Bishop M.1,2
1University of Florida, Physical Therapy, Gainesville, United States, 2Center for Pain Research and Behavioral Health, Gainesville, United States
Background: Patients´ expectations influence the short- and long-term outcomes of interventions by physiotherapists. This is particularly the case in the management of spinal pain.
Purpose: Our purpose was to determine if:
1) expectations about an intervention change after the intervention has been applied; and
2) expectations are somatospecific.
1) expectations about an intervention change after the intervention has been applied; and
2) expectations are somatospecific.
Methods: This was a secondary analysis of a randomized trial of interventions. Pain responses at 47°C and 49°C on the forearm and calf were tested in ninety healthy volunteers then randomized to thoracic spinal manipulation (SMT), cranio-cervical flexion exercise (CCF), or no intervention (control). Participants were provided with a picture of the intervention and asked to rate expectations of change in thermal pain intensity ratings (QST) at the calf following application of the intervention. After the intervention expectations of change in pain intensity ratings at the calf were measured again and immediately followed by QST. Expectations were analyzed using chi-squares. Thermal pain intensity was analyzed with three-way ANOVA. We were interested in interaction effects that included expectation.
Results: Pre-intervention expectations did not differ among groups (p > 0.05); however post-intervention expectations did with SMT (p 0.01) and CCF (p 0.05) groups more positive than control that they would experience less pain during testing. Significant time*expectation interactions occurred
for 47° C or 49° C in the leg (p=0.034 and p=0.006) but not the forearm (p>0.05 for both).
Conclusion(s): The results indicate that expectations regarding an intervention do change following intervention. Moreover, changes in expectation were associated with changes in responses to painful stimuli in the specific anatomical region to which expectation was directed.
Implications: Patients generally have high expectations for manual treatment of spine pain. Our data suggest that receiving an intervention after receiving the intervention expectations about pain relief became and were associated with immediate changes in pain sensitivity in the specific area toward which questioning was focused.
Funding acknowledgements: K01 AR054331 National Institutes of Health, USA
Topic: Pain & pain management
Ethics approval: This project was approved by the University of Florida Institutional Review Board (medical research IRB01).
All authors, affiliations and abstracts have been published as submitted.
