The influence of verbal suggestions in the management of musculoskeletal pain: a narrative review
The influence of verbal suggestions in the management of musculoskeletal pain: a narrative review
Authors
Cuyul Vásquez, Iván
Aguilar Barría, José
Foitzick Pérez, Natalia
Fuentes, Jorge
Aguilar Barría, José
Foitzick Pérez, Natalia
Fuentes, Jorge
Authors
Date
Datos de publicación:
10.1080/10833196.2019.1639011
Keywords
Dolor músculo esquelético - Efecto placebo - Expectativas - Sugerencia verbal
Collections
Abstract
Antecedentes: se ha considerado que el dolor es el síntoma más incapacitante de los trastornos musculoesqueléticos. Es motivo de un gran número de consultas médicas y de elevados costes sanitarios en todo el mundo. El dolor de espalda crónico afecta a una población más grande que otros tipos de dolor, con una prevalencia observada de entre el 53% y el 81%; esto tiene repercusiones económicas, clínicas y sociales para el sistema de salud.
Objetivo: El propósito del presente artículo es describir la utilidad y los mecanismos neurobiológicos de la sugestión verbal como aliado terapéutico durante el manejo de pacientes con dolor musculoesquelético.
Descubrimientos importantes: inducir expectativas mediante sugerencias verbales puede activar las vías placebo o nocebo cuando el profesional clínico utiliza palabras positivas o negativas, respectivamente. Cuando la administración de fármacos y las intervenciones de fisioterapia van acompañadas de palabras que inducen expectativas positivas, esto puede mejorar ciertos parámetros clínicos como el dolor y / o la función en personas que padecen lumbalgia. Igualmente importante, el uso de la sugestión verbal positiva puede disminuir la percepción del dolor en pacientes con osteoartritis.
Conclusiones: En el manejo del dolor clínico musculoesquelético, la inclusión de la sugestión verbal tiene el potencial de inducir expectativas que pueden generar hipoalgesia a través del efecto placebo; sin embargo, se necesita más investigación para determinar la magnitud y la importancia clínica de esta contribución.
Abstract Background: Pain has been considered to be the most disabling symptom of musculoskeletal disorders. It is the cause of a large number of medical consultations and high health costs around the world. Chronic back pain affects a larger population than other types of pain, with observed prevalence of between 53% and 81%; this has economic, clinical and social repercussions for the health system. Objective: The purpose of the present article is to describe the utility and the neurobiological mechanisms of verbal suggestion as a therapeutic ally during the management of patients with musculoskeletal pain. Important discoveries: Inducing expectations by means of verbal suggestions can activate placebo or nocebo pathways when the clinical professional uses either positive or negative words respectively. When the administration of drugs and physiotherapy interventions are accompanied by words which induce positive expectations, this may improve certain clinical parameters such as pain and/or function in people suffering low back pain. Equally important, the use of positive verbal suggestion may decrease the perception of pain in patients with osteoarthritis. Conclusions: In the management of clinical musculoskeletal pain, the inclusion of verbal suggestion has the potential to induce expectations which may generate hypoalgesia through the placebo effect; however, more research is needed to determine the magnitude and clinical significance of this contribution.
Abstract Background: Pain has been considered to be the most disabling symptom of musculoskeletal disorders. It is the cause of a large number of medical consultations and high health costs around the world. Chronic back pain affects a larger population than other types of pain, with observed prevalence of between 53% and 81%; this has economic, clinical and social repercussions for the health system. Objective: The purpose of the present article is to describe the utility and the neurobiological mechanisms of verbal suggestion as a therapeutic ally during the management of patients with musculoskeletal pain. Important discoveries: Inducing expectations by means of verbal suggestions can activate placebo or nocebo pathways when the clinical professional uses either positive or negative words respectively. When the administration of drugs and physiotherapy interventions are accompanied by words which induce positive expectations, this may improve certain clinical parameters such as pain and/or function in people suffering low back pain. Equally important, the use of positive verbal suggestion may decrease the perception of pain in patients with osteoarthritis. Conclusions: In the management of clinical musculoskeletal pain, the inclusion of verbal suggestion has the potential to induce expectations which may generate hypoalgesia through the placebo effect; however, more research is needed to determine the magnitude and clinical significance of this contribution.