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      Memory of pain in adults: a protocol for systematic review and meta-analysis

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          Abstract

          Background

          The way pain is remembered and reported can affect medical decisions taken by patients and health-care professionals. Memory of pain has been investigated extensively for the past few decades; however, the results of previous studies are highly variable, indicating that the recollection of pain can be accurate, overestimated or underestimated. It is therefore difficult to conclude how well pain is remembered. The aim of this systematic review and meta-analysis is to summarize research findings on memory of pain in healthy adults and patients suffering from acute and chronic pain.

          Methods

          The systematic review will be performed by searching for articles indexed in the following databases: PubMed, MEDLINE, PsycINFO, Web of Science, ScienceDirect, PsycARTICLES, Scopus and Academic Search Complete. Studies will be included if (1) they investigated healthy adults or patients with any acute or chronic pain condition and if (2) they assessed experienced pain (pain intensity and/or pain unpleasantness) and its recollection. No restrictions related to the date of publication and recall delay will be applied. Studies will be screened for eligibility and risk of bias by two independent assessors. The risk of bias will be assessed by a modified Downs and Black checklist. A narrative synthesis will be performed in the first stage; in the second stage, the results of studies with comparable designs will be pooled in meta-analytical syntheses.

          Discussion

          The question of whether pain is remembered accurately is crucial for valid pain diagnosis, effective treatment and prognosis. So far, a number of studies on memory of pain have been conducted; however, a definitive conclusion on whether memory of pain is accurate is still lacking. In this systematic review and meta-analysis, available data will be pooled together to further inform research and clinical practice.

          Systematic review registration

          PROSPERO CRD42018093523

          Electronic supplementary material

          The online version of this article (10.1186/s13643-019-1115-4) contains supplementary material, which is available to authorized users.

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          Most cited references30

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          WHEN MORE PAIN IS PREFERRED TO LESS:. Adding a Better End

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            An analysis of factors that contribute to the magnitude of placebo analgesia in an experimental paradigm.

            Placebo analgesia was produced by conditioning trials wherein heat induced experimental pain was surreptitiously reduced in order to test psychological factors of expectancy and desire for pain reduction as possible mediators of placebo analgesia. The magnitudes of placebo effects were assessed after these conditioning trials and during trials wherein stimulus intensities were reestablished to original baseline levels. In addition, analyses were made of the influence of these psychological factors on concurrently assessed pain and remembered pain intensities. Statistically reliable placebo effects on sensory and affective measures of pain were graded according to the extent of surreptitious lowering of stimulus strength during the manipulation trials, consistent with conditioning. However, all of these effects were strongly associated with expectancy but not desire for relief. These results show that although conditioning may be sufficient for placebo analgesia, it is likely to be mediated by expectancy. The results further demonstrated that placebo effects based on remembered pain were 3 to 4 times greater than those based on concurrently assessed placebo effects, primarily because baseline pain was remembered as being much more intense than it actually was. However, similar to concurrent placebo effects, remembered placebo effects were strongly associated with expected pain levels that occurred just after conditioning. Taken together, these results suggest that magnitudes of placebo effect are dependent on multiple factors, including conditioning, expectancy, and whether analgesia is assessed concurrently or retrospectively.
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              Memories of colonoscopy: a randomized trial.

              Patients' memories of the past may influence their decisions about the future, yet memories are imperfect and susceptible to bias. We tested whether a memory failure observed in psychology experiments could be applied in a clinical setting to lessen patients' memories of the pain of an unpleasant medical procedure. We studied consecutive outpatients undergoing colonoscopy who were medically stable, mentally competent, and able to speak English (n=682). By random assignment, half the patients had a short interval added to the end of their procedure during which the tip of the colonoscope remained in the rectum. Pain during the procedure was measured with a ten point intensity scale. Memory following the procedure was measured using both a rating scale and a ranking task. Randomization resulted in two similar groups. As theorized, patients who underwent the extended procedure experienced the final moments as less painful (1.7 vs. 2.5 on a ten point intensity scale, P<0.001), rated the entire experience as less unpleasant (4.4 vs. 4.9 on a 10 cm visual analogue scale, P=0.006), and ranked the procedure as less aversive compared to seven other unpleasant experiences (4.1 vs. 4.6 with eight as the worst, P=0.002). Rates of returning for a repeat colonoscopy (median duration of follow-up 5.3 years) averaged 50.4% and were slightly higher (odds ratio=1.41, P=0.038) for those who underwent the longer procedure controlling for prior colonoscopy, procedure indications, and abnormal findings. Memory failures observed in experimental conditions can be found in clinical settings involving awake patients and may offer opportunities for improving patients' willingness to undergo future unpleasant medical procedures.
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                Author and article information

                Contributors
                w.adamczyk@awf.katowice.pl
                dominika.farley@uj.edu.pl
                karolina.wiercioch@doctoral.uj.edu.pl
                elzbieta.bajcar@uj.edu.pl
                ewa.buglewicz@gmail.com
                nastaj.jakub@gmail.com
                a.gruszka-gosiewska@uj.edu.pl
                +48126632417 , przemyslaw.babel@uj.edu.pl
                Journal
                Syst Rev
                Syst Rev
                Systematic Reviews
                BioMed Central (London )
                2046-4053
                13 August 2019
                13 August 2019
                2019
                : 8
                : 201
                Affiliations
                [1 ]ISNI 0000 0001 2162 9631, GRID grid.5522.0, Pain Research Group, Institute of Psychology, , Jagiellonian University, ; ul. Ingardena 6, 30-060 Kraków, Poland
                [2 ]GRID grid.445174.7, Laboratory of Pain Research, , The Jerzy Kukuczka Academy of Physical Education, ; Katowice, Poland
                Author information
                http://orcid.org/0000-0003-0578-1013
                Article
                1115
                10.1186/s13643-019-1115-4
                6693173
                31409415
                29b039eb-b387-4f0c-8c0c-b05cbb22c1ae
                © The Author(s). 2019

                Open AccessThis article is distributed under the terms of the Creative Commons Attribution 4.0 International License ( http://creativecommons.org/licenses/by/4.0/), which permits unrestricted use, distribution, and reproduction in any medium, provided you give appropriate credit to the original author(s) and the source, provide a link to the Creative Commons license, and indicate if changes were made. The Creative Commons Public Domain Dedication waiver ( http://creativecommons.org/publicdomain/zero/1.0/) applies to the data made available in this article, unless otherwise stated.

                History
                : 9 May 2018
                : 23 July 2019
                Categories
                Protocol
                Custom metadata
                © The Author(s) 2019

                Public health
                acute pain,chronic pain,memory of pain,recollection,remembrance
                Public health
                acute pain, chronic pain, memory of pain, recollection, remembrance

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