The journal of pain : official journal of the American Pain Society
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Review
Persistent pain, long-term opioids, and restoring trust in the patient-clinician relationship.
The erosion of trust in the patient-clinician relationship is an underappreciated, and vital, component of the prescription opioid crisis. Drawing from lived experience of patients and clinicians, and a narrative evidence review, this report discusses how opioid use for persistent pain can impact the patient-clinician relationship from the vantage points of the patient and the family physician. For patients, the stress of dealing with persistent pain, misalignment with clinicians regarding goals of care, experiences of disrespect and stigma, fear of abrupt tapers, and frustration with a fragmented health system, all combine to breed a lack of trust. ⋯ To support implementation of evidence-based guidelines and achieve public health goals of safer prescribing and reducing harm from prescription opioids, we recommend steps health systems and clinicians can take to rebuild trust in the patient-clinician relationship, enable patient-centered pain care, and embed patient perspectives into opioid safety processes. PERSPECTIVE: Erosion of patient-clinician trust is a barrier to implementing evidence-based guidelines that aim to improve opioid safety. This paper explores lived patient and clinician experiences and recommends steps for health systems and clinicians to rebuild this trust as a strategy to actualize the benefits of adherence to these guidelines.
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Randomized Controlled Trial
Research Article: The prediction of the analgesic placebo response is moderated by outward-focused attention: a sham, randomized clinical trial of chronic back pain patients.
The within-subject variability (WSV) of pain-intensity reports has gained attention as a predictor of the placebo response but has demonstrated mixed results. We hypothesized that participants' inward- and outward-directed attention will moderate WSV's prediction of the analgesic placebo response. In this sham randomized clinical trial (protocol number NCT05994118); placebo response was induced in chronic back-pain patients (n=113) through a saline injection plus verbal suggestion. ⋯ Better understanding of factors shaping the placebo response could further contribute to both clinical practice and clinical trials. PERSPECTIVE: The current study demonstrates that the prediction of the analgesic placebo response could be improved if relevant personal characteristics are included as moderators of the prediction. Better predictions of the placebo response could contribute to improve both clinical research and clinical care.