Lessons from a Trial of Acupuncture and Massage for Low Back Pain: Patient Expectations and Treatment Effects
Abstract
STUDY DESIGN: A subanalysis of data derived from a randomized clinical trial was performed. OBJECTIVE: To evaluate the association of a patient's expectation for benefit from a specific treatment with improved functional outcome. SUMMARY OF BACKGROUND DATA: Psychosocial factors, ambiguous diagnoses, and lack of a clearly superior treatment have complicated the management of patients with chronic low back pain. The authors hypothesized that patient expectation for benefit from a specific treatment is associated with improved functional outcomes when that treatment is administered. METHODS: In a randomized trial, 135 patients with chronic low back pain who received acupuncture or massage were studied. Before randomization, study participants were asked to describe their expectations regarding the helpfulness of each treatment on a scale of 0 to 10. The primary outcome was level of function at 10 weeks as measured by the modified Roland Disability scale. RESULTS: After adjustment for baseline characteristics, improved function was observed for 86% of the participants with higher expectations for the treatment they received, as compared with 68% of those with lower expectations (P = 0.01). Furthermore, patients who expected greater benefit from massage than from acupuncture were more likely to experience better outcomes with massage than with acupuncture, and vice versa (P = 0.03). CONCLUSIONS: The results of this study suggest that patient expectations may influence clinical outcome independently of the treatment itself. In contrast, general optimism about treatment, divorced from a specific treatment, is not strongly associated with outcome. These results may have important implications for clinical trial design and recruitment, and may help to explain the apparent success of some conventional and alternative therapies in trials that do not control for patient expectations. The findings also may be important for therapy choices made in the clinical setting.
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Symptom severity for several pain conditions including irritable bowel syndrome, temporomandibular disorders, headache, and fibromyalgia varies across the menstrual cycle.
“the severity of symptoms for several pain conditions including irritable bowel syndrome, temporomandibular disorders, headache, and fibromyalgia varies across the menstrual cycle 185–191.”
From Evaluating psychosocial contributions to chronic pain outcomes (2018) · cites this paper as [186]
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- Authors
- Kalauokalani, D., Cherkin, D. C., Sherman, K. J., Koepsell, T. D., & Deyo, R. A.
- Affiliations
- Washington University in St. Louis (US)
- Group Health Cooperative (US)
- University of Washington (US)
- Corresponding author
- Kalauokalani, Donna
- Venue
- Spine
- Published
- 2001-07
- Volume
- 26
- Issue
- 13
- Pages
- 1418-1424
- ISSN
- 0362-2436 (ISSN-L)
- OpenAlex
- W2070426225
- Cited by
- 407
- References
- 35
- Citations by year
- 2026: 4 · 2025: 6 · 2024: 3 · 2023: 9 · 2022: 14 · 2021: 13 · 2020: 15 · 2019: 12 · 2018: 9 · 2017: 15 · 2016: 24 · 2015: 15 · 2014: 14 · 2013: 23 · 2012: 20
- FWCI
- 10.69
- Type
- journal article
- Language
- en
- Open access
- closed
- Locations
- Spine (publishedVersion)
- PubMed (publishedVersion)
- Funders
- Dartmouth-Hitchcock Medical Center
- Agency for Healthcare Research and Quality (HS 09351)
- Topics
- Health Sciences › Medicine › Pharmacology › Musculoskeletal pain and rehabilitation
- Life Sciences › Neuroscience › Cognitive Neuroscience › Pain Management and Placebo Effect
- Health Sciences › Medicine › Complementary and alternative medicine › Acupuncture Treatment Research Studies
- Keywords
- chronic low back pain, acupuncture, massage, patient expectations, treatment expectations, functional outcome, placebo effect, psychosocial factors, clinical trial design, trial recruitment
- MeSH terms
- Adult, Aged, Female, Humans, Male, Massage, Middle Aged, Acupuncture Therapy, Treatment Outcome, Patient Satisfaction, Low Back Pain
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