• Anneleen Malfliet, Enrique Lluch Girbés, Daniel Pecos-Martin, Thomas Gallego-Izquierdo, and Antonio Valera-Calero.
• Research Foundation - Flanders (FWO), Brussels, Belgium.
• Pain Pract. 2019 Apr 1; 19 (4): 370-381.

BackgroundThe role of contextual factors like pre-existing treatment expectations has been established. However, the effect of verbally delivered treatment expectations in patient-therapist communication has not been considered, nor has the role of cortisol changes within the placebo/nocebo response in people with chronic neck pain.ObjectiveTo examine the effect of verbally delivered treatment expectations on clinical outcomes in physical therapy practice and to determine if changes in cortisol levels are associated with changes in neck pain and disability.MethodsEighty-three patients with chronic neck pain were randomly allocated to 3 different verbally delivered expectations (positive, negative, neutral) during physical therapy interventions.Main Outcome Measuressalivary cortisol, pain and disability, and cervical range of motion.ResultsPain significantly improved in the positive (P < 0.001) and neutral (P < 0.001) expectations groups. For salivary cortisol levels, a significant increase was observed in response to treatment in the neutral (P = 0.045) and negative (P < 0.001) expectations groups. No significant correlations were found between changes in salivary cortisol levels and the change in pain in the neutral and negative expectations groups.ConclusionsPhysical therapists treating people with chronic neck pain should be attentive when communicating the expected treatment effects to their patients. Whereas verbally delivered positive or neutral expectations may be beneficial for pain-related measures, giving negative expectations may result in a lack of a treatment response on pain. Cortisol levels increased in response to verbally delivered neutral and negative expectations, in the absence of a nocebo effect. This questions the presumed role of cortisol in the nocebo effect.© 2018 World Institute of Pain.

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