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Journal of the European Academy of... Oct 2023Every medical treatment inevitably comprises not only physiological, but also psychological components, reflected by placebo and nocebo effects, which significantly...
How familiar are German dermatologists with placebo and nocebo effects and to what extent are these targeted in clinical practice: A survey within the dermatological community.
BACKGROUND
Every medical treatment inevitably comprises not only physiological, but also psychological components, reflected by placebo and nocebo effects, which significantly affect treatment outcome. However, the extent of knowledge on the mechanisms steering placebo and nocebo effects in the dermatological community in Germany is currently unclear.
OBJECTIVES
To assess the state of knowledge about placebo and nocebo effects in the German dermatological community, to evaluate whether this knowledge is already being used in clinical practice, and to investigate whether German dermatologists are interested in learning more about the topic.
METHODS
German Dermatologists, the majority working in their own practice, were asked to fill in an online survey addressing the knowledge about placebo and nocebo effects and the feasibility of special techniques to enhance placebo and minimize nocebo effects within the clinical routine.
RESULTS
N = 154 complete (79%) or partial (21%) responses to the survey were recorded in the online database and included in the analysis. All participants reported to know what the placebo effect is and 59.7% (74/124) indicated that they already had experience with prescribing or recommending a treatment without active substances. In contrast, only 62.0% (80/129) stated to know what the nocebo effect is. Participants showed a rather superficial knowledge regarding placebo and nocebo mechanisms. The majority of participants (76.7%, 99/129) expressed their willingness to be further educated about the underlying mechanisms mediating placebo and nocebo effects and the possible application in clinical practice.
CONCLUSIONS
The current survey offers a so far unique insight into the state of knowledge of German dermatologists on placebo and nocebo effects. The results indicate a need for education about this topic. Encouragingly, however, German dermatologists considered communication strategies to maximize placebo and reduce nocebo effects and expressed motivation to be trained to implement these strategies in everyday clinical practice.
Topics: Humans; Nocebo Effect; Dermatologists; Placebo Effect; Treatment Outcome; Learning
PubMed: 37322597
DOI: 10.1111/jdv.19258 -
Pain Feb 2024The role of placebo analgesia and nocebo hyperalgesia in patients with Alzheimer disease (AD) is largely unknown, with only few studies in the area. Therefore, this... (Randomized Controlled Trial)
Randomized Controlled Trial
The role of placebo analgesia and nocebo hyperalgesia in patients with Alzheimer disease (AD) is largely unknown, with only few studies in the area. Therefore, this study aims to investigate to which extent placebo analgesia and nocebo hyperalgesia effects are present in patients experiencing mild-to-moderate AD. Twenty-one patients with AD (test population) and 26 healthy participants (HP; design validation) were exposed to thermal pain stimulation on 3 test days: Lidocaine condition (open/hidden lidocaine administration), capsaicin condition (open/hidden capsaicin administration), and natural history (no treatment), in a randomized, within-subject design. Open lidocaine and open capsaicin were accompanied by verbal suggestions for pain relief and pain increase, respectively. Expected pain and actual pain intensity were measured on a numerical rating scale (0-10). Placebo and nocebo effects were calculated as pain differences in open-hidden lidocaine and capsaicin, respectively, controlled for no treatment. Healthy participants obtained a placebo effect ( P = 0.01) and a trend for a nocebo effect ( P = 0.07). Patients with AD did not obtain a placebo effect ( P = 0.44) nor a significant nocebo effect ( P = 0.86). Healthy participants expected lower and higher pain with open vs hidden lidocaine and capsaicin, respectively ( P < 0.001). The same expectation effects were seen in patients with AD (open vs hidden lidocaine, P = 0.008; open vs hidden capsaicin, P < 0.001). With a well-controlled experimental setting, this study suggests that patients with AD may not experience placebo analgesia effects. Nocebo hyperalgesia effects in patients with AD needs further research. These findings may have implications for the conduction of clinical trials and the treatment of patients with AD in clinical practice.
