Examining the Effects of Patient Expectations, Therapeutic Alliance, and Pain Sensitivity on Treatment Response Following Lidocaine Infusion in an Interdisciplinary Chronic Pain Clinic
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Authors
Montag, Landon
Date
Type
thesis
Language
eng
Keyword
chronic pain , pain , expectations , therapeutic alliance , working alliance , central sensitization , lidocaine
Alternative Title
Abstract
Introduction: Pain perception is a product of both incoming nociceptive input and top-down predictions (“expectations”). Expectations can be shaped by maladaptive patterns of thought which lead adults with chronic pain to expect negative pain outcomes, especially if they experience central sensitization.
Objectives: To address this in a clinical setting, we initiated an open-label, prospective cohort study of adults with chronic pain receiving an intravenous lidocaine infusion. We explored the influence of psychosocial factors on treatment outcomes, specifically whether: 1) patients’ expectations for treatment efficacy were associated with pain relief; 2) patients’ trust in their clinical team (“therapeutic alliance”) was associated with patients’ expectations and pain relief; and 3) central sensitization mediated the relationship between expectations and pain relief.
Methods: Patients scheduled for lidocaine infusion at the Kingston Health Sciences Centre, Chronic Pain Clinic or Kingston Orthopaedic Pain Institute were recruited. Measures of therapeutic alliance, expectations of treatment efficacy, and central sensitization were collected before and 8 weeks post-treatment, in addition to general health and other pain-related measures. Patients also reported their pain intensity daily for 8 weeks post-treatment to measure treatment response. Pain relief was computed by subtracting patients’ pre-treatment pain rating by their average pain over 8 weeks post-treatment. Comparative analyses, Pearson correlations, and a mediation analysis were performed.
Results: 67 participants completed the study, 46 of which completed the pain diary for ≥7 days. Average pain intensity over the 8 weeks post-treatment was significantly lower than pre-treatment pain intensity (t(45)=4.39, p<0.001, N=46). Expectations significantly correlated with pain relief (r=0.45, p<0.01, N=42), days of pain relief (r=0.33, p<0.05, N=42), and consecutive days of pain relief (r=0.39, p<0.01, N=42). Therapeutic alliance significantly correlated with expectations (r=0.29, p<0.05, N=58), pain relief (r=0.35, p<0.05, N=43), days of pain relief (r=0.37, p<0.05, N=43), and consecutive days of pain relief (r=0.32, p<0.05, N=43). Central sensitization did not mediate the relationship between expectations and pain relief.
Conclusions: This study elucidates the role of expectation effects and therapeutic alliance in enhancing treatment response following an intravenous lidocaine infusion. Our findings may allow for the optimization of clinical protocols to maximize the benefits of placebo analgesia.
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ProQuest PhD and Master's Theses International Dissemination Agreement
Intellectual Property Guidelines at Queen's University
Copying and Preserving Your Thesis
This publication is made available by the authority of the copyright owner solely for the purpose of private study and research and may not be copied or reproduced except as permitted by the copyright laws without written authority from the copyright owner.
Attribution 3.0 United States