What if patients believed a drug will not work? Or expected that a med will work? Can such notions actually have an affect on efficacy? Well, a new study suggests patient views can, indeed, alter outcomes. A brain imaging study of patients at Oxford University demonstrated that altering patient views could enhance or diminish the efficacy of strong painkillers,PharmaTimes writes.
In reaching this conclusion, the researchers put 22 healthy adult volunteers in an MRI scanner, administered an intravenous line containing Ultiva, an opioid-based painkiller, and applied heat to a leg at a level where pain was felt. And guess what? An initial control pain rating of 66 (out of 100) fell to 55 when the painkiller was given secretly, but then dropped to 39 after patients were told they received treatment, although dosages were the same.
Here's the interesting part: The study participants were then told treatment was stopped and warned pain could increase. But the drug was actually still being administered, yet the pain rating rose to 64, which PharmaTimes notes was a similar magnitude to what was reported in the absence of any pain relief. And brain scans showed the participants did experience different levels of pain when expectations changed, even though the painkiller dose remained constant.
"On the basis of subjective and objective evidence, we contend that an individual’s expectation of a drug’s effect critically influences its therapeutic efficacy and that regulatory brain mechanisms differ as a function of expectancy," the researchers write in Science Translational Medicine (read the abstract). "We propose that it may be necessary to integrate patients’ beliefs and expectations into drug treatment regimes alongside traditional considerations in order to optimize treatment outcomes."
"Doctors shouldn’t underestimate the significant influence that patients’ negative expectations can have on outcome," lead researcher Irene Tracey of the Centre for Functional Magnetic Resonance Imaging of the Brain at Oxford University tells PharmaTimes.
4 Comments
Nonsense to study such effects in pain. Pain meds have a placebo effect of about 66%...
I believe an important take home message is that patients who have a solid understanding of their disease state and treatments might rely less on less-founded beliefs. We can then concentrate of setting legitimate expectations.
Just my two cents.
My take is that physicians who believe in the drug as oposed to those physicians thinking it will not work will then get much better results by expressing those positive beleifs to the patient. I think this is absolutely true.
Testing induced pain from heat packs in healthy adults is meaningless. The ability to endure or become used to pain after a time will confound the results.
While the placebo effect is well-documented, my personal opinion is that if a patient is not in significant enough pain to determine the difference between therapy and non-therapy, then they don't need therapy.
Patients who are truly in pain (i.e. postsurgical) can tell the difference between opiods and placebo!
Disclaimer: I am not a doctor, just someone with common sense and some experience analyzing clinical trial data.