Secondary Logo

Institutional members access full text with Ovid®

Share this article on:

Relieving patients' pain with expectation interventions: a meta-analysis

Peerdeman, Kaya J.; van Laarhoven, Antoinette I.M.; Keij, Sascha M.; Vase, Lene; Rovers, Maroeska M.; Peters, Madelon L.; Evers, Andrea W.M.

doi: 10.1097/j.pain.0000000000000540
Comprehensive Review

Patients' expectations are important predictors of the outcome of analgesic treatments, as demonstrated predominantly in research on placebo effects. Three commonly investigated interventions that have been found to induce expectations (verbal suggestion, conditioning, and mental imagery) entail promising, brief, and easy-to-implement adjunctive procedures for optimizing the effectiveness of analgesic treatments. However, evidence for their efficacy stems mostly from research on experimentally evoked pain in healthy samples, and these findings might not be directly transferable to clinical populations. The current meta-analysis investigated the effects of these expectation inductions on patients' pain relief. Five bibliographic databases were systematically searched for studies that assessed the effects of brief verbal suggestion, conditioning, or imagery interventions on pain in clinical populations, with patients experiencing experimental, acute procedural, or chronic pain, compared with no treatment or control treatment. Of the 15,955 studies retrieved, 30 met the inclusion criteria, of which 27 provided sufficient data for quantitative analyses. Overall, a medium-sized effect of the interventions on patients' pain relief was observed (Hedges g = 0.61, I 2 = 73%), with varying effects of verbal suggestion (k = 18, g = 0.75), conditioning (always paired with verbal suggestion, k = 3, g = 0.65), and imagery (k = 6, g = 0.27). Subset analyses indicated medium to large effects on experimental and acute procedural pain and small effects on chronic pain. In conclusion, patients' pain can be relieved with expectation interventions; particularly, verbal suggestion for acute procedural pain was found to be effective.

Supplemental Digital Content is Available in the Text.

aUnit Health, Medical and Neuropsychology, Leiden University, Leiden, the Netherlands

bLeiden Institute for Brain and Cognition, Leiden University, Leiden, the Netherlands

cDepartment of Psychology and Behavioural Sciences, Aarhus University, Aarhus, Denmark

dDanish Pain Research Center, Aarhus University Hospital, Aarhus, Denmark

eRadboud Institute for Health Sciences, Radboud University Medical Center, Nijmegen, the Netherlands

fDepartment of Clinical Psychological Science, Maastricht University, Maastricht, the Netherlands

gDepartment of Medical Psychology, Radboud University Medical Center, Nijmegen, the Netherlands

Corresponding author. Address: Unit Health, Medical and Neuropsychology, Leiden University, PO Box 9555, 2300 RB Leiden, the Netherlands. Tel.: +31-71-527-3622; fax: +31-71-527-3619. E-mail address: (K.J. Peerdeman).

Sponsorships or competing interests that may be relevant to content are disclosed at the end of this article.

Supplemental digital content is available for this article. Direct URL citations appear in the printed text and are provided in the HTML and PDF versions of this article on the journal's Web site (

Received November 16, 2015

Received in revised form January 27, 2016

Accepted February 22, 2016

© 2016 International Association for the Study of Pain
You currently do not have access to this article

To access this article:

Note: If your society membership provides full-access, you may need to login on your society website