Do patient and physician expectations predict response to pain-relieving procedures?
OBJECTIVE
To evaluate the relationships between patient and physician pretreatment expectations of pain relief and subsequent pain relief reported by chronic pain patients immediately after treatment.


METHODS
Prospective study of consecutive patients undergoing a procedure in a pain clinic for treatment of chronic pain. Patients rated their current pain level and their expectation of pain relief immediately prior to undergoing a procedure (e.g., intravenous drug infusion, nerve block) for the treatment of chronic pain. Simultaneously and independently, the treating physician completed a similar questionnaire. At completion of the procedure, patients rated their current pain level and degree of pain relief.


METHODS
University of Washington Multidisciplinary Pain Center procedure suite.


METHODS
Forty-six consecutive chronic pain patients.


METHODS
Intravenous drug infusions and nerve blocks.


METHODS
Current pain and pain relief ratings.


RESULTS
Patients' pain relief expectation ratings were not correlated significantly with their postprocedure pain relief ratings or pre-post procedure changes in pain ratings. However, a statistically significant correlation was found between physician expectations of pain relief and patient pain relief ratings and patient pre-post procedure changes in pain.


CONCLUSIONS
The results of this study suggest that physicians are better predictors than are patients of patients responses to these procedures and/or that physicians may somehow subtly communicate their expectations to patients during the procedure, and these expectations then influence patient response. Patient pretreatment expectations may not always play a significant role in nonspecific treatment effects.
Galer
B S
BS
Department of Neurology, University of Washington School of Medicine, Seattle, USA.
Schwartz
L
L
Turner
J A
JA
D000328:Adult; D001290:Attitude; D001291:Attitude of Health Personnel; D002908:Chronic Disease; D005260:Female; D006801:Humans; D008297:Male; D009407:Nerve Block; D010146:Pain / Q000523:psychology*; D018710:Pain Clinics; D059408:Pain Management; D010147:Pain Measurement; D010361:Patients / Q000523:psychology; D010820:Physicians / Q000523:psychology; D011446:Prospective Studies