Evidence map›Paper›PMID 42862041›Full record

Trial reportEuropean journal of pain (London, England)2026

Effects of Hidden Conditioning and Positive Expectations on Pain Intensity Following Spinal Manipulative Therapy: A Three-Arm Randomized Controlled Trial.

Helen Cristina Nogueira Carrer, Thamiris Costa de Lima, Bianca Emanuelli Saes Campanha, Steven Z George, Felipe J J Reis, Deise Lilian Costa Dias, Thais Cristina Chaves

Registry-linked trialAbstract readRandomized Controlled Trial
PubMed Full text at PMC Publisher
In one paragraph

Trial report in European journal of pain (London, England), 2026. The graph could read no effect estimate from its abstract, so it casts no vote on the map. It is linked to trial NCT05202704 (Investigating the Hypoalgesic Effects of Spinal Manipulative Therapy Using Hidden Pain Conditioning and Positive Expectation in Chronic Low Back Pain Patients), which is not on this map. Not yet cited in PubMed.

0numbers the graph read from it
0cells of the map it votes in
0citing papers in PubMed
–field-weighted citation impact
1 · What the graph read from it

What it found

Each row is one number read from the abstract, on the scale the paper reported it, with its interval. Left of the dashed line favours the treatment, right favours the comparator. Under each row is the sentence it came from. New to these charts? A ten-minute tutorial.

The abstract states no effect estimate the extractor could read, or names no intervention and outcome on the map, so this paper lights no cell and moves no belief. It is still indexed, cited and linked below.

2 · The registry

The trial behind it

Trials whose registry record cites this paper, or whose number appears in the abstract. A trial that started after this paper was published is citing it as background, not reporting it.

NCT05202704 naunknown statusnot on this map

Investigating the Hypoalgesic Effects of Spinal Manipulative Therapy Using Hidden Pain Conditioning and Positive Expectation in Chronic Low Back Pain Patients: Protocol for a Randomized Controlled Trial

TypeinterventionalSponsorUniversidade Federal de Sao CarlosRan2022 to 2024Enrolled264ConditionsChronic Low Back PainArmsProcedure/Surgery: Experimental: Hidden conditioning + Positive Expectation, Procedure/Surgery: Active Comparator: Positive Expectation, Procedure/Surgery: Active Comparator: Neutral Expectation, Spinal Manipulative Therapy
3 · Its place in the literature

Who cites it

0 citing papers in PubMed.

No citing paper in PubMed yet.

4 · The record

Corrections and comments

PubMed lists nothing against this paper. Absence here is not a guarantee, only a check that was made.

5 · Who and what money

Authors and funding

7 authors.

Helen Cristina Nogueira CarrerDepartment of Physical Therapy, Federal University of São Carlos, UFSCar, São Carlos, Brazil.ORCID https://orcid.org/0000-0001-5821-937X
Thamiris Costa de LimaPostgraduate Program in Physical Therapy, Federal University of São Carlos, UFSCar, São Carlos, Brazil.ORCID https://orcid.org/0000-0002-7371-6232
Bianca Emanuelli Saes CampanhaPostgraduate Program in Physical Therapy, Federal University of São Carlos, UFSCar, São Carlos, Brazil.ORCID https://orcid.org/0009-0005-7304-3540
Steven Z GeorgeDepartments of Orthopaedic Surgery and Population Health Science and the Duke Clinical Research Institute, Duke University School of Medicine, Durham, North Carolina, USA.ORCID https://orcid.org/0000-0003-4988-9421
Felipe J J ReisScience, Technology, and Innovation in Health, Instituto Federal de Educação, Ciência e Tecnologia do Rio de Janeiro (IFRJ), Rio de Janeiro, RJ, Brazil.ORCID https://orcid.org/0000-0002-9471-1174
Deise Lilian Costa DiasDepartment of Physical Therapy, Federal University of São Carlos, UFSCar, São Carlos, Brazil.
Thais Cristina ChavesDepartment of Physical Therapy, Federal University of São Carlos, UFSCar, São Carlos, Brazil.ORCID https://orcid.org/0000-0002-6222-4961

Funding

CNPq (National Council for Scientific and Technological Development) 302223/2022-3FAPESP (São Paulo Research Foundation) 2019/22924-6FAPESP (São Paulo Research Foundation) 2019/23356-1
6 · The paper itself

Abstract

backgroundConditioning and positive expectations are potential mechanisms for pain relief. However, there is a gap in the literature on the isolated or combined impact of these factors for decreasing pain intensity.

methodsThis study investigated whether a hidden conditioning procedure with a hidden lowering of the thermal noxious stimulus during a conditioning session combined with positive expectation would result in greater low back pain intensity reduction compared to positive and neutral expectations alone. All groups participating in the study received six sessions of spinal manipulative therapy (SMT). Patients (n = 264) with nonspecific chronic low back pain (CLBP), aged between 18 and 65 years, were randomly allocated to three groups: hidden conditioning with positive expectations (C-PEG), positive expectations alone (PEG), or neutral expectations alone (NEUG). Participants were submitted to a conditioning test pre- and post-first session of SMT, where heat pain stimuli were surreptitiously lowered only in the C-PEG group. The primary outcomes were low back pain intensity and global perceived effect (GPE) of improvement assessed post-first SMT session and at 6-week (primary endpoint) and 3-month follow-ups. Linear mixed-effects models were used to assess group and time effects.

resultsNo significant difference was found between the three groups at any of the follow-ups for pain intensity or GPE. Positive expectations (pre-treatment) and psychosocial variables partially mediated the relationship between baseline low back pain and disability outcomes. All groups showed a within-group reduction in low back pain and disability at follow-ups. SIGNIFICANCE STATEMENT: Conditioning and positive expectation with SMT did not improve pain intensity or GPE outcomes for participants with low back pain, when compared to positive or neutral expectations alone. These findings suggest that patients did not generalize learned associations during conditioning to low back pain intensity outcome. Regardless of treatment assignment, positive expectations and psychosocial factors played a mediating role in pain intensity, GPE, and disability outcomes.

trial registrationClinicalTrials.gov identifier: NCT05202704.

Indexed as

Chronic PainConditioning, PsychologicalLow Back PainManipulation, SpinalAdolescentAdultAgedFemaleHumansMaleMiddle AgedPain MeasurementTreatment OutcomeYoung Adultchronic paincontextual factorsexpectationhidden conditioningspinal manipulative therapy

Identifiers

PMID42862041
PMCPMC13656883

What OpenQuestion holds

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Registered trials

Read under generation 80e0d062 · epoch 390. Bibliography from PubMed, PubMed Central and OpenAlex; grants from NIH RePORTER; trial links from ClinicalTrials.gov; estimates, votes and beliefs from the OpenQuestion graph.