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The Effect of Treatment History on Therapeutic Outcome: An Experimental Approach

Simon Kessner1; Katja Wiech, PhD2,3; Katarina Forkmann, MS4; Markus Ploner, MD5; Ulrike Bingel, MD4,6
[+] Author Affiliations
1Medical student at the University Medical Center Hamburg-Eppendorf, Hamburg, Germany
2Oxford Centre for Functional Magnetic Resonance Imaging of the Brain and Nuffield Department of Clinical Neurosciences, John Radcliffe Hospital, University of Oxford, Oxford, England
3Centre for Pain Research, University of Bath, Bath, England
4Department of Neurology, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
5Department of Neurology, Technische Universität München, Munich, Germany
6Department of Systems Neuroscience, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
JAMA Intern Med. 2013;173(15):1468-1469. doi:10.1001/jamainternmed.2013.6705.
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Therapeutic context can critically determine treatment outcome.1 Prior experience with a treatment is an important contextual factor that has been shown to modulate treatment efficacy.2,3 To date, this influence of prior treatment experience has been studied only within the same treatment approach. However, in clinical practice, treatments are often changed, particularly in case of failure. The aim of this study was therefore to investigate whether the effects of treatment history carry over from one treatment approach to another.

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Experimental Design and Behavioral and Neuroimaging Results

A, The experiment took place on 3 consecutive days. On days 1 and 2, either a positive or negative treatment experience was induced by combining an inert patch treatment with a conditioning procedure. On day 3, the analgesic response to a second analgesic treatment, applied as an ointment, was assessed. Bars indicate the stimulation intensities of applied heat pain stimuli on a scale of 0 to 100, with 0 indicating no pain and 100 indicating unbearable pain. B, The therapeutic effect of the ointment treatment, defined as the pain reduction on the treated compared with the untreated site, was significantly lower in the negative than in the positive treatment history group. Bars (error bars) show the mean (standard error of the mean) difference in VAS pain ratings between the treated and untreated sites for the positive and negative treatment history groups; P = .007. C, Functional magnetic resonance imaging responses as a physiological marker of analgesia showed a weaker reduction of pain-related activity in the posterior insula in the negative compared with the positive treatment history group. Interaction contrast [(Control Site − Treatment SitePositive Group) – (Control Site − Treatment SiteNegative Group)] thresholded at P < .005 for visualization purposes is overlaid on a T1-weighted structural brain image. Peak voxel, 48, −8, 10 in Montreal Neurological Institute coordinates; t = 4.0; P = .04 corrected using small volume correction (20-mm sphere). R indicates right; color bar indicates t-value.

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