The Effect of Procedural Framing on Epidural Steroid Injection Outcomes: A Randomized Controlled Study

Summary

Back pain is the leading cause of disability and military medical boards across the globe. Epidural steroid injections (ESI) are the most commonly performed pain procedure in the world. There is strong evidence that the placebo effect for all pain treatments, including ESI, is greater than the intrinsic effect. The placebo effect is highly dependent on a patient's 'expectations', and therefore how the procedure is framed. This study aims to compare ESI when the procedure is framed very positively- as is often done in clinical practice vs. more neutrally (which is less commonly done in clinical practice but consistent with evidence). The placebo effect is also stronger for procedures than medications. The evidence on the benefits of ESI is highly dependent on whether it is compiled by interventional doctors who perform the procedure or non-interventional researchers. In order to determine how 'framing' a treatment affects pain outcomes, the investigative team will conduct a 3-arm randomized trial comparing positive framing of ESI, neutral framing of ESI, and medications, in patients with lumbosacral radiculopathy.

Description

Eligibility

Age range

Not specified

Sex

All

Healthy volunteers

No

Interventions

• Behavioral
  Behavioral manipulation of ESI expectations

  5-slide summary of ESI portrayed in a positive light, accompanied by a study investigator.

• Other
  No behavioral manipulation of ESI expectations

  1-slide summary of ESI portrayed in a neutral light.

• Other
  No behavioral manipulation of pharmacotherapy expectations

  1-slide summary of medications for neuropathic pain portrayed in a neutral light.

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