The following is a summary of “Importance of context (placebo effects) in conservative interventions for musculoskeletal pain: A systematic review and meta-analysis of randomized controlled trials,” published in the December 2023 issue of Pain by Saueressig et al.

Beyond therapy, patient expectations and other contextual factors might influence treatment success for musculoskeletal pain – a systematic review and meta-analysis of placebo-controlled trials explored their impact.

Researchers conducted a retrospective study of placebo-controlled trials to quantify the impact of non-treatment factors on conservative musculoskeletal pain interventions.

They conducted searches in MEDLINE, EMBASE, CINAHL, Web of Science Core Collection, CENTRAL, and SPORTDiscus from inception (September 2021). Additionally, trial registry searches, backward and forward citation tracking, and searches for prior systematic reviews were performed. The Cochrane risk of bias 2 tool was utilized.

The results showed 64 RCTs (N = 4314) from 8898 records. Pain intensity exhibited a mean difference (MD: −5.32, 95% CI: −7.20, −3.44; N = 57 studies, 74 outcomes, GRADE: very low). A slight positive effect for placebo interventions in physical function was observed (SMD: −0.22, 95% CI: −0.35, −0.09; N = 37 studies, 48 outcomes, GRADE: very low). Consistent findings across diverse patient-reported outcomes were observed; however, meta-regression analyses failed to explain heterogeneity.

Investigators concluded that contextual effects in musculoskeletal pain treatments proved modest yet potentially relevant alongside established methods.

Source: onlinelibrary.wiley.com/doi/full/10.1002/ejp.2222