Placebo Analgesia From a Rubber Hand

© 2017 American Pain Society Placebo analgesia, reductions in pain after administration of an inert treatment, is a well documented phenomenon. We report, to our knowledge, the first demonstration that placebo analgesia can be experienced when a sham analgesic is applied onto a rubber hand. The effect was obtained by exploiting the rubber hand illusion, in which ownership is felt over a rubber arm that is unattached to the body. Under conditions of synchronous as well as asynchronous visuotactile stimulation, a thermal pain stimulus was delivered on the real arm of 20 participants and seemingly also on the rubber arm, before and after applying a sham analgesic and a control cream only to the rubber arm. During synchronous visuotactile stimulation, pain was experienced on the rubber arm, and the application of the sham analgesic to the rubber arm significantly decreased the severity of reported pain. This shows that experience of the body can modulate expectations and the induction of placebo analgesia. Perspective This article presents an experiment suggesting that a placebo treatment applied to a rubber hand during the rubber hand illusion can produce placebo analgesia . This finding indicates that embodiment may influence the placebo effect, a previously unexamined factor in the treatment process with potential applications to treatment administration

Placebo and Active Treatment Additivity in Placebo Analgesia: Research to Date and Future Directions

Australian Research Counci

Patient-Led Urate Self-Monitoring to Improve Clinical Outcomes in People With Gout: A Feasibility Study.

ObjectiveSelf-monitored point-of-care urate-measuring devices are an underexplored strategy to improve adherence to urate-lowering therapy and clinical outcomes in gout. This study observed patient-led urate self-monitoring practice and assessed its influence on allopurinol adherence, urate control, and health-related quality of life.MethodsPeople with gout (n = 31) and prescribed allopurinol self-monitored their urate concentrations (HumaSens2.0plus) at baseline and thereafter monthly for 12 months (3 months per quarter). Adherence to allopurinol was measured using medication event monitoring technology (Medication Event Monitoring System cap). Time spent below the target urate concentration (ResultsMost participants were male (94%) and had urate concentrations below the target (74%) at baseline. Overall, seven participants demonstrated repeated periods of "missed doses" (two or fewer allopurinol doses missed consecutively) and "drug holidays" (three or more missed doses). Most participants (94%) persisted with allopurinol. Time spent within the target urate concentration increased 1.3-fold (from 79% to 100%; P = 0.346), and the incidence of gout flares decreased 1.6-fold (from 8 to 5; P = 0.25) in the final quarter compared to that in the first quarter of the study. Health-related quality of life was reduced for participants reporting at least one gout flare (median utility values 0.9309 vs 0.9563, P = 0.04).ConclusionPatient-led urate self-monitoring may support the maintenance of allopurinol adherence and improve urate control, thus reducing the incidence of gout flares. Further research on patient-led urate self-monitoring in a randomized controlled study is warranted

Patient-led urate self-monitoring to improve clinical outcomes in people with gout: a feasibility study

Objective. Self-monitored, point-of-care urate measuring devices are an underexplored strategy to improve adherence to urate-lowering therapy and clinical outcomes in gout. This study observed patient-led urate self-monitoring practice, and assessed its influence on; allopurinol adherence, urate control, and health-related quality-of-life.Methods. People with gout (n=31) and prescribed allopurinol self-monitored their urate concentrations (HumaSens2.0plus) at baseline and thereafter monthly for 12 months (3 months per quarter). Adherence to allopurinol was measured using medication event monitoring technology (MEMS® cap). Time spent below target urate concentration (&lt;0.36 mmol/L) was determined. Health-related quality-of-life was measured using a survey (EQ-5D-5L). Gout flares were recorded. Two-tailed Spearman correlation and Wilcoxon matched-pairs signed-rank test (p&lt;0.05) were used for statistical comparisons.Results. Most participants were male (94%) with urate concentrations below target (74%) at baseline. Overall, seven participants demonstrated repeated periods of “missed doses” (≤2 allopurinol doses missed consecutively) and “drug holidays” (≥3 missed). Most (94%) participants persisted with allopurinol. Time spent within target urate concentrations increased 1.3-fold (79% to 100%, p=0.346) and the incidence of gout flares decreased 1.6-fold (8 to 5, p=0.25) in the final compared to the first quarter of the study. Health-related quality-of-life was reduced for participants reporting at least one gout flare (median utility values 0.9309 versus 0.9563, p=0.04).Conclusion. Patient-led urate self-monitoring may support the maintenance of allopurinol adherence, improve urate control, thus reducing the incidence of gout flares. Further research on patient-led urate self-monitoring in a randomised controlled study is warranted. <br/

The experiences and perspectives of people with gout on urate self-monitoring

INTRODUCTION: Gout management remains suboptimal despite safe and effective urate-lowering therapy. Self-monitoring of urate may improve gout management, however, the acceptability of urate self-monitoring by people with gout is unknown. The aim of this study was to explore the experiences of urate self-monitoring in people with gout.METHODS: Semistructured interviews were conducted with people taking urate-lowering therapy (N = 30) in a 12-month trial of urate self-monitoring in rural and urban Australia. Interviews covered the experience of monitoring and its effect on gout self-management. Deidentified transcripts were analysed thematically.RESULTS: Participants valued the ability to self-monitor and gain more understanding of urate control compared with the annual monitoring ordered by their doctors. Participants indicated that self-monitoring at home was easy, convenient and informed gout self-management behaviours such as dietary modifications, hydration, exercise and medication routines. Many participants self-monitored to understand urate concentration changes in response to feeling a gout flare was imminent or whether their behaviours, for example, alcohol intake, increased the risk of a gout flare. Urate concentrations were shared with doctors mainly when they were above target to seek management support, and this led to allopurinol dose increases in some cases.CONCLUSION: Urate self-monitoring was viewed by people with gout as convenient and useful for independent management of gout. They believed self-monitoring achieved better gout control with a less restricted lifestyle. Urate data was shared with doctors at the patient's discretion and helped inform clinical decisions, such as allopurinol dose changes. Further research on implementing urate self-monitoring in routine care would enable an evaluation of its impact on medication adherence and clinical outcomes, as well as inform gout management guidelines.PATIENT OR PUBLIC CONTRIBUTION: One person with gout, who was not a participant, was involved in the study design by providing feedback and pilot testing the semistructured interview guide. In response to their feedback, subsequent modifications to the interview guide were made to improve the understandability of the questions from a patient perspective. No additional questions were suggested.</p