Placebos and pain reduction

Page 301
Black blue
PAIN
301
Results
The results were analysed to examine differences between the two groups (treatment
versus control) and to examine differences in changes in the measures (from time 1 to
time 2 and at follow-up) between the two groups.
Time 1 to time 2
The results showed significantly different changes between the two groups in all their
ratings. Compared with the control group, the subjects who had received cognitive
behavioural treatment reported lower pain intensity, lower functional impairment, better
daily mood, fewer bodily symptoms, less anxiety, less depression, fewer pain-related
bodily symptoms and fewer pain-related sleep disorders.
Time 1 to time 2 to time 3
When the results at six-month follow-up were included, again the results showed significant differences between the two groups on all variables except daily mood and sleep
disorders.
The role of adherence
The subjects in the treatment condition were then divided into those who adhered to
the recommended exercise regimen at follow-up (adherers) and those who did not
(non-adherers). The results from this analysis indicate that the adherers showed an
improvement in pain intensity at follow-up compared with their ratings immediately
after the treatment intervention, whilst the non-adherers ratings at follow-up were the
same as immediately after the treatment.
Conclusion
The authors conclude that the study provides support for the use of cognitive–
behavioural treatment for chronic pain. The authors also point to the central role of
treatment adherence in predicting improvement. They suggest that this effect of
adherence indicates that the improvement in pain was a result of the specific treatment
factors (i.e. the exercises) not the non-specific treatment factors (contact with professionals, a feeling of doing something). However, it is possible that the central role for
adherence in the present study is similar to that discussed in Chapter 13 in the context of
placebos, with treatment adherence itself being a placebo effect.
Placebos and pain reduction
Placebos have been defined as inert substances that cause symptom relief (see Chapter
13). Traditionally, placebos were used in randomized control trials to compare an active
Page 301
Black blue