Lessons from a trial of acupuncture and massage for low back pain - Patient expectations and treatment effects

Study Design. A subanalysis of data derived from a randomized clinical tria l was performed, Objective. To evaluate the association of a patient's expectation for benef it from a specific treatment with improved functional outcome. Summary of Background Data. Psychosocial factors, ambiguous diagnoses, and lack of a clearly superior treatment have complicated the management of pat ients with chronic low back pain, The authors hypothesized that patient exp ectation for benefit from a specific treatment is associated with improved functional outcomes when that treatment is administered. Methods. In a randomized trial, 135 patients with chronic low back pain who received acupuncture or massage were studied. Before randomization, study participants were asked to describe their expectations regarding the helpfu lness of each treatment on a scale of 0 to 10. The primary outcome was leve l of function at 10 weeks as measured by the modified Roland Disability sca le, Results, After adjustment for baseline characteristics, improved function w as observed for 86% of the participants with higher expectations for the tr eatment they received, as compared with 68% of those with lower expectation s (P = 0.01), Furthermore, patients who expected greater benefit from massa ge than from acupuncture were more likely to experience better outcomes wit h massage than with acupuncture, and vice versa (P = 0.03). Conclusions. The results of this study suggest that patient expectations ma y influence clinical outcome independently of the treatment itself. In cont rast, general optimism about treatment, divorced from a specific treatment, is not strongly associated with outcome. These results may have important implications for clinical trial design and recruitment, and may help to exp lain the apparent success of some conventional and alternative therapies in trials that do not control for patient expectations. The findings also may be important for therapy choices made in the clinical setting.