Contextual effects in musculoskeletal pain: are we overlooking essential factors?
PainSci notes on Poulter 2025:
There is the treatment itself … and then there is the context in which it happens, the messy halo of variables that surround and influence it, the “contextual effects” of the treatment.
All of which is chronically misunderstood and underestimated! For instance, contextual effects are similar to the placebo response, but they aren’t the same thing, and they’re more important. Contextual effects strongly influence how things work out, both in the clinic and the lab — probably more than the placebo response.
This new evidence-based opinion paper tires to clear up four common points of confusion. Nerd factor 8 — not exactly a light read. Fortunately, there’s also a less nerdy version! It’s is also longer, but definitely more readable … about, say, nerd factor 6? Lead author David Poulter published his version of the article before his academic colleagues got to it.
related content
Specifically regarding Poulter 2025:
This page is part of the PainScience BIBLIOGRAPHY, which contains plain language summaries of thousands of scientific papers & others sources. It’s like a highly specialized blog. A few highlights:
- Classical Conditioning Fails to Elicit Allodynia in an Experimental Study with Healthy Humans. Madden 2017 Pain Med.
- Topical glyceryl trinitrate (GTN) and eccentric exercises in the treatment of mid-portion achilles tendinopathy (the NEAT trial): a randomised double-blind placebo-controlled trial. Kirwan 2024 Br J Sports Med.
- Placebo analgesia in physical and psychological interventions: Systematic review and meta-analysis of three-armed trials. Hohenschurz-Schmidt 2024 Eur J Pain.
- Recovery trajectories in common musculoskeletal complaints by diagnosis contra prognostic phenotypes. Aasdahl 2021 BMC Musculoskelet Disord.
- Cannabidiol (CBD) products for pain: ineffective, expensive, and with potential harms. Moore 2023 J Pain.