| T O P I C R E V I E W |
| mk6283 |
Posted - 07/10/2008 : 19:29:43
Ann Rheum Dis. Published Online First: 9 June 2008.
Extended Report
The placebo effect and its determinants in osteoarthritis – meta-analysis of randomised controlled trials
W Zhang 1*, J Robertson 1, A C Jones 2, P A Dieppe 3 and M Doherty 1
1 Nottingham University, United Kingdom
2 Nottingham University Hospitals, United Kingdom
3 Oxford University, United Kingdom
* To whom correspondence should be addressed. E-mail: weiya.zhang@nottingham.ac.uk .
Accepted 27 May 2008
Abstract
Objective: To examine the placebo effect and its potential determinants in the treatment of osteoarthritis (OA).
Data sources: Systematic literature search of Medline, EMBASE, Scientific Citation Index, CINAHL and Cochrane Library.
Review methods: Randomised placebo controlled trials in OA were included. The placebo effect was defined as the overall change from baseline in the placebo group. It was estimated as the effect size (ES) - the standard mean difference between baseline and endpoint – and this was compared with the ES obtained from untreated control. ES for pain was the primary outcome. Statistical pooling was undertaken as appropriate and 95% confidence interval (CI) was used for comparison. Quality of trials was assessed and potential determinants of placebo effect were examined using multiple regression analysis. Partial regression coefficient (beta) was used to present the adjusted size of the association.
Results: We identified 198 trials with 193 placebo groups (16,364 patients) and 14 untreated control groups (1,167 patients) that met our inclusion criteria. These included a range of therapies (non-pharmacological, pharmacological and surgical treatments). Placebo was effective at relieving pain (ES=0.51, 95%CI 0.46, 0.55 for the placebo group and 0.03, 95%CI -0.13, 0.18 for untreated control). Placebo was also effective at improving function and stiffness. The pain-relieving effect increased when the active treatment effect (beta=0.38, p<0.001), baseline pain (0.006, p=0.014) and sample size (0.001, p=0.004) increased, and when placebo was given through injections/needles (0.144, p=0.020).
Conclusion: Placebo is effective in the treatment of OA, especially for pain, stiffness and self-reported function. The size of this effect is influenced by the strength of the active treatment, the baseline disease severity, the route of delivery and the sample size of the study.
Copyright © 2008 BMJ Publishing Group Ltd & European League Against Rheumatism
The above message comes from "BMJ", who is solely responsible for its content.
|
| 2 L A T E S T R E P L I E S (Newest First) |
| Scottydog |
Posted - 07/12/2008 : 14:39:15
I have a friend who is convinced she will be crippled with arthritis - jokes about her husband throwing her over the cliff in her wheelchair in years to come - exasperating, as her mother has OA but isn't crippled by it! She seems determined to suffer. But our genes come from many ancestors - why should we expect to be the unlucky ones? |
| stanfr |
Posted - 07/12/2008 : 14:17:05
Thanks for the post. Placebo is a fascinating subject. It's too bad Sarno rejects any relationship between placebo and TMS, i guess understandable since he doesn't want TMS criticized as being placebo. I belieeve placebo is associated with mind-body; if those results just indicated effect on pain that would be one thing but note it also mentions degree of movement, etc.
In my case, i found placebo does not work well with my TMS symptoms, even when i wasn't aware i was dealing with TMS, traditional medical trematments didnt work very well. But somethings work at times, other times they don't. I can't figure it out! |
|
|
