Short-term effects of preparatory suggestions on pain in adults undergoing nonpharmacological treatments: a systematic review protocol

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INTRODUCTION: Clinicians often prepare patients for a treatment by suggesting that their pain levels are likely to reduce or increase during or shortly after the treatment, thereby potentially creating expectations about pain. Several randomized controlled trials have investigated the short-term effects of preparatory suggestions on pain in adults undergoing nonpharmacological treatments, but their findings are inconsistent. OBJECTIVE: We will conduct a systematic review to explore whether positive and negative preparatory suggestions reduce and increase pain, respectively, in adults during and shortly after nonpharmacological treatments compared to no or neutral preparatory suggestions, and if so, to what extent. ELIGIBILITY CRITERIA: The review will include randomized controlled trials in which the participants are adults undergoing a nonpharmacological treatment. The intervention group must receive positive or negative preparatory suggestions, while the comparator group must receive no or neutral preparatory suggestions. The outcomes must be within the category of pain and assessed numerically during or shortly after the treatment. METHODS: The review will be conducted in line with the JBI methodology for systematic reviews of effectiveness. Studies were identified by searching in Embase (Ovid), MEDLINE (Ovid), PsycINFO (Ovid), Cochrane CENTRAL, and Google Scholar. Two reviewers will independently screen the identified studies, extract data, and evaluate the methodological quality and certainty in the findings. In addition, a narrative synthesis and meta-analyses will be performed. Effect sizes for continuous and binary outcomes will be computed as standardized mean differences and relative risks, respectively. A restricted maximum likelihood mixed effects model will be applied in the meta-analyses. REVIEW REGISTRATION: PROSPERO CRD42024587230.

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