Concepts of placebo, dating back to medieval times, are becoming increasingly important today for understanding the efficacy and limitations of pain management therapies. For example, we most recently discussed in Pain-Topics UPDATES major influences of placebo effects in acupuncture [here] and transcutaneous electrical nerve stimulation (TENS) [here] as therapies for pain. With the newly reported discovery that the unconscious mind may play a key role in placebo effects, researchers have proposed a novel mechanism that helps to further explain the power of placebos and their sinister sister, nocebo.
Writing online in the Proceedings of the National Academy of Sciences (PNAS), Karin Jensen, PhD — of Massachusetts General Hospital and the Program in Placebo Studies at Beth Israel Deaconess Medical Center/Harvard Medical School — and colleagues report a novel study that demonstrated how placebo and nocebo (negative placebo) effects may rely on brain mechanisms that are not dependent on conscious awareness [Jensen et al. 2012]. They enrolled a total of 40 healthy volunteers (24 female, 16 male; median age 23) in 2 experiments:
Spinal manipulative therapy (SMT) or “adjustment” is a widely practiced intervention by chiropractors, osteopaths, and physiotherapists for acute and chronic low-back pain. An updated review of the research on SMT for short-term or acute low-back pain suggests it is no more effective than other therapy options. However, as much as anything, the indecisive research outcomes attest to the lack of high quality evidence in this area of pain management.
For heart attack victims, subsequent use of NSAIDs can be hazardous, according to research evidence from Denmark. Use of the drugs may increase the risk of a second heart attack or even death for at least 5 years, and caution regarding NSAID use in this patient population is advised at all times.
Recently reported research found that transcutaneous electrical nerve stimulation (TENS) was significantly helpful in reducing chronic pain intensity and disability while improving perceived health status for up to 1 year. However, these outcomes were comparable to those produced by sham/placebo TENS. Does this mean that TENS is worthless as a pain-treatment modality, or is there a need to reconsider the role and value of meaningful placebos in pain management?
Many persons with chronic pain conditions are prescribed antidepressants for associated mood disturbances and/or to help treat the pain itself. Over time, these medications can build up a physiological dependence that may result in disturbing withdrawal symptoms if the drugs are discontinued. Based on an extensive survey, a respected medical organization has recently issued some advice for safely stopping antidepressants, which should be of interest to practitioners and patients.
According to new research, women who take ibuprofen or acetaminophen as seldom as 2 days per week may have an increased risk of hearing loss, and taking these pain relievers more often increases the risk still further. Similar effects had been found in men taking NSAIDs, including aspirin, for pain on a regular basis; however, cause-effect relationships are difficult to determine from the research evidence.
The largest and most rigorous study to date, employing a meticulous data meta-analysis, provides evidence that acupuncture is more than just an elaborate placebo for treating chronic pain. However, placebo effects do appear to play a considerable role and the contribution of the type and quality of acupuncture itself may be of relatively minor consequence. So, the debate over the value of acupuncture in chronic pain management seems unsettled.
Researchers in Norway found that having just one cup of coffee can help to ease the pain of strain-inducing office work, even if the person has chronic pain to begin with. This study was widely touted in news media, but it sounds too good to be true; and it probably is since the research had a number of limitations.
Newly reported research reveals that in some patients continued opioid analgesic use after surgery has relatively little to do with the actual pain. Psychological distress and potential for substance abuse may be important considerations that practitioners should take into account as risk factors. However, this was a preliminary investigation and the actual message of the study may not be what the researchers intended.
Featured Items: tapentadol extended-release (Nucynta ER) approved for diabetic peripheral neuropathy; linaclotide (Linzess) capsules approved for IBS-C and Chronic Idiopathic Constipation; extended-release hydromorphone hcl (Exalgo) 32-mg strength approved; Reumofan Plus recall and updated safety warning; prefilled Carpuject hydromorphone syringe single lot recall. — All brand names are trademarks of their respective manufacturers. Compiled by Winnie Dawson, MA, RN, BSN. 
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