Are some people more susceptible to placebos? A systematic review and meta-analysis of inter-individual variability in musculoskeletal pain

IF 4 2区医学 Q1 CLINICAL NEUROLOGY

Journal of Pain Pub Date : 2024-11-28 DOI:10.1016/j.jpain.2024.104745

Tobias Saueressig PT, Dipl.-Vw , Patrick J. Owen PhD (A/Prof.) , Hugo Pedder PhD (Dr) , Svenja Kaczorowski PT, MSc , Clint T. Miller PhD (Dr) , Lars Donath PhD (Prof.) , Daniel L. Belavý PhD (Prof.)

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引用次数: 0

Abstract

Existing data suggest placebo responses to treatments are small, but some people may be more likely to respond. We conducted a systematic review and meta-analysis of randomized controlled trials (RCTs) on interindividual variability in response to placebo interventions MEDLINE, EMBASE, CINAHL, Web of Science Core Collection, CENTRAL, and SPORTDiscus were searched from inception to September 2023. Trial registry searches, citation tracking, and searches for prior systematic reviews were completed. The PEDro scale assessed study quality. Random effects robust variance estimation estimated the log variability ratio (VR), identifying subgroups with varying responses. Twenty-six studies were included, comprising various musculoskeletal pain conditions. Analysis of pain intensity (VR: 1.06, 95%-confidence interval (CI):[0.97; 1.16], 95%-prediction interval (PI):[0.75; 1.51], p = 0.17, k = 26 studies, N = 52 outcomes, GRADE: low), physical function (VR: 1.14, 95%-CI:[0.97; 1.34], 95%-PI:[0.62; 2.11], p = 0.11, k = 19, N = 40, GRADE: low), and health-related quality of life (VR: 1.14, 95%-CI:[0.91; 1.41], 95%-PI:[0.72; 1.80], p = 0.19, k = 7, N = 13, GRADE: low) outcomes revealed minimal, non-statistically significant variability in placebo response compared to control. However, wide prediction intervals suggest uncertainty regarding individual response patterns. There are likely no distinct subgroups of people who are more likely to respond to placebo interventions in musculoskeletal pain; although the available data limits the certainty of this assessment. Future work should consider individual participant data meta-analyses to better elucidate potential responder subgroups and optimize treatment strategies for musculoskeletal pain.

Perspective

This study systematically reviewed and analyzed RCTs to assess interindividual variability in placebo responses for musculoskeletal pain. Findings suggest minimal variability in placebo response, with no distinct subgroups more likely to respond. Wide prediction intervals indicate uncertainty, highlighting the need for future individual participant data meta-analyses to better elucidate potential responder subgroups.

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是不是有些人更容易受到安慰剂的影响？肌肉骨骼疼痛个体差异的系统回顾和荟萃分析。

现有数据表明，安慰剂对治疗的反应很小，但有些人可能更有可能做出反应。我们对随机对照试验（rct）进行了系统回顾和荟萃分析，研究了对安慰剂干预反应的个体间变异性。MEDLINE、EMBASE、CINAHL、Web of Science Core Collection、CENTRAL和SPORTDiscus从成立到2023年9月进行了检索。完成了试验注册表检索、引文跟踪和先前系统评价的检索。PEDro量表评估研究质量。随机效应稳健方差估计估计对数变异性比率（VR），识别具有不同反应的亚组。纳入了26项研究，包括各种肌肉骨骼疼痛状况。疼痛强度分析(VR: 1.06, 95%可信区间（CI）：[0.97；1.16]， 95%预测区间（PI）：[0.75；1.51], p = 0.17, k = 26项研究，N = 52个结局，GRADE：低)，身体功能(VR: 1.14, 95% ci:[0.97；1.34], 95% -π:[0.62;2.11], p = 0.11, k = 19, N = 40， GRADE：低)，与健康相关的生活质量(VR: 1.14, 95% ci:[0.91；1.41], 95% -π:[0.72;1.80], p = 0.19, k = 7, N = 13， GRADE：低)结果显示，与对照组相比，安慰剂反应的可变性很小，无统计学意义。然而，较宽的预测间隔意味着个体反应模式的不确定性。在肌肉骨骼疼痛方面，可能没有明显的亚组更可能对安慰剂干预作出反应；尽管现有数据限制了这一评估的确定性。未来的工作应考虑个体参与者数据荟萃分析，以更好地阐明潜在的应答亚组，并优化肌肉骨骼疼痛的治疗策略。观点：本研究系统地回顾和分析了随机对照试验，以评估安慰剂对肌肉骨骼疼痛反应的个体差异。研究结果表明，安慰剂反应的可变性很小，没有明显的亚组更有可能反应。较宽的预测间隔表明不确定性，强调需要对未来的个体参与者数据进行meta分析，以更好地阐明潜在的应答者亚组。

本文章由计算机程序翻译，如有差异，请以英文原文为准。

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来源期刊

Journal of Pain 医学-临床神经学

CiteScore

6.30

自引率

7.50%

发文量

441

审稿时长

42 days

期刊介绍： The Journal of Pain publishes original articles related to all aspects of pain, including clinical and basic research, patient care, education, and health policy. Articles selected for publication in the Journal are most commonly reports of original clinical research or reports of original basic research. In addition, invited critical reviews, including meta analyses of drugs for pain management, invited commentaries on reviews, and exceptional case studies are published in the Journal. The mission of the Journal is to improve the care of patients in pain by providing a forum for clinical researchers, basic scientists, clinicians, and other health professionals to publish original research.