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Positive messages may reduce patient pain: A meta-analysis

Positive messages may reduce patient pain: A meta-analysis
Positive messages may reduce patient pain: A meta-analysis
Introduction: Current treatments for pain have limited benefits and worrying side
effects. Some studies suggest that pain is reduced when clinicians deliver positive
messages. However, the effects of positive messages are heterogeneous and have not been subject to meta-analysis. We aimed to estimate the efficacy of positive messages for pain reduction.

Methods: We included randomized trials of the effects of positive messages in a
subset of the studies included in a recent systematic review of context factors for
treating pain. Several electronic databases were searched. Reference lists of relevant studies were also searched. Two authors independently undertook study selection, data extraction, risk of bias assessment, and analyses. Our primary outcome measures were differences in patient- or observer-reported pain between groups who were given positive messages and those who were not.

Results: Of the 16 randomized trials (1703 patients) that met the inclusion criteria, 12 trials had sufficient data for meta-analysis. The pooled standardized effect size was −0.31 (95% confidence interval [CI] −0.61 to −0.01, p = 0.04, I2 = 82%). The effect size remained positive but not statistically significant after we excluded studies considered to have a high risk of bias (standard effect size −0.17, 95% CI −0.54 to 0.19, P = 0.36, I2 = 84%).

Conclusion: Care of patients with chronic or acute pain may be enhanced when
clinicians deliver positive messages about possible clinical outcomes. However, we have identified several limitations of the present study that suggest caution when interpreting the results. We recommend further high-quality studies to confirm (or falsify) our result.
1876-3820
Howick, Jeremy
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Lewith, George
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Mebius, Alexander
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Fanshawe, Thomas R.
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Bishop, Felicity
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van Osch, Mara
561bc926-4dbc-4008-a1b9-ab12e66624cf
van Dulmen, Sandra
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Christelis, Nick
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Kaptchuk, Ted
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Mistiaen, Patriek
e7bdcf50-21c2-4874-b22b-6591fe19b6fa
Howick, Jeremy
0d21085b-6b93-4a4e-8d87-1cc3a83f8768
Lewith, George
0fc483fa-f17b-47c5-94d9-5c15e65a7625
Mebius, Alexander
17678be2-ad4d-4815-a6fe-ea879437767a
Fanshawe, Thomas R.
39948cdd-a359-4b6c-ad92-15a0a00b5e41
Bishop, Felicity
1f5429c5-325f-4ac4-aae3-6ba85d079928
van Osch, Mara
561bc926-4dbc-4008-a1b9-ab12e66624cf
van Dulmen, Sandra
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Christelis, Nick
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Kaptchuk, Ted
2f00a336-47cc-408c-998a-c85d8f7e3feb
Mistiaen, Patriek
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Howick, Jeremy, Lewith, George, Mebius, Alexander, Fanshawe, Thomas R., Bishop, Felicity, van Osch, Mara, van Dulmen, Sandra, Christelis, Nick, Kaptchuk, Ted and Mistiaen, Patriek (2017) Positive messages may reduce patient pain: A meta-analysis. European Journal of Integrative Medicine. (doi:10.1016/j.eujim.2017.03.005).

Record type: Article

Abstract

Introduction: Current treatments for pain have limited benefits and worrying side
effects. Some studies suggest that pain is reduced when clinicians deliver positive
messages. However, the effects of positive messages are heterogeneous and have not been subject to meta-analysis. We aimed to estimate the efficacy of positive messages for pain reduction.

Methods: We included randomized trials of the effects of positive messages in a
subset of the studies included in a recent systematic review of context factors for
treating pain. Several electronic databases were searched. Reference lists of relevant studies were also searched. Two authors independently undertook study selection, data extraction, risk of bias assessment, and analyses. Our primary outcome measures were differences in patient- or observer-reported pain between groups who were given positive messages and those who were not.

Results: Of the 16 randomized trials (1703 patients) that met the inclusion criteria, 12 trials had sufficient data for meta-analysis. The pooled standardized effect size was −0.31 (95% confidence interval [CI] −0.61 to −0.01, p = 0.04, I2 = 82%). The effect size remained positive but not statistically significant after we excluded studies considered to have a high risk of bias (standard effect size −0.17, 95% CI −0.54 to 0.19, P = 0.36, I2 = 84%).

Conclusion: Care of patients with chronic or acute pain may be enhanced when
clinicians deliver positive messages about possible clinical outcomes. However, we have identified several limitations of the present study that suggest caution when interpreting the results. We recommend further high-quality studies to confirm (or falsify) our result.

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Howick2017 EuJIM Author Accepted MS - Accepted Manuscript
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More information

Accepted/In Press date: 15 March 2017
e-pub ahead of print date: 21 March 2017
Organisations: Human Wellbeing, Primary Care & Population Sciences

Identifiers

Local EPrints ID: 407353
URI: https://eprints.soton.ac.uk/id/eprint/407353
ISSN: 1876-3820
PURE UUID: ef363b3a-c0e7-4d23-83e9-d2cc8fd16b21
ORCID for Felicity Bishop: ORCID iD orcid.org/0000-0002-8737-6662

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Date deposited: 04 Apr 2017 01:05
Last modified: 10 Sep 2019 04:59

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