| Autor: |
Haines, Derek Raymond, Wang, Michael, Campion, Peter D., Alladin, Waseem |
| Předmět: |
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| Zdroj: |
Pain Clinic; 2005, Vol. 17 Issue 1, p1-13, 13p, 1 Diagram, 6 Charts, 5 Graphs |
| Abstrakt: |
Proglumide is a cholecystokinin antagonist which has been shown to block nocebo hyperalgesia in human patients. In contrast to the placebo response, the nocebo phenomenon involves negative expectations such as fearing the worst. We hypothesised that patients with chronic 'widespread' conditions, such as fibromyalgia and chronic fatigue syndrome, were so hampered by fearful appraisals of their current state that they might in fact be nocebo responders. If so, proglumide should counteract the situation and at least improve some aspect these patients' lives. However, a randomised double blind crossover trial of proglumide versus ascorbic acid in patients with chronic pain and/or fatigue did not support this hypothesis, there being no clinically significant improvements during the proglumide phase of the trial. Analysis of the changes in the fearful appraisal subscale scores of the PASS questionnaire during the control phase of the trial, showed that some of the patients could be divided into placebo and nocebo responders; i.e. the fearful appraisal reduced during a placebo response in the control phase of the trial, but increased during a nocebo response. The proglumide phase of the trial showed the expected reduction in fearful appraisal in the nocebo responders, but the placebo response was diminished by the proglumide, i.e. the fearful appraisal scores increased in the placebo responders. It seems that the proglumide exerts paradoxical effects on fearful appraisal, tending to return both placebo and nocebo responses towards pretrial baseline values. These responses were not strong enough to show a clinical effect in the trial, but do indicate a possible interaction of proglumide with fearful appraisal. Some of the implications of this finding are discussed. [ABSTRACT FROM AUTHOR] |
| Databáze: |
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