Nocebo hyperalgesia is a pervasive problem in which the treatment context triggers negative expectations that exacerbate pain. Thus, developing ethical strategies to mitigate nocebo hyperalgesia is crucial. Emerging research suggests that choice has the capacity to reduce nocebo side effects, but choice effects on nocebo hyperalgesia have not been explored. This study investigated the impact of choice on conditioned nocebo hyperalgesia using a well-established electrocutaneous pain paradigm where increases in noxious stimulation were surreptitiously paired with the activation of a sham device. In study 1, healthy volunteers (N = 104) were randomised to choice over (nocebo) treatment administration, nocebo administration without choice, or a natural history control group. Nocebo hyperalgesia was greater for those with choice than no choice, suggesting that choice increased rather than diminished nocebo hyperalgesia. Study 2 tested whether providing positive information about the benefits of choice in coping with pain could counteract heightened nocebo hyperalgesia caused by choice. A different sample of healthy adults (N = 137) were randomised to receive nocebo treatment with choice and positive choice information, choice only, or no choice. The positive choice information failed to attenuate the effect of choice on nocebo hyperalgesia. The current results suggest that, rather than decreasing nocebo hyperalgesia, treatment choice may exacerbate pain outcomes when a painful procedure is repeatedly administered. As such, using choice as a strategy to mitigate nocebo outcomes should be treated with caution.

中文翻译：

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选择的缺点是：仪器控制会增加条件性反安慰剂痛觉过敏。

反安慰剂痛觉过敏是一个普遍存在的问题，治疗环境会引发负面期望，从而加剧疼痛。因此，制定减轻反安慰剂痛觉过敏的伦理策略至关重要。新兴研究表明，选择能够减少反安慰剂副作用，但选择对反安慰剂痛觉过敏的影响尚未被探索。这项研究使用完善的皮电疼痛范例研究了选择对条件性反安慰剂痛觉过敏的影响，其中有害刺激的增加与假设备的激活秘密配对。在研究 1 中，健康志愿者 (N = 104) 被随机分为选择（反安慰剂）治疗组、无选择的反安慰剂组或自然史对照组。对于那些有选择的人来说，反安慰剂痛觉过敏比没有选择的人更严重，这表明选择增加而不是减少了反安慰剂痛觉过敏。研究2测试了提供关于选择在应对疼痛方面的好处的积极信息是否可以抵消因选择而引起的反安慰剂痛觉过敏。健康成年人的不同样本（N = 137）被随机分配接受反安慰剂治疗，包括选择和积极选择信息、仅选择或无选择。积极的选择信息未能减弱选择对反安慰剂痛觉过敏的影响。目前的结果表明，当重复进行痛苦的手术时，治疗选择可能会加剧疼痛结果，而不是减少反安慰剂痛觉过敏。因此，应谨慎对待使用选择作为减轻反安慰剂结果的策略。