Treatment expectations but not preference affect outcome in a trial of CBT and exercise for pain

Marcus John Beasley, Elizabeth Alice Ferguson-Jones, Gary John Macfarlane, MUSICIAN Study team

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Abstract

Background

Patients’ beliefs and attitudes towards a treatment can affect treatment response. In unblinded trials this can affect outcomes.

Aims

The aim of this analysis was to examine the association between treatment preference and expectation, and outcome in a trial of pain treatments.

Methods

In a randomised trial (ISRCTN67013851) of four treatments for chronic widespread pain, participants were asked which they would prefer, and what improvement they expect from each. The proportion of participants reporting positive health outcomes at three time-points after treatment were compared between those matched or unmatched with their preference, and between those with and without expectation for improvement. Odds ratios were calculated adjusted for baseline characteristics associated with preference and expectation.

Results

442 participants were recruited to the trial (69.5% female). The proportion reporting positive outcome among participants matched to their preference compared to those unmatched was: 33.3% vs 34.4% at end of treatment (adjusted OR 0.80, 95% CI 0.44–1.46), 34.4% vs 29.0% at 3 months (aOR 1.23, 0.67–2.26), and 34.8% vs 30.3% at 2 years (aOR 1.31, 0.70–2.46). The proportion of participants reporting positive outcome among those expecting improvement compared to those not was: 36.6% vs 15.0% at end of treatment (aOR 2.03, 1.07–3.85), 34.1% vs 13.2% at 3 months (aOR 2.31, 1.22–4.38), and 32.8% vs 19.1% at 2 years (aOR 1.16, 0.67–2.36).

Conclusions

Treatment preference had no clear effect on outcomes, but expectation did. These results could inform future approaches to management, while researchers assessing treatments should take into account this expectation effect.
Original languageEnglish
Pages (from-to)161-170
Number of pages10
JournalCanadian Journal of Pain
Volume1
Issue number1
Early online date11 Oct 2017
DOIs
Publication statusPublished - 2017

Keywords

  • placebo response
  • treatment preference
  • expectation
  • randomised controlled trials
  • treatment effect
  • non-specific effects

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