Highlights
- •Treatment beliefs offer an additional approach to understanding placebo analgesia.
- •Variation in placebo analgesia was predicted by pre-treatment necessity beliefs.
- •Treatment necessity beliefs were informed by general treatment beliefs and beliefs about the pain.
- •Perceived sensitivity to the effects of medicines was associated with larger placebo analgesia.
Abstract
This study examined whether placebo responses were predicted by a theoretical model
of specific and general treatment beliefs. Using a randomized crossover, experimental
design (168 healthy individuals) we assessed whether responses to a cold pressor task
were influenced by 2 placebo creams described as pharmaceutical versus natural. We
assessed whether placebo responses were predicted by pretreatment beliefs about the
treatments (placebo) and by beliefs about the pain. The efficacy of pharmaceutical
as well as natural placebos in reducing pain intensity was predicted by aspects of
pain catastrophizing including feelings of helplessness (pharmaceutical: B = .03,
P < .01, natural: B = .02, P < .05) and magnification of pain (pharmaceutical: B = .04, P < .05, natural: B = .05, P < .05) but also by pretreatment necessity beliefs (pharmaceutical: B = .21, P < .01, natural: B = .16, P < .05) and, for the pharmaceutical condition, by more general beliefs about personal
sensitivity to pharmaceuticals (B = .14, P < .05). Treatment necessity beliefs also partially mediated the effects of helplessness
on placebo responses. Treatment necessity beliefs for the pharmaceutical placebo were
influenced by general pharmaceutical beliefs whereas necessity beliefs for the natural
placebo were informed by general background beliefs about holistic treatments. Our
findings show that treatment beliefs influence the placebo effect suggesting that
they may offer an additional approach for understanding the placebo effect.
Perspective
Placebo effects contribute to responses to active analgesics. Understanding how beliefs
about different types of treatment influence placebo analgesia may be useful in understanding
variations in treatment response. Using the cold pressor paradigm we found that placebo
analgesia was influenced by beliefs about natural remedies, pharmaceutical medicines,
and about pain.
Key words
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References
- Factors associated with poor seizure control and increased side effects after switching to generic antiepileptic drugs.Epilepsy Res. 2011; 95: 158-167
- Developing a measure of treatment beliefs: The complementary and alternative medicine beliefs inventory.Complement Ther Med. 2005; 13: 144-149
- Profiling patient attitudes to phosphate binding medication: A route to personalising treatment and adherence support.Psychol Health. 2014; 29: 1407-1420
- Biological, clinical, and ethical advances of placebo effects.Lancet. 2010; 375: 686-695
- The effects of acceptance of thoughts, mindful awareness of breathing, and spontaneous coping on an experimentally induced pain task.Psych Rec. 2014; 64: 447-455
- Dispositional optimism predicts placebo analgesia.J Pain. 2010; 11: 1165-1171
- Physical symptoms, beliefs about medications, negative mood, and long-term HIV medication adherence.Ann Behav Med. 2007; 34: 46-55
- Test-retest reliability of the Short-Form McGill Pain Questionnaire - Assessment of intraclass correlation coefficients and limits of agreement in patients with osteoarthritis.Clin J Pain. 2005; 21: 73-82
- Public perceptions of the risks, benefits and use of natural remedies, pharmaceutical medicines and personalised medicines.Complement Ther Med. 2013; 21: 487-491
- Beliefs about expectations moderate the influence of expectations on pain perception.Int J Behav Med. 2013; 20: 52-58
- More optimism, less pain! The influence of generalized and pain-specific expectations on experienced cold-pressor pain.J Behav Med. 2014; 37: 47-58
- Pain perception to the cold pressor test during the menstrual cycle in relation to estrogen levels and a comparison with men.Integr Physiol Behav Sci. 2000; 35: 132-141
- Patients’ beliefs about treatment: The hidden determinant of treatment outcome?.J Psychosom Res. 1999; 47: 491-495
- Treatment perceptions and self-regulation.in: Cameron L.D. Leventhal H. The Self-Regulation of Health and Behaviour. Taylor and Francis Books Ltd, UK2003: 138-142
- Understanding patients’ adherence-related beliefs about medicines prescribed for long-term conditions: A meta-analytic review of the Necessity-Concerns Framework.PLoS One. 2013; 8: e80633
