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Psychiatria Danubina Jun 2014It is well-known that placebo is a substance without medical effects, which benefits the health status because of the patient's belief that the substance is effective... (Review)
Review
It is well-known that placebo is a substance without medical effects, which benefits the health status because of the patient's belief that the substance is effective and that the nocebo is defined as a substance without medical effects but which worsenes the health status of the person taking it by the negative beliefs and expectations of the patient. Starting with the history of the placebo effect and giving a review of the most significant studies reporting about the placebo effect from 1939-2013 it was our intention to give the all-around look on this phenomena discussing the neurobiological and other theories of its origin and concentrating especially on the field of psychiatry and finally coming to conclusions regarding the conductance of clinical trials and ethics. Regarding psychiatry, the placebo effect has a substantial role in most of psychiatric conditions including depression, anxiety, addictions, and contrary to what may have been expected, schizophrenia. Likewise, the nocebo effect is not to be neglected as the studies are being conducted to identify the factors causing it so it could be prevented.
Topics: History, 18th Century; History, 19th Century; History, 20th Century; History, 21st Century; Humans; Mental Disorders; Nocebo Effect; Placebo Effect; Placebos
PubMed: 24909245
DOI: No ID Found -
International Review of Neurobiology 2018Placebo and nocebo effects form part of all therapeutic environments and play a significant role in the effectiveness of treatment outcomes. Patient expectancies drive... (Review)
Review
INTRODUCTION
Placebo and nocebo effects form part of all therapeutic environments and play a significant role in the effectiveness of treatment outcomes. Patient expectancies drive these phenomena, which can be shaped through contextual factors including verbal suggestions, conditioning, and social observation.
OBJECTIVES
This review seeks to identify the biopsychosocial factors of the patient-practitioner interaction that play a role in the development of placebo and nocebo effects, as well as the anthropological elements of the biodynamic process of relating that are meaningful in the development of expectancies.
METHODS
We conducted a narrative review of frameworks of the placebo and nocebo effect, including the impact of expectancies and interpersonal relationships in the context of healing and the clinical setting.
RESULTS
Expectancies leading to placebo and nocebo effects can be modified by macro and micro factors, such as culture and society, as well as individual psychobiological traits, respectively. The developmental sociobiological adaptations that form and consolidate mindsets and meaningful contexts play an important role in shaping patient expectancies, as well as patients' conscious and subconscious reactions to signs and actions taking place within the clinical environment. Practitioner characteristics, like empathy, friendliness, and competence, favor the formation of positive expectancies. Caring and warm patient-practitioner interactions can enhance the therapeutic value of clinical encounters when patients' positive expectancies are actively encouraged and engaged.
CONCLUSION
A patient-centered approach rooted in demonstrating care and empathy can positively enhance a patient's experience within the clinical environment and activate psychosociobiological adaptations associated with the placebo phenomenon. Pain patients could particularly benefit from non-invasive approaches for improving treatment effectiveness and quality-of-life.
Topics: Anthropology; Emotions; Humans; Nocebo Effect; Physician-Patient Relations; Placebos; Psychology; Treatment Outcome
PubMed: 30146048
DOI: 10.1016/bs.irn.2018.07.033 -
The New England Journal of Medicine Jul 2015
Topics: Biomedical Research; Humans; Neurotransmitter Agents; Placebo Effect; Placebos; Synaptic Transmission
PubMed: 26132938
DOI: 10.1056/NEJMp1504023 -
International Review of Neurobiology 2020The placebo effect in many areas of neurological therapeutics is common and prominent. The importance of the response means that any new treatment must account for the... (Review)
Review
The placebo effect in many areas of neurological therapeutics is common and prominent. The importance of the response means that any new treatment must account for the placebo effect, but this in turn raises major challenges as to how to conduct scientifically meaningful research in an ethically acceptable fashion. Basic principles that may be in tension with one another are those of beneficence and respect for autonomy. It may be challenging to respect autonomy if the scientific design of a study depends upon the use of deception, but this is often mitigated by the information provided to trial participants as part of the informed consent process. Deception is a particular challenge if placebos are to be used in a clinical/therapeutic setting, outside the context of a clinical trial. While practice-based placebo use may on occasion be both beneficial and ethically acceptable, close attention must then be paid to ensuring that basic ethical principles are respected and that placebos are either prescribed in an open and honest fashion, or that any deception is authorized.
Topics: Deception; Ethics, Medical; Humans; Informed Consent; Nervous System Diseases; Placebo Effect; Placebos
PubMed: 32563286
DOI: 10.1016/bs.irn.2020.03.030 -
International Review of Neurobiology 2018The history of the placebo phenomenon is both interesting and informative. The placebo effect is a core component of health care, and if one considers a contemporary... (Review)
Review
The history of the placebo phenomenon is both interesting and informative. The placebo effect is a core component of health care, and if one considers a contemporary view of placebo effects, this has likely been the case for as long as records exist. An exploration of placebos and placebo effects across several centuries demonstrates many interesting facts, ranging from very early writings and experiments to the modern investigation of placebo mechanisms. A longitudinal review reveals the many challenges that have been faced, whether this is understanding what a placebo is, why it may work, and the meaning of such responses for routine clinical practice. At the core of this process are the concepts surrounding placebo, as these are imperative in the application of placebo to both routine clinical care and in the context of clinical trial design. This narrative review will look at the history of placebo, particularly key aspects over time, with a view to presenting a modern re-conceptualization of this field so as to facilitate ongoing scientific inquiry and to improve health care.
