{"id":772,"date":"2010-03-10T14:01:11","date_gmt":"2010-03-10T19:01:11","guid":{"rendered":"http:\/\/blogs.nejm.org\/?p=772"},"modified":"2015-06-04T15:25:40","modified_gmt":"2015-06-04T19:25:40","slug":"the-extraordinary-power-of-placebo","status":"publish","type":"post","link":"https:\/\/blogs.nejm.org\/hiv-id-observations\/index.php\/the-extraordinary-power-of-placebo\/2010\/03\/10\/","title":{"rendered":"The Extraordinary Power of Placebo"},"content":{"rendered":"

\"monty_footSmWide\"<\/p>\n

Just published in the journal Neurology <\/em>— not typically on my radar screen — is this remarkable study comparing pregabalin to placebo<\/a> for HIV-related distal sensory peripheral neuropathy.<\/p>\n

Here are the results:<\/p>\n

At endpoint, pregabalin and placebo showed substantial reductions in mean Numeric Pain Rating Scale (NPRS) score from baseline: -2.88 vs -2.63, p = 0.3941.
\n(-snip-)
\nIndividuals with HIV-associated neuropathy achieved NPRS treatment effect size similar to those in studies of diabetic peripheral and postherpetic neuralgia.\u00a0However, the placebo group in the current study had a much higher NPRS change than in the diabetic peripheral neuropathy or postherpetic neuralgia studies<\/p><\/blockquote>\n

In other words, the pregabalin here worked great, but the placebo effect was so gargantuan that the placebo was just as good.<\/p>\n

Writing in Journal Watch: \u00a0AIDS Clinical Care<\/a><\/em>, the always-astute Abbie Zuger has a theory why this happened:<\/p>\n

Notably, this study is not the first in which a treatment for HIV-related peripheral neuropathy has elicited an unusually high placebo response.\u00a0The reasons behind that phenomenon would be extremely interesting to pursue \u2014 might HIV-positive individuals have greater faith in the power of medication than do others?<\/p><\/blockquote>\n

I think she’s on to something important here. \u00a0After all, in how many other diseases can patients so directly link the medications they are taking to their own survival?<\/p>\n

And we clinicians who practice HIV medicine should keep this in mind when prescribing medications to our patients. \u00a0Strong mutual conviction that something will<\/em> work — from both provider and patient — may well be a self-fulfilling prophecy.<\/p>\n

Why not leverage this for all it’s worth?<\/p>\n","protected":false},"excerpt":{"rendered":"

Just published in the journal Neurology — not typically on my radar screen — is this remarkable study comparing pregabalin to placebo for HIV-related distal sensory peripheral neuropathy. Here are the results: At endpoint, pregabalin and placebo showed substantial reductions in mean Numeric Pain Rating Scale (NPRS) score from baseline: -2.88 vs -2.63, p = […]<\/p>\n","protected":false},"author":6,"featured_media":0,"comment_status":"open","ping_status":"open","sticky":false,"template":"","format":"standard","meta":{"footnotes":""},"categories":[3,4,8,10],"tags":[197,423,644,798],"class_list":["post-772","post","type-post","status-publish","format-standard","hentry","category-health-care","category-hiv","category-patient-care","category-research","tag-clinical-trials","tag-hiv","tag-neuropathy","tag-research"],"post_mailing_queue_ids":[],"_links":{"self":[{"href":"https:\/\/blogs.nejm.org\/hiv-id-observations\/index.php\/wp-json\/wp\/v2\/posts\/772","targetHints":{"allow":["GET"]}}],"collection":[{"href":"https:\/\/blogs.nejm.org\/hiv-id-observations\/index.php\/wp-json\/wp\/v2\/posts"}],"about":[{"href":"https:\/\/blogs.nejm.org\/hiv-id-observations\/index.php\/wp-json\/wp\/v2\/types\/post"}],"author":[{"embeddable":true,"href":"https:\/\/blogs.nejm.org\/hiv-id-observations\/index.php\/wp-json\/wp\/v2\/users\/6"}],"replies":[{"embeddable":true,"href":"https:\/\/blogs.nejm.org\/hiv-id-observations\/index.php\/wp-json\/wp\/v2\/comments?post=772"}],"version-history":[{"count":0,"href":"https:\/\/blogs.nejm.org\/hiv-id-observations\/index.php\/wp-json\/wp\/v2\/posts\/772\/revisions"}],"wp:attachment":[{"href":"https:\/\/blogs.nejm.org\/hiv-id-observations\/index.php\/wp-json\/wp\/v2\/media?parent=772"}],"wp:term":[{"taxonomy":"category","embeddable":true,"href":"https:\/\/blogs.nejm.org\/hiv-id-observations\/index.php\/wp-json\/wp\/v2\/categories?post=772"},{"taxonomy":"post_tag","embeddable":true,"href":"https:\/\/blogs.nejm.org\/hiv-id-observations\/index.php\/wp-json\/wp\/v2\/tags?post=772"}],"curies":[{"name":"wp","href":"https:\/\/api.w.org\/{rel}","templated":true}]}}