Effects of sex on placebo effects in chronic pain participants: a cross-sectional study

被引：22

作者：

Olson, Elizabeth M. ^{[1
]}

Akintola, Titilola ^{[2
]}

Phillips, Jane ^{[3
,4
]}

Blasini, Maxie ^{[2
]}

Haycock, Nathaniel R. ^{[2
]}

Martinez, Pedro E. ^{[5
]}

Greenspan, Joel D. ^{[3
,4
,6
]}

Dorsey, Susan G. ^{[2
,6
]}

Wang, Yang ^{[2
]}

Colloca, Luana ^{[2
,6
,7
]}

机构：

[1] Univ Maryland, Sch Med, Baltimore, MD 21201 USA

[2] Univ Maryland, Sch Nursing, Dept Pain & Translat Symptom Sci, Baltimore, MD 21201 USA

[3] Univ Maryland, Sch Dent, Dept Neural & Pain Sci, Baltimore, MD 21201 USA

[4] Univ Maryland, Sch Dent, Brotman Facial Pain Clin, Baltimore, MD 21201 USA

[5] NIMH, NIH, Bethesda, MD 20892 USA

[6] Univ Maryland, Ctr Adv Chron Pain Res, Baltimore, MD 21201 USA

[7] Univ Maryland, Sch Med, Dept Anesthesiol, Baltimore, MD 21201 USA

来源：

PAIN | 2021年 / 162卷 / 02期

关键词：

Orofacial pain; Temporomandibular pain; Learning; Conditioning; Expectation; EXPECTATION; GENDER; EXTINCTION; ANALGESIA; STRESS;

D O I：

10.1097/j.pain.0000000000002038

中图分类号：

R614 [麻醉学];

学科分类号：

100217 ;

摘要：

Sex-related differences can influence outcomes of randomized clinical trials and may jeopardize the effectiveness of pain management and other therapeutics. Thus, it is essential to understand the mechanistic and translational aspects of sex differences in placebo outcomes. Recently, studies in healthy participants have shed light on how sex-related placebo effects might influence outcomes, yet no research has been conducted in a patient population. Herein, we used a tripartite approach to evaluate the interaction of prior therapeutic experience (eg, conditioning), expectations, and placebo effects in 280 chronic (orofacial) pain patients (215 women). In this cross-sectional study, we assessed sex differences in placebo effects, conditioning as a proxy of prior therapeutic effects, and expectations evaluated before and after the exposure to positive outcomes, taking into account participant-experimenter sex concordance and hormonal levels (estradiol and progesterone assessed in premenopausal women). We used mediation analysis to determine how conditioning strength and expectations impacted sex differences in placebo outcomes. Independent of gonadal hormone levels, women showed stronger placebo effects than men. We also found significant statistical sex differences in the conditioning strength and reinforced expectations whereby reinforced expectations mediated the sex-related placebo effects. In addition, the participant-experimenter sex concordance influenced conditioning strength, reinforced expectations, and placebo effects in women but not in men. Our findings suggest that women experience larger conditioning effects, expectations, and placebo effects emphasizing the need to consider sex as a biological variable when placebo components of any outcomes are part of drug development trials and in pain management.

引用

页码：531 / 542

页数：12