Universität zu Köln

Kosek, Eva, Rosen, Annelie, Carville, Serena, Choy, Ernest, Gracely, Richard H., Marcus, Hanke, Petzke, Frank, Ingvar, Martin ORCID: 0000-0002-9041-5714 and Jensen, Karin B. (2017). Lower Placebo Responses After Long-Term Exposure to Fibromyalgia Pain. J. Pain, 18 (7). S. 835 - 844. EDINBURGH: CHURCHILL LIVINGSTONE. ISSN 1526-5900

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Abstract

Knowledge about placebo mechanisms in patients with chronic pain is scarce. Fibromyalgia syndrome (FM) is associated with dysfunctions of central pain inhibition, and because placebo analgesia entails activation of endogenous pain inhibition, we hypothesized that long-term exposure to FM pain would negatively affect placebo responses. In our study we examined the placebo group (n = 37, mean age 45 years) from a 12-week, randomized, double-blind, placebo-controlled trial investigating the effects of milnacipran or placebo. Twenty-two patients were classified as placebo non responders and 15 as responders, according to the Patient Global Impression of Change scale. Primary outcome was the change in pressure pain sensitivity from baseline to post-treatment. Secondary outcomes included ratings of clinical pain (visual analog scale), FM effect (Fibromyalgia Impact Questionnaire), and pain drawing. Among placebo responders, longer FM duration was associated with smaller reductions in pressure pain sensitivity (r=.689, P=.004), but not among nonresponders (r=.348, P=.112). In our study we showed that FM duration influences endogenous pain regulation, because pain levels and placebo-induced analgesia were negatively affected. Our results point to the importance of early FM interventions, because endogenous pain regulation may still be harnessed at that early time. Also, placebo-controlled trials should take FM duration into consideration when interpreting results. Perspective: This study presents a novel perspective on placebo analgesia, because placebo responses among patients with chronic pain were analyzed. Long-term exposure to fibromyalgia pain was associated with lower placebo analgesia, and the results show the importance of taking pain duration into account when interpreting the results from placebo-controlled trials. (C) 2017 The Authors. Published by Elsevier Inc. on behalf of the American Pain Society. This is an open access article under the CC BY-NC-ND license (http://creativecommons.org/licenses/by-nc-nd/4.0/).

Item Type:	Journal Article
Creators:	Creators Email ORCID ORCID Put Code Kosek, Eva UNSPECIFIED UNSPECIFIED UNSPECIFIED Rosen, Annelie UNSPECIFIED UNSPECIFIED UNSPECIFIED Carville, Serena UNSPECIFIED UNSPECIFIED UNSPECIFIED Choy, Ernest UNSPECIFIED UNSPECIFIED UNSPECIFIED Gracely, Richard H. UNSPECIFIED UNSPECIFIED UNSPECIFIED Marcus, Hanke UNSPECIFIED UNSPECIFIED UNSPECIFIED Petzke, Frank UNSPECIFIED UNSPECIFIED UNSPECIFIED Ingvar, Martin UNSPECIFIED orcid.org/0000-0002-9041-5714 UNSPECIFIED Jensen, Karin B. UNSPECIFIED UNSPECIFIED UNSPECIFIED
URN:	urn:nbn:de:hbz:38-226693
DOI:	10.1016/j.jpain.2017.02.434
Journal or Publication Title:	J. Pain
Volume:	18
Number:	7
Page Range:	S. 835 - 844
Date:	2017
Publisher:	CHURCHILL LIVINGSTONE
Place of Publication:	EDINBURGH
ISSN:	1526-5900
Language:	English
Faculty:	Unspecified
Divisions:	Unspecified
Subjects:	no entry
Uncontrolled Keywords:	Keywords Language BRAIN; EXPECTATION; MODULATION; ACTIVATION; MECHANISMS; ANALGESIA; FMRI Multiple languages Clinical Neurology; Neurosciences Multiple languages
Refereed:	Yes
URI:	http://kups.ub.uni-koeln.de/id/eprint/22669