Psychological context effects of participant expectation on pain pressure thresholds as an adjunct to cervicothoracic HVLA thrust manipulation: A randomised controlled trial

Abstract

BackgroundChronic pain is a growing global and economically costly problem leading the National Health Service (NHS) in the UK to actively search for novel strategies to improve health outcomes. Some trials have shown a benefit when practitioners use a positive communication style, however, much of the available literature investigating the use of positive language to alter patient expectation utilises subjective reports from patients. ObjectivesTo demonstrate whether positive and negative communication before a high-velocity low amplitude (HVLA) thrust spinal manipulation of the C7-T1 spine segments, and within an osteopathic consultation setting, increases and decreases (respectively) pain pressure thresholds (PPT) to form contextual placebo and nocebo effects. Study designpre-test, post-test randomised controlled design. Methods35 asymptomatic participants were recruited and randomised into three separate condition arms using a repeated measures cross-over design; negative communication (NegC), neutral communication (NeuC), or positive communication (PosC). Each condition included spinal manipulation (HVLA thrust) to the C7-T1 segments. PPTs were measured by an algometer over the spinous process of C7 pre and post each condition setting. ResultsThere was a significant effect of language style on PPT for the three conditions. Post-hoc tests demonstrated that positive communication had a significant effect on PPT (i.e., placebo effect), but the negative communication demonstrated no significant effect (i.e., no nocebo). ConclusionThese results were discussed in the context of communication style used during an osteopathic clinical consultation to potentially improve health outcomes in NHS and other clinical settings (Clinical trial registry https://clinicaltrials.gov/number: NCT03855254).