Expectancies as predictors of symptom improvement after antimicrobial therapy for persistent symptoms attributed to Lyme disease

Abstract

Introduction/Objective Expectancies about symptom improvement or deterioration are reliable predictors of symptom progression and treatment outcomes (symptom resolution or symptomatic improvement) in many (non-)pharmacological studies and treatments. This study examined predictors of symptom improvement after antimicrobial therapy for persistent symptoms attributed to Lyme disease, hypothesizing particularly pre-treatment expectancies regarding symptom improvement to be predictive. Methods A predictive study was performed on pre-treatment and post-treatment individual characteristics, including expectancies, and physical and mental health–related quality of life (HRQoL) from the PLEASE-trial comparing randomized 12-weeks of doxycycline, clarithromycin-hydroxychloroquine, or placebo following 2 weeks of intravenous ceftriaxone. At end-of-treatment (14 weeks after trial start) and follow-up (52 weeks), complete data of 231 and 170 (of initial 280) patients with persistent symptoms temporally related to a history of erythema migrans or otherwise confirmed symptomatic Lyme disease, or accompanied by B. burgdorferi IgG or IgM antibodies, were examined through hierarchical regression analyses. Results In addition to pre-treatment HRQoL, pre-treatment expectancies regarding symptom improvement were consistently associated with stronger physical and mental HRQoL improvements at both end-of-treatment and follow-up (95% CI range: .09;.54, p < .01 to .27;.92, p < .001). Post-treatment expectancies regarding having received antibiotics vs. placebo was associated with more HRQoL improvement at end-of-treatment, but not at follow-up (95% CI-range 1.00;4.75, p = .003 to −7.34; −2.22, p < .001). Conclusions The present study shows that, next to pre-treatment functioning, patients’ pre-treatment and post-treatment expectancies regarding improvement of persistent symptoms attributed to Lyme disease relate to a more beneficial symptom course. Expectancies of patients may be relevant to explain and potentially improve patient outcomes (e.g., by optimized communication about treatment success). Trial registration ClinicalTrials.gov, NCT01207739 (Registration date: 23–09-2010) Key Points• As there is currently no sufficient symptom resolution or symptomatic improvement for many patients with persistent symptoms attributed to Lyme disease, it is relevant to know which factors determine symptom progression and predict heterogeneity in treatment response.• Next to pre-treatment functioning, expectancies regarding symptom improvement and having received antimicrobial study medication are associated with a more beneficial symptom course after both shorter-term and longer-term antimicrobial treatment.• Expectancies are relevant to consider in treatment studies and may be useful in clinical settings to improve symptom course and treatment outcome (e.g., by optimized communication about treatment success).

Assessment of cognitive function, structural brain changes and fatigue 6 months after treatment of neuroborreliosis

“…We did not include a questionnaire to assess patients' subjective cognitive problems in detail, nor did we ask them about their expectancy regarding the outcome when included in the acute phase. A recent study on expectancy regarding outcome showed that both premorbid function and positive expectancy were related to a more beneficial outcome in patients [46]. Patients reported higher level of fatigue compared with the controls, and patients on sick leave related to neuroborreliosis reported higher level of fatigue compared with patients not on sick leave.…”

“…We did not include a questionnaire to assess patients’ subjective cognitive problems in detail, nor did we ask them about their expectancy regarding the outcome when included in the acute phase. A recent study on expectancy regarding outcome showed that both premorbid function and positive expectancy were related to a more beneficial outcome in patients [ 46 ].…”

Nocebo hyperalgesia and other expectancy-related factors in daily fibromyalgia pain: Combining experimental and electronic diary methods

“…Pain can be shaped by different types of expectancies [1,2]. Expectancies of upcoming pain (i.e., pain expectancies), as well as expectancy-related factors such as anxiety, catastrophizing, and optimism have been found to be associated with pain [1,[3][4][5]]. Yet, their combined role in shaping pain experiences in chronic pain conditions, such as fibromyalgia, is fairly unknown.…”