Evaluating the benefits of a second pain treatment following a clinical trial.
Tracy M Anastas, Aaron P Turner, Erica J Ho and 4 others
PMID 37338442WHAT IT FOUND
Veterans who chose a second pain treatment after a trial saw small improvements in depression and worst pain, but average pain did not change.
Mindfulness users reported less pain interference than hypnosis users, though no group was clearly superior overall.
Key findings
01Depression scores decreased by an average of 1.62 points and worst pain intensity decreased by 0.28 points from pre- to post-open label, regardless of which treatment was chosen.
02Participants in the mindfulness meditation condition reported less pain interference across both timepoints compared to those in the hypnosis condition.
03There were no significant changes in average pain intensity from pre- to post-open label phase.
STILL TO COME
How it was doneWhat they found
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What it does not show
The sample size was small (n=68), making it underpowered to detect subtle differences between specific treatments. Participants self-selected into the open-label phase and were likely those who had positive experiences in the initial trial, introducing selection bias. There was no follow-up assessment after the second treatment ended, so it is unknown if benefits were sustained. The 'control' condition (pain education) was an active treatment, so improvements cannot be attributed solely to the novel nature of the second therapy. Hypotheses were generated post hoc after knowing the primary trial results, increasing the risk of false positives.
Declared interests
Funding and conflicts of interest are not explicitly detailed in the provided text, though the study was approved by the VHA and a university IRB. The text notes that intervention groups counted towards clinician workload, which was appreciated by the study clinicians.
The easy way to misread this
Do not interpret the improvements in depression and worst pain as evidence that adding a second treatment is superior to continuing or repeating the first. The changes were small, the sample was self-selected, and the lack of a true no-treatment control means these gains could reflect natural fluctuation or placebo effects rather than a specific therapeutic benefit.