Placebo response changes depending on the neuropathic pain syndrome: results of a systematic review and meta-analysis
Abstract
OBJECTIVE: To compare placebo responses in neuropathic pain syndromes. DESIGN: Systematic literature review and meta-analysis. SETTING AND PATIENTS: Randomized placebo-controlled trials assessing pain intensity or pain relief in any neuropathic pain syndrome published since 1995 with ≥5days follow-up. INTERVENTIONS: Placebo response. OUTCOME MEASURES: Pain intensity and responder rates (proportion reporting ≥50% pain relief). Meta-regression models were built. RESULTS: Ninety-four studies (N=5,317) were included in the pain intensity analysis; 47 studies (N=3,087) were included in the responder analysis. After controlling for potential confounders (e.g., subject characteristics, study design characteristics), the placebo response was found to be large and varied with the pain syndrome. Compared with diabetic neuropathic/polyneuropathic pain (DPN), the placebo response for a decline in pain intensity and responder rate was smaller in trials that assessed central pain and postherpetic neuralgia (PHN) and larger in trials that assessed HIV pain. The model-predicted mean decrease (95% confidence interval [CI]) from baseline in pain intensity (0-10 scale) was as follows: DPN, 1.45 (1.35 to 1.55); PHN, 1.16 (1.03 to 1.29); central pain, 0.44 (-0.41 to 1.30); HIV pain, 1.82 (1.51 to 2.12). The predicted responder rates (95% CI) were as follows: DPN, 20% (14.6 to 25.8); PHN, 11.5% (8.4 to 14.5); central pain, 7.2% (2.1 to 12.3); HIV pain, 42.8% (34.9 to 50.7). The type of treatment in the active arm also influenced the placebo response. CONCLUSIONS: Placebo response is influenced by the pain syndrome evaluated. These differences should be considered when evaluating novel compounds for the treatment of neuropathic pain conditions.
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Side effects may to some degree depend on aetiology; for example, drugs with CNS-related side effects may be less tolerated in patients with CNS lesions.
“Side effects may, however, to some degree depend on the aetiology, eg, drugs with CNS-related side effects may be less tolerated in patients with CNS lesions.44”
From Pharmacotherapy for neuropathic pain in adults: a systematic review and meta-analysis (2015) · cites this paper as [44]
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Placebo response in neuropathic pain trials ☆
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- Authors
- Cepeda, M. S., Berlin, J. A., Gao, C. Y., Wiegand, F., & Wada, D. R.
- Corresponding author
- Cepeda, M. Soledad
- Venue
- Pain Medicine
- Publisher
- Oxford University Press (OUP)
- Published
- 2012-04
- Volume
- 13
- Issue
- 4
- Pages
- 575-595
- ISSN
- 1526-2375 (ISSN-L)
- 1526-4637
- OpenAlex
- W1848692709
- Cited by
- 71
- References
- 158
- Citations by year
- 2026: 2 · 2025: 1 · 2024: 1 · 2023: 2 · 2022: 4 · 2021: 3 · 2020: 9 · 2019: 3 · 2018: 7 · 2017: 2 · 2016: 3 · 2015: 13 · 2014: 8 · 2013: 11 · 2012: 2
- FWCI
- 0.87
- Type
- journal article
- Language
- en
- Open access
- closed
- Locations
- Pain Medicine (publishedVersion)
- PubMed (publishedVersion)
- HighWire Press Open Archive (submittedVersion)
- Topics
- Life Sciences › Neuroscience › Cognitive Neuroscience › Pain Management and Placebo Effect
- Health Sciences › Medicine › Physiology › Pain Mechanisms and Treatments
- Health Sciences › Medicine › Anesthesiology and Pain Medicine › Pain Management and Treatment
- Keywords
- placebo response, neuropathic pain, diabetic neuropathic pain, postherpetic neuralgia, central pain, pain intensity, responder rate, treatment effect estimation
- MeSH terms
- Diabetic Neuropathies, Humans, Neuralgia, Placebos, Randomized Controlled Trials as Topic, Neuralgia, Postherpetic, Pain Perception
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