How instructions, learning, and expectations shape pain and clinical outcomes

Atlas, Lauren Y.

doi:10.31234/osf.io/qhkat

Cited by 3 publications

(4 citation statements)

References 142 publications

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“…This may reduce the likelihood of attributing the observed effects entirely to placebo, because placebo is closely related to expectations. 2 Safety continues to be a major concern regarding the medicinal use of cannabis. Overall, up to 45% of our patients reported any AE at any time point during the study, more commonly at the first month of treatment.…”

Section: Discussionmentioning

confidence: 99%

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Cannabis oil extracts for chronic pain: what else can be learned from another structured prospective cohort?

Pud,

Aamar,

Schiff-Keren

et al. 2024

PR9

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Introduction: The use of medicinal cannabis for managing pain expands, although its efficacy and safety have not been fully established through randomized controlled trials. Objectives: This structured, prospective questionnaire-based cohort was aimed to assess long-term effectiveness and safety of cannabis oil extracts in patients with chronic pain. Methods: Adult Israeli patients licensed to use cannabis oil extracts for chronic pain were followed prospectively for 6 months. The primary outcome measure was change from baseline in average weekly pain intensity, and secondary outcomes were changes in related symptoms and quality of life, recorded before treatment initiation and 1, 3, and 6 months thereafter. Generalized linear mixed model was used to analyze changes over time. In addition, “responders” (≥30% reduction in weekly pain at any time point) were identified. Results: The study included 218 patients at baseline, and 188, 154, and 131 at 1, 3, and 6 months, respectively. At 6 months, the mean daily doses of cannabidiol and Δ9-tetrahydrocannabinol were 22.4 ± 24.0 mg and 20.8 ± 30.1 mg, respectively. Pain decreased from 7.9 ± 1.7 at baseline to 6.6 ± 2.2 at 6 months (F(3,450) = 26.22, P < 0.0001). Most secondary parameters also significantly improved. Of the 218 participants, 24% were “responders” but could not be identified by baseline parameters. “Responders” exhibited higher improvement in secondary outcomes. Adverse events were common but mostly nonserious. Conclusion: This prospective cohort demonstrated a modest overall long-term improvement in chronic pain and related symptoms and a reasonable safety profile with the use of relatively low doses of individually titrated Δ9-tetrahydrocannabinol and cannabidiol.

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Section: Discussionmentioning

confidence: 99%

“…This may reduce the likelihood of attributing the observed effects entirely to placebo, because placebo is closely related to expectations. 2…”

Section: Discussionmentioning

confidence: 99%

Cannabis oil extracts for chronic pain: what else can be learned from another structured prospective cohort?

Pud,

Aamar,

Schiff-Keren

et al. 2024

PR9

View full text Add to dashboard Cite

show abstract

“…One limitation of the present study is the absence of a measure of participants' expectations about how the stimulation would impact their pain. Previous studies of experimental pain have shown that an individual's expectations regarding an intervention can influence their subsequent pain report [5,6,8], and there is robust clinical evidence in the placebo literature that a patient's expectations about a treatment are correlated with their pain outcomes [11]. However, if these expectations are frequently violated, they have reduced effects [24].…”

Section: Discussionmentioning

confidence: 99%

It’s the Sound, not the Pulse: Peripheral Magnetic Stimulation Reduces Central Sensitization through Auditory Modulatory Effects

Abssy,

Osborne,

Osokin

et al. 2024

Preprint

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Repetitive peripheral magnetic stimulation (rPMS) is a non-pharmacological, non-invasive analgesic modality with limited side effects. However, there is a paucity of controlled studies demonstrating its efficacy compared to existing pain management tools. Here, in an initial sample of 100 healthy participants (age 18-40), we compared the analgesic efficacy of two rPMS stimulation protocols—continuous theta burst stimulation (ctbPMS) and intermittent TBS (itbPMS)—against transcutaneous electric nerve stimulation (TENS), a peripheral stimulation technique that is commonly used for pain management. We also included a sham rPMS protocol where participants heard the sound of rPMS stimulation while the coil was placed over their arm, but received no peripheral stimulation. We hypothesized that itbPMS and ctbPMS—but not sham—would reduce pain intensity, pain unpleasantness, and secondary hyperalgesia evoked by a phasic heat pain (PHP) paradigm on the volar forearm with similar efficacy to TENS. Neither rPMS nor TENS reduced reported pain intensity or unpleasantness (p>0.25). However, ctbPMS and itbPMS significantly reduced the area of secondary hyperalgesia, whereas TENS did not (F3,96= 4.828, p= 0.004). Unexpectedly, sham rPMS, which involved auditory but no peripheral nerve stimulation, also significantly reduced secondary hyperalgesia compared to TENS. We performed a second study (n=32) to investigate auditory contributions to rPMS analgesia. Masking the rPMS stimulation sound with pink noise eliminated its analgesic effect on secondary hyperalgesia (p=0.5). This is the first study to show that the analgesic properties of rPMS in acute experimental pain may be largely attributed to its auditory component rather than peripheral nerve stimulation.

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“…The instruction-based associative learning task is based on the fact that humans can rapidly learn based on verbal instructions (e.g., Cole, Braver, & Meiran, 2017). This instruction-based associative learning task is widely used in aversive learning, value-based learning, and other tasks (Atlas, 2023;Cole et al, 2017;Deltomme, Mertens, Tibboel, & Braem, 2018). Unlike previous studies relies on faces or words (e.g., Bortolon & Raffard, 2018;Yaoi, Osaka, & Osaka, 2021), stimuli in the current study are geometric shapes, whose moral meanings were acquired right before the perceptual matching task.…”

Section: Introductionmentioning

confidence: 99%

Self-referencing prioritizes moral character on perceptual matching

Chuan-Peng¹,

Peng²

2023

Preprint

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Evidence for the prioritization of moral information in cognitive processes is mixed. We examined this question using a series of eleven experiments where participants first learned associations between moral characters and geometric shapes and then performed simple speed tasks. In the first six experiments, we tested and validated prioritized responses to good characters over bad and neutral characters. To pin down the processes that are critical to the prioritization effects, in the remaining five experiments, we examined two opposing hypotheses: the valence hypothesis suggests that a general positivity bias towards all underpins the effects, while the self-binding account posits that self-referencing, rather than other-referencing is the fundamental driver of the effects. The data support the latter. Together, these results show a robust prioritization effect of good character through self-referencing processes, indicating the innate connection between morality and oneself and how humans use self-reference to explore the world and learn morality.

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How instructions, learning, and expectations shape pain and clinical outcomes

Cited by 3 publications

References 142 publications

Cannabis oil extracts for chronic pain: what else can be learned from another structured prospective cohort?

Cannabis oil extracts for chronic pain: what else can be learned from another structured prospective cohort?

It’s the Sound, not the Pulse: Peripheral Magnetic Stimulation Reduces Central Sensitization through Auditory Modulatory Effects

Self-referencing prioritizes moral character on perceptual matching

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