Topics: Humans; Alzheimer Disease; Analgesia; Capsaicin; Healthy Volunteers; Hyperalgesia; Lidocaine; Nocebo Effect; Pain; Placebo Effect
PubMed: 37703397
DOI: 10.1097/j.pain.0000000000003035 -
Pain Jul 2024Previous research has indicated that an open-label placebo can reduce pain in both healthy participants and patients with chronic pain. Because nondeceptive placebos... (Randomized Controlled Trial)
Randomized Controlled Trial
Previous research has indicated that an open-label placebo can reduce pain in both healthy participants and patients with chronic pain. Because nondeceptive placebos seem to be an effective and more ethical alternative to deceptive placebos, optimizing this kind of treatment is essential. Observational learning was previously shown to induce the deceptive placebo effect; therefore, this study aimed to verify its effectiveness in fortifying the open-label placebo effect. Healthy volunteers (N = 117) were randomly assigned to 4 groups: open-label placebo with observational learning (OLP + OBL), open-label placebo (OLP), deceptive placebo with observational learning (OBL), or control group. Participants underwent baseline and testing measurements, during which they self-reported pain induced by heat stimulation. Between assessments, placebo cream was openly administered in the OLP and OLP + OBL groups. The OLP + OBL group next watched a model experiencing hypoalgesia after cream application. In the OBL group, participants received placebo cream with no information about its effect, and then they watched the model. The placebo effect was successfully evoked in all experimental groups (OLP + OBL, OLP, and OBL), which confirms the effectiveness of both open-label and deceptive placebo interventions for pain reduction. However, the hypoalgesic effect was of similar magnitude in the OLP and OLP + OBL groups, which indicates that observation did not contribute to the effect. The results showed that reinforcing the open-label placebo by observational learning may be redundant, but more research is needed to confirm these findings.
Topics: Humans; Male; Female; Placebo Effect; Adult; Young Adult; Pain Measurement; Pain Threshold; Learning; Adolescent; Pain; Placebos
PubMed: 38227574
DOI: 10.1097/j.pain.0000000000003161 -
The Lancet. Gastroenterology &... Apr 2024
Topics: Humans; Glutens; Nocebo Effect; Celiac Disease; Diet, Gluten-Free
PubMed: 38460538
DOI: 10.1016/S2468-1253(24)00035-9 -
Nutrition and Health Aug 2023The pink color enhances the perceived sweetness, increasing the individuals' expectation of the presence of sugar/carbohydrate in a beverage. Hence, it is plausible to...
The pink color enhances the perceived sweetness, increasing the individuals' expectation of the presence of sugar/carbohydrate in a beverage. Hence, it is plausible to speculate that providing a pink solution during exercise could induce an ergogenic benefit through a potential placebo effect. We examined whether ingesting a pink non-caloric, artificially sweetened solution can improve endurance strength exercise performance and psychological responses. Eighteen strength-trained individuals (34 ± 7 y; 1.74 ± 0.06 m; 79.86 ± 10.91 kg) completed three experimental trials in a randomized, single-blind, crossover counterbalanced fashion. In each trial, participants performed a 5-set strength endurance test at 70% of the one-repetition maximum in the bench press exercise, interspersed by 2 min. Before each set, participants ingested either a pink (PINK) or a transparent (TRANSP) non-caloric, artificially sweetened solution. A session without ingestion (CON) was also completed. Total number of repetitions and psychological responses such as motivation, emotional arousal, affect, and ratings of perceived exertion were obtained throughout the exercise protocol. Total repetitions improved in PINK (60 ± 12 reps) compared to TRANSP (= 0.03; 56 ± 10 reps; ES = 0.22; ±3.8%) and CON (= 0.01; 56 ± 9 reps; ES = 0.33; ±6.6%), but no difference occurred between TRANSP and CON (= 0.84; ES = 0.12; ±2.4%). Comparable responses were observed in motivation, emotional arousal, affect, and ratings of perceived exertion in PINK, TRANSP, and CON trials (all, > 0.05), despite the greater total physical work performed in PINK trial. Ingesting a pink non-caloric, artificially sweetened solution improved strength endurance performance with comparable psychological responses. These results have implications for future nutritional studies and performance assessments in real-world sports scenarios.
