Alternative therapy expectations affect results

Patients who expect acupuncture or massage to work wonders for their back pain seem to improve more than patients who have lower expectations, according to a report.

Dr. Donna Kalauokalani, of Washington University in St. Louis, Missouri, and her colleagues performed a 10-week study of 135 patients who complained about chronic low back pain. At the start of the study, patients were asked to rate how helpful they expected either acupuncture or massage therapy to be on a scale of 0 to 10. Afterwards, they were randomly assigned to receive one of the treatments for up to 10 sessions.

About half of the patients reported high hopes for the treatment, rating their expectations as 8 or above, the researchers report in the July issue of Spine. These individuals tended to be more functionally disabled at the start of the study than others who reported lower expectations, the authors note.

Patients with higher expectations were five times more likely to report a substantial improvement in their symptoms than those with average expectations, the report indicates. This difference remained true even after the investigators took into consideration the patients’ sociodemographics, health status, and physical factors.

Patients with high expectations for massage tended to do better if they were assigned to the massage group and those with high expectations for acupuncture tended to do better if they received acupuncture, Kalauokalani’s team points out. On the other hand, ‘general optimism about treatment, divorced from a specific treatment, is not strongly associated with outcome,’ they note.

“Patient expectation thus may account for some of the variability in the results of clinical trials of low back pain treatment,’ Kalauokalani and colleagues write. The findings ‘also may be important for therapy choices made in the clinical setting,” the researchers conclude.