Many people suffering from chronic pain do not benefit sufficiently from treatment. One possible reason for this is poor previous experience and negative expectations regarding the course of treatment, as a study from our Marburg CRC site published in Scientific Reports shows.
Researchers from Prof. Winfried Rief's team interviewed 212 patients undergoing pharmacotherapy, physiotherapy and/or psychotherapy for chronic pain. The patients were asked about their previous experiences of improvement, worsening and side effects, as well as their expectations of the current treatment. Their respective pain-related disability was also recorded. These responses were then used to calculate the relationship between previous treatment experiences and current expectations, and the extent to which both are linked to pain-related disability.
As expected given the current state of placebo research, the participants' treatment expectations were closely related to their previous experiences. Those who had experienced a worsening of their symptoms were more likely to expect further worsening, and those who had experienced adverse side effects were concerned about them occurring again. Positive experiences, on the other hand, were predominantly linked to positive expectations.
Are negative and positive expectations separate constructs?
However, this was not the case for pain-related disability, where positive experiences and expectations had no measurable influence on current disability levels. Conversely, negative previous experiences and negative current therapy expectations were linked to greater disability.
This difference is surprising and could be important for future therapies. The study's authors suggest considering negative and positive experiences as distinct concepts rather than as opposite ends of a continuous spectrum, as has usually been the case until now. For example, raising positive expectations of an upcoming therapy would not be sufficient to increase its chances of success. At the same time, practitioners should specifically identify negative previous experiences and expectations in their patients in order to address them.