- Patients’ perceptions of highly active antiretroviral therapy in relation to treatment uptake and adherence: The utility of the necessity-concerns framework.J Acquir Immune Defic Syndr. 2007; 45: 334-341
- The perceived sensitivity to medicines (PSM) scale: An evaluation of validity and reliability.Br J Health Psychol. 2013; 18: 18-30
- Patients’ attitudes to medicines and adherence to maintenance treatment in inflammatory bowel disease.Inflamm Bowel Dis. 2009; 15: 837-844
- Self-regulation and self-management in asthma: Exploring the role of illness perceptions and treatment beliefs in explaining non-adherence to preventer medication.Psychol Health. 2002; 17: 17-32
- The Beliefs About Medicines Questionnaire: The development and evaluation of a new method for assessing the cognitive representation of medication.Psychol Health. 1999; 14: 1-24
- The PHQ-9: Validity of a brief depression severity measure.J Gen Intern Med. 2001; 16: 606-613
- Self-regulation, health, and behavior: A perceptual-cognitive approach.Psychol Health. 1998; 13: 717-733
- Validity of the Brief Patient Health Questionnaire Mood Scale (PHQ-9) in the general population.Gen Hosp Psychiatry. 2006; 28: 71-77
- The short-form McGill Pain Questionnaire.Pain. 1987; 30: 191-197
- Temperature and the cold pressor test.J Pain. 2004; 5: 233-237
- Prediction of nonspecific side effects in rheumatoid arthritis patients by beliefs about medicines.Arthritis Care Res. 2010; 62: 791-799
- Factor structure, reliability, and validity of the Pain Catastrophizing Scale.J Behav Med. 1997; 20: 589-605
- Choice and placebo expectation effects in the context of pain analgesia.J Behav Med. 2012; 35: 462-470
- Pregabalin for the treatment of painful diabetic peripheral neuropathy: A double-blind, placebo-controlled trial.Pain. 2004; 110: 628-638
- Neural mechanisms mediating positive and negative treatment expectations in visceral pain: A functional magnetic resonance imaging study on placebo and nocebo effects in healthy volunteers.Pain. 2013; 154: 2372-2380
- The Master Book of Mathematical Recreations.Courier Corporation, USA1968
- Manual for the State-Trait Anxiety Inventory STAI (Form Y)(“Self-Evaluation Questionnaire”).Consulting Psychologists Press Inc, USA1983
- The additive impact of anxiety and a placebo on pain.Pain Med. 2001; 2: 267-279
- The Pain Catastrophizing Scale: Development and validation.Psychol Assess. 1995; 7: 524-532
- Catastrophizing, depression and expectancies for pain and emotional distress.Pain. 2001; 91: 147-154
- Illness perceptions in patients with fibromyalgia and their relationship to quality of life and catastrophizing.Arthritis Rheum. 2008; 58: 3618-3626
- The contributions of suggestion, desire, and expectation to placebo effects in irritable bowel syndrome patients. An empirical investigation.Pain. 2003; 105: 17-25
- Increased placebo analgesia over time in irritable bowel syndrome (IBS) patients is associated with desire and expectation but not endogenous opioid mechanisms.Pain. 2005; 115: 338-347
- Guidelines for the cold pressor task as an experimental pain stimulus for use with children.J Pain. 2005; 6: 218-227
- Development and validation of brief measures of positive and negative affect: The PANAS scales.J Pers Soc Psychol. 1988; 54: 1063-1070
- Evaluating the efficacy of graded in vivo exposure for the treatment of fear in patients with chronic back pain: A randomized controlled clinical trial.Pain. 2008; 136: 271-280
- Habituation and recovery of vascular responses in calf and forearm and of the level of pain sensation during the cold pressor test in man.Eur J Appl Physiol Occup Physiol. 1990; 61: 106-111
- Habituation of the cold pressor response in normo-and hypertensive human subjects.Eur J Appl Physiol Occup Physiol. 1985; 54: 136-144
Article info
Publication history
Published online: March 07, 2017
Accepted:
February 25,
2017
Received in revised form:
January 29,
2017
Received:
September 12,
2016
Footnotes
A.W. was supported by UCL School of Pharmacy Studentship. S.C.E.C. was supported by a UCL Excellence Fellowship. R.H. was supported by the National Institute for Health Research Collaboration for Leadership in Applied Health Research and Care North Thames at Bart's Health NHS Trust. The views expressed are those of the author(s) and not necessarily those of the National Health Service, the National Institute for Health Research, or the Department of Health.
The authors have no conflicts of interest to declare.
Identification
Copyright
© 2017 Published by Elsevier Inc. on behalf of the American Pain Society
