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- Title
Mind games in dentistry: confounded evidence suggests a substantial nocebo response in dental impaction pain model.
- Authors
Majid, Omer Waleed
- Abstract
Design: A systematic review and metaanalysis of randomized clinical trials (RCTs). Data sources: Electronic search was conducted in PubMed, Embase, Scopus, Web of Science and the Cochrane Central Register of Controlled Trials (CENTRAL), on 22 May 2021. Selection criteria: Eligibility criteria included parallel-group placebo-controlled RCTs assessing analgesics after third molar (M3) surgery in healthy patients, reporting the number of patients with at least one drug-related adverse event (AE), and being published in English. Data extraction and synthesis: Two reviewers independently screened all identified articles against the eligibility criteria, and performed quality assessment and data extraction. Any disagreements were resolved by discussion involving a third reviewer. The primary outcome was the pooled rate of drug-related AEs in placebo and active arms of RCTs assessing analgesic treatment following M3 surgery. Secondary outcome was the drug-related dropout rates in the same setting. Results: A total of 50 RCTs in 47 articles were included in the analyses. The pooled rates of patients with AE ≥ 1 in the placebo and active arms were 22.8% and 20.6%, respectively. The pooled drug-related dropout rates in the placebo and active arms were 0.24% and 0.08%, respectively. There were no significant risk differences in patients with AE ≥ 1 and drug-related dropouts (p = 0.61 and p = 0.94; respectively). High statistical heterogeneity was found for the proportion of patients with AE ≥ 1 (I2 = 79.7%, p < 0.001), but not for drug-related dropout rates (I2 = 0%, p = 1.00). Conclusion: Patients in the placebo arm reported AEs at a similar frequency as patients receiving active treatment, suggesting that most analgesic-related AEs after M3 surgery may be attributed to the nocebo phenomenon.
- Subjects
TOOTHACHE; NOCEBOS; CLINICAL trials; THIRD molars; DATA extraction
- Publication
Evidence-Based Dentistry, 2024, Vol 25, Issue 1, p11
- ISSN
1462-0049
- Publication type
Article
- DOI
10.1038/s41432-023-00940-1