Topics: Animals; Biomedical Research; Clinical Trials as Topic; History, 18th Century; History, 19th Century; History, 20th Century; Humans; Placebo Effect; Placebos
PubMed: 30146043
DOI: 10.1016/bs.irn.2018.07.010 -
Neurological Sciences : Official... May 2006The placebo effect is the effect that follows the administration of an inert treatment (the placebo), be it pharmacological or not. It is important to understand that a... (Review)
Review
The placebo effect is the effect that follows the administration of an inert treatment (the placebo), be it pharmacological or not. It is important to understand that a placebo procedure simulates a therapy through the surrounding psychosocial context. Therefore, the study of the placebo effect is the study of the psychosocial context around the patient and its effects on the patient's brain. The real placebo response is a psychobiological phenomenon that can be due to different mechanisms, for example expectation and conditioning. Thus, there is not a single placebo effect but many, so that we have to look for different mechanisms in different conditions and in different systems and apparatuses. Today we are beginning to understand some of the neurobiological mechanisms of the placebo response, and this knowledge may help better understand the top-down control of the incoming sensory input, like pain, and the intricate interaction between mind and body.
Topics: Analgesia; Headache; Humans; Placebo Effect; Placebos
PubMed: 16688609
DOI: 10.1007/s10072-006-0580-4 -
International Review of Neurobiology 2020The placebo effect is a widely recognized phenomenon in clinical research, with a negative perception that it could hide the "true" drug effect. In clinical care its... (Review)
Review
The placebo effect is a widely recognized phenomenon in clinical research, with a negative perception that it could hide the "true" drug effect. In clinical care its positive potential to increase known drug effects has been neglected for too long. The placebo and nocebo responses have been described in many neurologic disorders such as Parkinson's, Huntington's and Alzheimer's diseases, restless leg syndrome, tics, essential tremor, dystonia, functional movement disorders, neuropathic pain, headaches, migraine, amyotrophic lateral sclerosis, myasthenia gravis, chronic inflammatory demyelinating polyneuropathy, multiple sclerosis and epilepsy. Knowledge regarding placebo mechanisms and their consequences on clinical outcome have greatly improved over the last two decades. This evolution has led to reconsiderations of the importance of placebo response in the clinic and has given several clues on how to improve it in daily practice. In this chapter, we first illustrate "why," e.g. the reasons (relevance to clinical practice, help in differential diagnosis/treatment of psychogenic movements, clinical impact, proven neurobiological grounds, health economic potential), and "how," e.g. the means (increase patients' knowledge, increase learning, improve patient-doctor relationship, increase Hawthorne effect, increase positive/decrease negative expectations (the Rosenthal effect), personalize placebo response), the placebo should be maximized (and nocebo avoided) in neurological clinical practice. Future studies regarding more specific neurobiological mechanisms will allow a finer tuning of placebo response in clinical practice. The use of placebo in clinical practice raises ethical issues, and a recent expert consensus regarding placebo use in the clinic is a first step to future guidelines necessary to this field.
Topics: Humans; Nervous System Diseases; Personality; Placebo Effect; Placebos
PubMed: 32563294
DOI: 10.1016/bs.irn.2020.04.003 -
QJM : Monthly Journal of the... Mar 1995
Review
Topics: Anti-Anxiety Agents; Attitude to Health; Conditioning, Psychological; Humans; Opioid Peptides; Pain Management; Placebo Effect; Placebos
PubMed: 7767672
DOI: No ID Found -
Deutsche Medizinische Wochenschrift... Dec 2020For a long time considered ineffective, placebos nowadays have an accepted role in studies as well as clinical practice. The identification of psychological as well as... (Review)
Review
For a long time considered ineffective, placebos nowadays have an accepted role in studies as well as clinical practice. The identification of psychological as well as neurophysiological mechanisms helped to conceptualize and legitimize the placebo effect. Moreover, studies have even proven a therapeutic value. Consequently, the benefits of a thoughtfully applied placebo effect are increasingly being exploited. This article reviews the concept and current understanding of the placebo effect and depicts its use in the field of pain management.
Topics: Humans; Pain; Pain Management; Placebo Effect; Placebos
PubMed: 33327015
DOI: 10.1055/a-1220-3712 -
Survey of Ophthalmology 1999Placebos have been traditionally regarded as deceptive therapies and have not been understood in the broader context of social symbols and of interpersonal factors that... (Review)
Review
Placebos have been traditionally regarded as deceptive therapies and have not been understood in the broader context of social symbols and of interpersonal factors that surround the healing process itself. Although the power of inert substances to heal is well recognized, the placebo effect also influences the outcome of conventional therapies. The role of the placebo in modern medicine is poorly defined because of a lack of a common understanding of what the placebo effect is and because of the negative connotions associated with its use. The response rate to placebo varies by illness. The natural course of disease and patient or physician bias can be misinterpreted as a placebo response. In research, the placebo effect is therapeutic noise to be removed by placebo-controlled trials. Few studies are designed to measure the placebo response rate directly. Placebos are a reminder of how little is known about mind-body interaction. The placebo effect may be one of the most versatile and underused therapeutic tools at the disposal of physicians.
Topics: Clinical Trials as Topic; Complementary Therapies; Eye Diseases; Humans; Ophthalmology; Placebo Effect; Placebos
PubMed: 10466586
DOI: 10.1016/s0039-6257(99)00060-0