Papers of the Week

Pain experience is affected by both ascending nociceptive signals and descending modulation. Expectations can affect pain experience and augment treatment-induced analgesia through descending inhibitory modulation of pain. This open-label, prospective cohort study examined the association between participant expectation ratings and pain reduction in adult participants with chronic pain receiving an intravenous lidocaine infusion. We aimed to explore whether: 1) participants’ expectations of treatment efficacy were associated with pain reduction over 8 weeks after infusion; and 2) participants’ therapeutic alliance was associated with expectations and/or pain reduction. We recruited 70 participants with chronic pain scheduled for lidocaine infusion. Study measures included pain intensity (pre-treatment, post-treatment, and daily for 8 weeks), treatment expectation (EXPECT), and therapeutic alliance (TIP & WAI-SR). Baseline treatment expectations was significantly correlated with pain reduction (r=0.42, p<0.01). Therapeutic alliance was significantly correlated with expectations (r=0.27, p<0.05), and pain reduction (r=0.38, p<0.01). This study quantifies the contribution of: 1) treatment expectations; and 2) therapeutic alliance to the magnitude of lidocaine-induced pain reduction. Results generate the hypothesis that focused efforts to augment treatment expectation and therapeutic alliance could serve to improve pain treatment outcomes. PERSPECTIVE: This study evaluates the relationship between pain reduction and ratings of: 1) treatment expectation; and 2) therapeutic alliance following an intravenous lidocaine infusion. Results generate the hypothesis that focused efforts to augment treatment expectation and therapeutic alliance could serve to improve pain treatment outcomes.