Nocebo hyperalgesia is a pervasive problem in which the treatment context triggers negative expectations that exacerbate pain. Thus, developing ethical strategies to mitigate nocebo hyperalgesia is crucial. Emerging research suggests that choice has the capacity to reduce nocebo side effects, but choice effects on nocebo hyperalgesia have not been explored. This study investigated the impact of choice on conditioned nocebo hyperalgesia using a well-established electrocutaneous pain paradigm where increases in noxious stimulation were surreptitiously paired with the activation of a sham device. In study 1, healthy volunteers (N = 104) were randomised to choice over (nocebo) treatment administration, nocebo administration without choice, or a natural history control group. Nocebo hyperalgesia was greater for those with choice than no choice, suggesting that choice increased rather than diminished nocebo hyperalgesia. Study 2 tested whether providing positive information about the benefits of choice in coping with pain could counteract heightened nocebo hyperalgesia caused by choice. A different sample of healthy adults (N = 137) were randomised to receive nocebo treatment with choice and positive choice information, choice only, or no choice. The positive choice information failed to attenuate the effect of choice on nocebo hyperalgesia. The current results suggest that, rather than decreasing nocebo hyperalgesia, treatment choice may exacerbate pain outcomes when a painful procedure is repeatedly administered. As such, using choice as a strategy to mitigate nocebo outcomes should be treated with caution.

中文翻译：

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选择的缺点：器械控制会增加条件性反安慰剂痛觉过敏。


Nocebo 痛觉过敏是一个普遍存在的问题，其中治疗环境会触发负面期望，从而加剧疼痛。因此，制定减轻 nocebo 痛觉过敏的伦理策略至关重要。新兴研究表明，选择能够减少反安慰剂的副作用，但尚未探索选择对反安慰剂痛觉过敏的影响。本研究使用一种成熟的皮肤电痛范式调查了选择对条件性反安慰剂痛觉过敏的影响，其中有害刺激的增加与假装置的激活秘密配对。在研究 1 中，健康志愿者 （N = 104） 被随机分配到选择 （nocebo） 治疗给药组、无选择反安慰剂给药或自然病史对照组。有选择的人比没有选择的人更严重 nocebo 痛觉过敏，这表明选择增加而不是减少 nocebo 痛觉过敏。研究 2 测试了提供有关选择在应对疼痛方面的好处的积极信息是否可以抵消由选择引起的反安慰剂痛觉过敏。健康成人的不同样本 （N = 137） 被随机分配接受有选择和阳性选择信息、仅选择或无选择的反安慰剂治疗。阳性选择信息未能减弱选择对反安慰剂痛觉过敏的影响。目前的结果表明，当反复进行痛苦的手术时，治疗选择可能会加剧疼痛结局，而不是减少反安慰剂痛觉过敏。因此，应谨慎对待使用选择作为减轻反安慰剂结局的策略。