adverse events, overdose and non-medical use. As a result, many patients seek to discontinue or reduce their opioid intake. Strategies for opioid tapering often lack efficacy, prompting the investigation of novel approaches like open-label placebo (OLP), that is, the administration of a placebo with full disclosure that it is a placebo. OLP has shown efficacy in chronic non-cancer pain syndromes and has been suggested as a promising candidate for medication tapering. This study aims to assess whether OLPs can enhance the reduction of daily morphine equivalent dose (MED) in chronic non-cancer pain patients and examines its potential in mitigating opioid withdrawal symptoms. METHODS AND ANALYSIS: This study is designed as a randomised, controlled, single-centre trial. Participants will be randomised into either an OLP group or a control group. The study duration will span six to nine weeks, during which all participants will aim to reduce their opioid intake. Both groups will monitor their opioid intake daily using a diary app and will receive feedback on their progress of reducing opioids. Additionally, participants in the OLP group will receive OLP tablets for the entire study period. During the first week, the OLP group will undergo a one week learning phase using a classical conditioning paradigm, where each opioid intake is paired with a placebo. In the subsequent five weeks, the OLP group will enter a dose-extension phase in which only the first opioid intake of the day is paired with a placebo, and additional placebos can be taken as desired. At the end of the study, qualitative interviews will be conducted with the first 15 participants in the OLP group. The primary outcome measure is daily opioid intake. Secondary outcomes include opioid withdrawal symptoms, pain severity, disability, anxiety, depression, opioid beliefs, intervention expectancy and qualitative data. Statistical analyses will include analysis of covariance and regression models. ETHICS AND DISSEMINATION: The ethics committee of the Canton of Zurich, Switzerland, approved the study (SNCTP-nr.: SNCTP000005853/BASEC nr.: 2023-02327).Participants will be compensated with 100 Swiss Francs for their full participation in the study. Participants who will take part in the qualitative interview will be compensated with additional 15 Swiss Francs. TRIAL REGISTRATION NUMBER: This study is registered at clinicaltrials.gov: NCT06350786.

摘要
https://cdn.ncbi.nlm.nih.gov/pmc/blobs/dfac/12104921/8a5b0aa83d2e/bmjopen-15-5-g001.jpg
https://cdn.ncbi.nlm.nih.gov/pmc/blobs/dfac/12104921/8a5b0aa83d2e/bmjopen-15-5-g001.jpg
https://cdn.ncbi.nlm.nih.gov/pmc/blobs/dfac/12104921/8a5b0aa83d2e/bmjopen-15-5-g001.jpg

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Conditioned open-label placebos to facilitate opioid reduction in patients with chronic non-cancer pain: study protocol of a randomised controlled trial.

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本文引用的文献

[1]
Efficacy of open-label placebos for premenstrual syndrome: a randomised controlled trial.

BMJ Evid Based Med. 2025-3-25

[2]
The roles of expectation, comparator, administration route, and population in open-label placebo effects: a network meta-analysis.

Sci Rep. 2023-7-22

[3]
Increased Use and Large Variation in Strong Opioids and Metamizole (Dipyrone) for Minor and Major Musculoskeletal Injuries Between 2008 and 2018: An Analysis of a Representative Sample of Swiss Workers.

J Occup Rehabil. 2024-3

[4]
Opioid sales and opioid-related poisonings in Switzerland: A descriptive population-based time-series analysis.

Lancet Reg Health Eur. 2022-6-27

[5]
Open-Label Placebo Administration Decreases Pain in Elderly Patients With Symptomatic Knee Osteoarthritis - A Randomized Controlled Trial.

Front Psychiatry. 2022-5-6

[6]
Efficacy of interventions to reduce long term opioid treatment for chronic non-cancer pain: systematic review and meta-analysis.

BMJ. 2022-4-4

[7]
Effect of Open-label Placebo on Children and Adolescents With Functional Abdominal Pain or Irritable Bowel Syndrome: A Randomized Clinical Trial.

JAMA Pediatr. 2022-4-1

[8]
Effects of open-label placebos in clinical trials: a systematic review and meta-analysis.

Sci Rep. 2021-2-16

[9]
Conditioned open-label placebo for opioid reduction after spine surgery: a randomized controlled trial.

Pain. 2021-6-1

[10]
Conditioning open-label placebo: a pilot pharmacobehavioral approach for opioid dose reduction and pain control.

Pain Rep. 2020-7-20

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