Does the word “placebo” evoke a placebo response?

Design and testing the validity of an inexpensive and accessible sham dry needling protocol

OBJECTIVE

To use a simple method of needle blunting to produce a placebo dry needling protocol which is indistinguishable from the sensations felt during therapeutic dry needling.

METHODS

A randomised cross-over design was used to compare the perception of needle skin penetration, pain experienced and types of sensations experienced following a single placebo dry needling and a single therapeutic dry needling application.

RESULTS

There were no significant differences in the proportions of patients reported ability to perceive needle penetration (p = 0.646), description of needling sensations (p = 0.3) or pain rating (p = 0.405) when comparing placebo needling to therapeutic dry needling.

CONCLUSION

Needle tip bending creates a simple, cost-effective and effective placebo needle for use in comparisons with therapeutic dry needling. This offers researchers a viable alternative to expensive and inappropriate acupuncture sham devices when conducting dry needling trials.

The effects of one session of roller massage on recovery from exercise-induced muscle damage: A randomized controlled trial

Background/objective

Roller massage has become a popular intervention in sports settings in order to treat muscle soreness and stiffness, as well as improving post-exercise recovery, although there is limited evidence for these assumptions. Therefore, the purpose of this study was to evaluate the effects of a single session of roller massage, applied with a controlled force after an exercise-induced muscle damage protocol, on muscle recovery.

Methods

A randomized controlled study was performed using a repeated-measures design. Thirty-six young men completed four sets of six eccentric actions of elbow flexors at 90°/s with a 90s rest interval between sets. Participants were randomly assigned into one of three groups: 1) Roller massage (n = 12), 2) Sham (n = 12), and 3) Control (n = 12). Maximal isometric voluntary contraction (MIVC), delayed-onset muscle soreness (DOMS), range of motion (ROM), and muscle thickness were measured at baseline, and at 24, 48, and 72 h post exercise.

Results

There was no significant group by time interaction for MIVC (p = 0.090) and ROM (p = 0.416). Also, although there was a significant group by time interaction for muscle thickness (p = 0.028), post hoc test did not find significant difference between groups (p > 0.05). DOMS was recovered at 72 h for roller massage (p < 0.001) and control (p < 0.001) groups, while the Sham group did not recover from DOMS across 72 h (p < 0.001). There was also no significant difference between groups in DOMS at any time (p > 0.05).

Conclusions

A single session of roller massage applied on elbow flexors had no effect on recovery of MIVC, muscle swelling, ROM and DOMS.

WITHDRAWN: Size Does Matter, But It Isn't Everything: The Challenge of Modest Treatment Effects in Chronic Pain Clinical Trials

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The Knowledge of Contextual Factors as Triggers of Placebo and Nocebo Effects in Patients With Musculoskeletal Pain: Findings From a National Survey

Backgrounds: Contextual factors (CFs) have been recently proposed as triggers of placebo and nocebo effects in musculoskeletal pain. CFs encompass the features of the clinician (e.g. uniform), patient (e.g. expectations), patient-clinician relationship (e.g. verbal communication), treatment (e.g. overt therapy), and healthcare setting (e.g. design). To date, the researchers' understanding of Italian patients' knowledge about the role of CFs in musculoskeletal pain is lacking. Objectives: The aim of this study was to investigate attitudes and beliefs of Italian patients with musculoskeletal pain about the use of CFs in clinical practice. Methods: A national sample of Italian patients with musculoskeletal pain was recruited from 12 outpatient private clinics in Italy. An invitation to participate in an online survey was sent to patients: a) exhibiting musculoskeletal pain; b) aged 18-75; c) with a valid e-mail account; and d) understanding Italian language. Survey Monkey software was used to deliver the survey. The questionnaire was self-reported and included 17 questions and 2 clinical vignettes on the patients' behavior, beliefs, and attitudes towards the adoption of CFs in clinical practice. Descriptive statistics and frequencies described the actual number of respondents to each question. Results: One thousand one hundred twelve patients participated in the survey. Five hundred seventy-four participants were female (52%). The average age of patients was 41.7 ± 15.2 years. Patients defined CFs as an intervention with an unspecific effect (64.3%), but they believed in their clinical effectiveness. They identified several therapeutic effects of CFs for different health problems. Their use was considered ethically acceptable when it exerts beneficial psychological effects (60.4%), but it was banned if considered deceptive (51.1%). During clinical practice, patients wanted to be informed about the use of CFs (46.0%) that are accepted as an addition to other interventions to optimize clinical responses (39.3%). Moreover, patients explained the power of CFs through body-mind connections (37.1%). Conclusion: Patients with musculoskeletal pain had positive attitudes towards the use and effectiveness of CFs when associated with evidence-based therapy. They mostly perceived the adoption of CFs in clinical practice as ethical.

Development of New Analgesics: An Answer to Opioid Epidemic

Management of pain is a fundamental imperative in medicine. Current analgesics suffer from limitations related to efficacy and adverse events of which abuse potential has assumed an important role. Here we highlight the factors that drive the development of novel analgesics and the advances made in the field.