Study: Patient Expectations Alter the Effect of Analgesia

Patients' expectations about analgesia and hyperalgesia can alter the efficacy of an opioid and lead to neurologic changes in the brain regions associated with evaluating pain intensity, according to a study reported in Pain Medicine News.

The study, which used a small sample of health volunteers, showed that patients' beliefs about their symptoms can shape their experience of pain and alter their neural activity, according to the report. Urlike Bingel, MD, the study's primary investigator, said this study is the first brain imaging study to examine neurologic changes that take place when patients' expectations change regarding analgesia.

The study enrolled 22 healthy subjects to undergo heat pain testing. None of the subjects were taking medications, had a history of neurologic or psychiatric disease or had received opioids in the past. The participants underwent four consecutive standardized heat pain tests while simultaneously receiving fMRI. The patients were first given a saline solution to establish baseline pain ratings, but were switched to remifentanil without being told about the change. The researchers then informed the subject they were receiving the active drug, and finally, the researchers lied to the subjects and informed them that remifentanil had been discontinued.

The researchers used 100-point visual analog scales and fMRI scans to determine whether the subjects experienced changes in brain activity during each round of testing. The results revealed that positive expectancy of analgesia significantly enhanced the analgesic effect of remifentanil.

Read the Pain Medicine News report on analgesia expectations.

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