Weitere Videos mit Dr. Paul D. Thompson
Cardiologist Dr. Paul D. Thompson, MD, explains the nocebo effect in statin muscle pain. He describes a 420-patient placebo-controlled study from his group and the crossover design he uses to confirm whether a patient's muscle discomfort is truly linked to the statin.
Statin Muscle Pain and the Nocebo Effect: Separating Real From Expected Symptoms
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- Placebo and nocebo effects
- Muscle pain in a placebo-controlled statin study
- Why he questions the "all in the head" view
- How his group tests muscle complaints
- What the crossover approach shows
- Full Transcript
Placebo and nocebo effects
Placebo and nocebo effects frame this discussion of statin muscle pain between Dr. Anton Titov, MD, and cardiologist Dr. Paul D. Thompson, MD. Dr. Thompson describes the placebo effect as feeling well just from receiving a treatment, even a sugar capsule. The nocebo effect works the other way: patients get symptoms and attribute them to the medication, although the medication is not the cause.
Muscle pain in a placebo-controlled statin study
A randomized study from his own group is one he considers among the best on this question. His team took 420 patients who had never been on a statin and randomized them to placebo or to 80 milligrams of atorvastatin, the highest dose. About 10% of people on the statin developed muscle pain that went away when the medication was stopped and came back when it was restarted. In the placebo group, 5% of patients reported almost identical pain.
Why he questions the "all in the head" view
Studies concluding that statin muscle pain is all in patients' heads draw criticism from Dr. Thompson. Those studies, he says, took people with discomfort off the statin and put them back on it, and showed that the patients could not tell when they were on the statin. In some, almost nobody could reproduce the pain. He thinks the reason is that the researchers did not first select people and prove that they really had statin-associated muscle pain.
How his group tests muscle complaints
His group studies statin side effects differently, Dr. Thompson explains. Patients from his clinic who report muscle discomfort receive either a placebo or a statin for eight weeks and are then crossed over, so each person also takes the other pill. Only people who have discomfort on the statin and not on the placebo enter his studies.
What the crossover approach shows
Dr. Thompson says that if a hundred people go through it, only about 35%, about a third, actually get discomfort only on the statin. He considers this the only way to really find out whether the pain is real.
Full Transcript
Dr. Anton Titov, MD: The nocebo effect with statins, muscle pain on a statin. On your blog you wrote that statins do cause muscle symptoms in some patients. You also wrote that many other muscle complaints are not caused by the statin. Expecting harm from a medication can itself bring symptoms, the nocebo effect. Professor Thompson, how should a patient with muscle pain on a statin think about the nocebo effect? Can a placebo cause muscle pain?
Dr. Paul D. Thompson, MD: The placebo effect: when we give patients placebos in studies, placebo means feel better. In other words, you feel well just by getting the drug, even if the drug is only a placebo, a sugar capsule or a fake pill.
Dr. Paul D. Thompson, MD: The nocebo effect is when patients get symptoms and they attribute it to the drug, but it is not due to the drug. Now, there are a lot of studies that have looked at this. We think we have done one of the best studies at actually looking at whether patients get muscle trouble.
Dr. Paul D. Thompson, MD: What we did is we took 420 patients who had never been on a statin. We randomized them to placebo or to the high dose, 80 milligrams, the highest dose of atorvastatin. What we found is that 10% of the people on the statin got muscle pain that went away when we stopped the drug and came back when we started the drug.
Dr. Paul D. Thompson, MD: But in the placebo group, 5% of the patients got almost identical pain. So we do know that some patients look to have the discomfort. Now, I have a lot of problems with a lot of the studies that have said this is all in patients' heads.
Dr. Paul D. Thompson, MD: Here is why. What those studies have done is they have taken people who have discomfort, and they have taken them off the statin and put them on the statin. What they have shown is that the patients cannot tell when they are on the statin.
Dr. Paul D. Thompson, MD: When we study the side effects of statins, we do it differently. We take patients from my clinic who say they have muscle discomfort, and we put them on a placebo or we put them on a statin for eight weeks, and then we cross them over. The placebos get statin, the statins get placebo.
Dr. Paul D. Thompson, MD: We only put people into our studies who have discomfort only on the statin and not on the placebo. Now, if you take a hundred people and you do that crossover, only about 35% of the people, about a third of the subjects, actually get discomfort only on the statin. But we think that is the only way to really do these sorts of studies to see if it is real or not.
Dr. Paul D. Thompson, MD: A lot of patients cannot produce the pain when they are on the statins. In some of the studies, almost nobody could reproduce the pain when they were on the statin. We think that is because they did not select people and prove beforehand that they really had statin-associated muscle pain.