PubMed: 37608532
DOI: 10.1177/02601060231196590 -
Revista Da Associacao Medica Brasileira... 2024
Topics: Homeopathy; Humans; Placebo Effect; Evidence-Based Medicine
PubMed: 38716949
DOI: 10.1590/1806-9282.20231438 -
Menopause (New York, N.Y.) Nov 2023Whether dehydroepiandrosterone (DHEA) supplementation improves cognitive performance in older women is uncertain. Nonetheless, DHEA supplements are readily available...
IMPORTANCE
Whether dehydroepiandrosterone (DHEA) supplementation improves cognitive performance in older women is uncertain. Nonetheless, DHEA supplements are readily available over the counter in several countries and are potentially being used to prevent cognitive decline and dementia.
OBJECTIVE
This systematic review was conducted to evaluate the effect of exogenous DHEA on cognitive performance in postmenopausal women.
EVIDENCE REVIEW
Ovid MEDLINE, EMBASE, PsycINFO, Web of Science Core Collection, and the Cochrane Central Register of Controlled Trials databases were searched for studies of postmenopausal women until November 30, 2022. Eligible studies were required to be randomized clinical trials, be at least single blind, have a placebo or comparator arm and published in English. Risk of bias of the included studies was assessed by the revised Cochrane risk-of-bias tool.
FINDINGS
Of the 15 articles retrieved for full-text review, four met the inclusion criteria. In all studies DHEA was administered as a 50-mg oral daily dose and all were double blind with an identical placebo. Three were placebo-controlled, crossover studies and one was a parallel-group clinical trial. The only positive outcome was limited to a 4-wk cross-over study in which DHEA statistically significantly enhanced five of six tests of visual-spatial performance compared with placebo in 24 cognitively normal postmenopausal women. Improvement in cognitive performance with DHEA treatment over placebo group was not seen in any other study. Heterogeneity of design and use of multiple measures of cognitive performance was a barrier to meta-analysis and between study comparisons. The studies were limited by high risk of bias in multiple domains.
CONCLUSION AND RELEVANCE
Overall, this systematic review does not support a beneficial effect of DHEA therapy on cognitive performance in postmenopausal women.
Topics: Aged; Female; Humans; Cognition; Cognition Disorders; Cross-Over Studies; Dehydroepiandrosterone; Postmenopause; Randomized Controlled Trials as Topic; Single-Blind Method
PubMed: 37788418
DOI: 10.1097/GME.0000000000002251 -
World Journal of Diabetes Apr 2024Despite the advent of relatively reliable modalities of diagnosing diabetic peripheral neuropathy (DPN), such as nerve conduction studies, there is still a knowledge gap...
Despite the advent of relatively reliable modalities of diagnosing diabetic peripheral neuropathy (DPN), such as nerve conduction studies, there is still a knowledge gap about the pathophysiology, and thus limited available interventions for symptom control and curtailing disease progression. The pharmacologic aspect of management is mainly centred on pain control, however, there are several important aspects of DPN such as loss of vibration sense, pressure sense, and proprioception which are associated with risks to lower limb health, which pharmacotherapy does not address. Furthermore, published evidence suggests non-pharmacologic interventions such as glycaemic control through dietary modification and exercise need to be combined with other measures such as psychotherapy, to reach a desired, however modest effect. Acupuncture is emerging as an important treatment modality for several chronic medical conditions including neuropathic and other pain syndromes. In their study published in the on the potential of acupuncture to reduce DPN symptoms and enhance nerve conduction parameters, Hoerder have been able to demonstrate that acupuncture improves sensory function and that this effect is likely sustained two months after treatment cessation. Although previous studies also support these findings, larger multi-center randomized control trials including a sham-controlled arm accounting for a placebo effect are required. Overall, given the satisfactory safety profile and the positive results found in these studies, it is likely that acupuncture may become an important aspect of the repertoire of effective DPN management.
