Print Email Facebook Twitter Efficacy of open-label counterconditioning for reducing nocebo effects on pressure pain Title Efficacy of open-label counterconditioning for reducing nocebo effects on pressure pain Author Meijer, Simone (Universiteit Leiden) Karacaoglu, Merve (Universiteit Leiden) van Middendorp, Henriët (Universiteit Leiden) Veldhuijzen, Dieuwke S. (Universiteit Leiden) Jensen, Karin B. (Karolinska Institutet) Peerdeman, Kaya J. (Universiteit Leiden) Evers, A.W.M. (TU Delft Applied Ergonomics and Design; Universiteit Leiden; Erasmus Universiteit Rotterdam; Leiden University Medical Center) Date 2023 Abstract Background: Nocebo effects can adversely affect the experience of physical symptoms, such as pain and itch. Nocebo effects on itch and pain have shown to be induced by conditioning with thermal heat stimuli and reduced by counterconditioning. However, open-label counterconditioning, in which participants are informed about the placebo content of the treatment, has not been investigated, while this can be highly relevant for clinical practice. Furthermore, (open-label) conditioning and counterconditioning has not been investigated for pain modalities relevant to musculoskeletal disorders, such as pressure pain. Methods: In a randomized controlled trial, we investigated in 110 healthy female participants whether nocebo effects on pressure pain combined with open-label verbal suggestions can be (1) induced via conditioning and (2) reduced via counterconditioning. Participants were allocated to either a nocebo- or sham-conditioning group. Next, the nocebo group was allocated to either counterconditioning, extinction or continued nocebo conditioning; sham conditioning was followed by placebo conditioning. Results: Nocebo effects were significantly larger after nocebo conditioning than sham conditioning (d = 1.27). Subsequently, a larger reduction of the nocebo effect was found after counterconditioning than after extinction (d = 1.02) and continued nocebo conditioning (d = 1.66), with effects similar to placebo conditioning (following sham conditioning). Conclusions: These results show that (counter)conditioning combined with open-label suggestions can modulate nocebo effects on pressure pain, which provides promise in designing learning-based treatments to reduce nocebo effects in patients with chronic pain disorders, particularly for musculoskeletal disorders. Significance: Few studies have investigated the efficacy counterconditioning to reduce nocebo effects. Whereas typically deceptive procedures are used, these are not ethically appropriate for use in clinical practice. The current study demonstrates that open-label counterconditioning in a pain modality relevant for many chronic pain conditions may be a promising new strategy for reducing nocebo effects in a non-deceptive and ethical manner, which provides promise in designing learning-based treatments to reduce nocebo effects in patients with chronic pain disorders. To reference this document use: http://resolver.tudelft.nl/uuid:60f644a8-2408-484f-8d26-75526a392a38 DOI https://doi.org/10.1002/ejp.2112 ISSN 1090-3801 Source EUROPEAN JOURNAL OF PAIN, 27 (7), 831-847 Part of collection Institutional Repository Document type journal article Rights © 2023 Simone Meijer, Merve Karacaoglu, Henriët van Middendorp, Dieuwke S. Veldhuijzen, Karin B. Jensen, Kaya J. Peerdeman, A.W.M. Evers Files PDF European_Journal_of_Pain_ ... cts_on.pdf 1.43 MB Close viewer /islandora/object/uuid:60f644a8-2408-484f-8d26-75526a392a38/datastream/OBJ/view