Observational studyBMJ open2026
Longitudinal assessment and clinical implications of treatment expectations in an outpatient pain centre: evaluation of the GEEE in patients with chronic pain.
Observational study in BMJ open, 2026. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Not yet cited in PubMed.
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Abstract
objectivesThere is evidence that treatment expectations predict treatment outcomes in pain management and other clinical conditions. However, translating these insights into clinical practice remains challenging: it is difficult to measure the multifaceted construct of expectations across diverse medical and psychological treatment modalities. Furthermore, little is known about how prior treatment experiences shape different expectation domains. A unified assessment approach is lacking, limiting comparability across studies and clinical contexts. The Generic Rating Scale for Previous Treatment Experiences, Treatment Expectations, and Treatment Effects (GEEE) seeks to overcome these limitations. The present study aims to explore the GEEE in a naturalistic clinical sample of people seeking treatment for chronic pain, which may provide preliminary evidence for its validity and applicability. An additional exploratory aim is to examine whether the GEEE is suitable for predicting treatment outcomes longitudinally in this clinical setting.
designProspective longitudinal observational study with three measurement time points (baseline, 3 weeks and 16 weeks).
settingSpecialised outpatient pain treatment centre in Germany.
participantsThe baseline sample comprised 219 patients with chronic pain, follow-up data were available from 140 participants at 3 weeks and 108 participants at 16 weeks, constituting the longitudinal subsamples. PRIMARY AND SECONDARY OUTCOME MEASURES: Primary outcomes were prior treatment experiences, current treatment expectations and treatment effects, which were assessed using the GEEE, as well as clinical outcomes of pain intensity and pain-related disability. Secondary measures included desire for pain relief, depression and anxiety symptoms, which were analysed in correlational tests to assess construct validity. Trajectories of treatment expectations and clinical outcomes were examined longitudinally, and it was assessed if baseline expectations predicted clinical outcomes over time.
resultsRegarding validation, at baseline, improvement expectations correlated weakly with expectations of worsening and side effects (Rho≈-0.14 to -0.15,
conclusionWe found supporting evidence for the validity of the GEEE and its applicability in longitudinal clinical research. Improvement expectations as measured with the GEEE at baseline predicted better treatment outcomes, while previous negative treatment experiences correlated with current treatment expectations. The findings underscore the value of assessing and addressing expectations and prior treatment experiences to optimise treatment outcomes.
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