PubMed: 38680695
DOI: 10.4239/wjd.v15.i4.579 -
Alcohol and Alcoholism (Oxford,... Sep 2023N-acetyl cysteine (NAC) is a potent antioxidant that modulates glutamatergic signalling which is thought to play a role in alcohol use disorder (AUD). There have been no... (Randomized Controlled Trial)
Randomized Controlled Trial
N-acetyl cysteine (NAC) is a potent antioxidant that modulates glutamatergic signalling which is thought to play a role in alcohol use disorder (AUD). There have been no clinical trials investigating NAC for AUD. We aimed to conduct a 28 day double-blind, placebo-controlled (PL) randomized trial of NAC in the treatment of AUD (NCT03879759). A total of 42 participants with AUD (56% alcohol-related liver disease) were randomized to receive placebo or NAC 2400 mg/day. Feasibility outcomes included treatment retention and adverse events. Primary clinical outcomes included alcohol consumption (heavy drinking days, standard drinks per drinking day). Secondary clinical outcome measures included craving, liver tests, and psychological outcomes. There were no significant differences in overall retention between treatment groups (χ2(1) = 0.14, P = 0.71: 86% vs 76% for placebo and NAC, respectively). The most commonly reported adverse event in NAC-treated individuals included headache (14%). For standard drinks per drinking day, there was a significant overall effect of time (F = 9.18, P < 0.001), no significant effect of treatment (F = 0.75, P = 0.79), and a significant time x treatment (NAC vs PL) effect (F = 2.73, P < 0.05). For number of heavy drinks per day, there was a significant overall effect of time (F = 3.16, P < 0.05) but no significant effect of treatment or time x treatment (P = 0.17). There were no significant NAC vs PL effects on secondary clinical outcome measures. In the first trial of NAC for the management of AUD, NAC appears to be feasible and safe. Although there was a significant effect of NAC vs placebo on some alcohol measures such as drinks per drinking day, there does appear to be a variable pattern of effect across time suggesting that a larger trial incorporating a longer treatment duration is now required to determine efficacy.
Topics: Humans; Acetylcysteine; Alcoholism; Double-Blind Method; Treatment Outcome; Male; Female; Adult; Middle Aged; Aged
PubMed: 37465907
DOI: 10.1093/alcalc/agad044 -
British Journal of Pain Aug 2023Conditioning can be used to modulate the perception of pain, in the form of placebo and nocebo effects. Previous studies show inconsistent results as to whether...
INTRODUCTION
Conditioning can be used to modulate the perception of pain, in the form of placebo and nocebo effects. Previous studies show inconsistent results as to whether adolescents show similar, weaker, or non-significant conditioned placebo and nocebo effects compared to effects found in adults. There are suggestions that such differences (if any) may dependent on the cues used in the thermal conditioning paradigms. Therefore, in this current study, we utilized novel, neutral 3D-shaped visual cues to implicitly induce conditioned placebo-like and nocebo-like effects in adolescents and adults.
METHODS
During the conditioning paradigm, distinct cues (Fribbles) were paired with low and high temperatures in 24 adults and 20 adolescents (mean age = 25.5 years). In the testing phase, these conditioned cues as well as a neutral (unconditioned) cue were presented with moderate temperatures.
RESULTS
Thermal discomfort of moderate temperatures was lower when presented with the conditioned low heat cue (placebo-like effect) and higher when thermal stimuli were presented with the high heat cue (nocebo-like effect) compared to the neutral cue. The effects were driven by adults, as neither the placebo-like nor the nocebo-like effect was significant in adolescents. The difference between adolescents and adults was not explained by differences in temperature or discomfort levels, as adults and adolescents had comparable calibrated temperatures and levels of discomfort during heat stimuli.
CONCLUSION
Our findings suggest that thermal perception in adolescents is less influenced by conditioning to an engaging novel visual cue, compared to adults. Our work may have implications for better understanding the scope and limitations of conditioning as a key mechanism of placebo and nocebo effects in youth.
PubMed: 37538948
DOI: 10.1177/20494637231153364