Pain Relief: Patient and Physician Expectations
This study looked at a similar phenomenon to that of the previous study, but looked at the positive aspect of physician behavior.
Patients seem to be keenly aware of physician expectations. The authors of this study illustrate this with findings from other studies:
"One double-blind study assessed the effect of the clinician researcher's knowledge of possible treatment. In one of two groups of patients undergoing dental extraction, clinicians knew they would administer either a narcotic analgesic, a placebo, or a narcotic antagonist. In the other group of patients, the same clinicians knew they would administer either a placebo or a narcotic antagonist (not a narcotic analgesic). Interestingly, patients in the first group reported significantly less pain after receiving the placebo than did those in the second group. Clinician expectations also appeared to influence patient treatment response in a study of the efficacy of a new antihypertensive drug. In the middle of this placebo-controlled double-blind study, the colleagues of the blinded researcher, who had believed the experimental treatment would be superior to existing antihypertensive medications, broke the study code and reported to him that the new drug appeared to be no more efficacious than the existing treatments. At this point in the study, although no subjects had been informed of these study results, both active and placebo groups showed an immediate marked increase in blood pressure."
In this current report, the researchers studied 46 consecutive patients with chronic pain. All of the subjects and physicians completed a questionnaire that ranked the current level of pain and the expectation of pain relief from the procedure (either intravenous drug infusion or a nerve block). The treatment was administered, and the patients were then re-evaluated for pain level.
The researchers then compared the actual pain relief to the anticipated pain relief of the patients and physicians. They found that there was no relationship between the patient's expectations and results, but that there was a relationship between the physician's expectations and resulting pain relief.
"The findings in this study have possible clinical and research implications that should be tested in further studies...[A]t least in some treatment situations, patient expectations of treatment effect may not be as important as physician expectations with respect to nonspecific treatment effects. This suggests that physicians or health care providers who are asked to render therapies that are believed by the provider not to be efficacious may influence treatment outcomes in a negative way or, vice versa, if a provider strongly believes in a therapy, a positive outcome may be more likely."
Galer BS, Schwartz L, Turner JA. Do patient and physician expectations predict response to pain-relieving procedures? The Clinical Journal of Pain 1997;13:348-351.
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