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The downside to choice: instrumental control increases conditioned nocebo hyperalgesia
Biya Tang1, Evan Livesey, Ben Colagiuri
1School of Psychology, The University of Sydney, Sydney, Australia.
Pain
|May 6, 2024
Summary
Treatment choice may worsen nocebo hyperalgesia, increasing pain rather than reducing it. Providing positive information about choice did not counteract this effect, suggesting caution when using choice to manage pain outcomes.
Area of Science:
- Neuroscience
- Psychology
- Pain Research
Background:
- Nocebo hyperalgesia, where negative expectations worsen pain, is a significant clinical challenge.
- Ethical strategies to mitigate nocebo effects are essential for patient care.
- Previous research indicated choice reduces side effects, but its impact on nocebo hyperalgesia was unknown.
Purpose of the Study:
- To investigate the effect of choice on conditioned nocebo hyperalgesia.
- To determine if positive information about choice can counteract increased nocebo hyperalgesia.
Main Methods:
- Utilized an electrocutaneous pain paradigm with sham device activation paired with noxious stimulation.
- Study 1: Healthy volunteers (N=104) were randomized to groups with choice, no choice, or natural history control.
- Study 2: Healthy adults (N=137) received nocebo treatment with choice and positive information, choice only, or no choice.
Main Results:
- Choice significantly increased nocebo hyperalgesia compared to no choice in Study 1.
- Positive information about choice failed to reduce the heightened nocebo hyperalgesia in Study 2.
- Results indicate that treatment choice may exacerbate pain in a nocebo context.
Conclusions:
- Contrary to expectations, offering treatment choice may worsen nocebo hyperalgesia and pain outcomes.
- The strategy of using choice to mitigate nocebo effects requires careful consideration and may not be universally beneficial.
- Further research is needed to understand the complex interplay between choice, expectation, and pain perception.
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