Psychobiological Mechanisms of Placebo and Nocebo Effects: Pathways to Improve Treatments and Reduce Side Effects

2019 ◽  
Vol 70 (1) ◽  
pp. 599-625 ◽  
Author(s):  
Keith J. Petrie ◽  
Winfried Rief

Placebo effects constitute a major part of treatment success in medical interventions. The nocebo effect also has a major impact, as it accounts for a significant proportion of the reported side effects for many treatments. Historically, clinical trials have aimed to reduce placebo effects; however, currently, there is interest in optimizing placebo effects to improve existing treatments and in examining ways to minimize nocebo effects to improve clinical outcome. To achieve these aims, a better understanding of the psychological and neurobiological mechanisms of the placebo and nocebo response is required. This review discusses the impact of the placebo and nocebo response in health care. We also examine the mechanisms involved in the placebo and nocebo effects, including the central mechanism of expectations. Finally, we examine ways to enhance placebo effects and reduce the impact of the nocebo response in clinical practice and suggest areas for future research.

Blood ◽  
2006 ◽  
Vol 108 (11) ◽  
pp. 5492-5492
Author(s):  
Jeff Horn ◽  
Ann T. Shaw

Abstract A significant proportion of individuals undergoing treatment for lymphoma are of working age and are in employment prior to diagnosis and during subsequent chemotherapy treatment. This small-scale study seeks to explore the impact that chemotherapy treatments have on employment. Specifically, the reasons for the decision to continue to work or not, and any perceived benefits or disadvantages encountered as a result are explored. Methods: All individuals presenting with newly diagnosed lymphoma, over a 12 month period, were identified retrospectively. Individuals of official working age, and who were receiving out-patient chemotherapy (i.e. who had the ability to be working at the time) were invited to participate. Participants were asked to complete a questionnaire that was designed to explore their experiences of employment during this time. Results: A total of 33 patients were invited to participate. A return rate of 70% was achieved. Of those who responded, 5 (22%) had already retired prior to diagnosis. A total of 12 patients (52%) continued to work during their chemotherapy treatment. Of these, 6 (50%) continued to work the same hours in the same conditions, whereas 6 (50%) worked an altered or flexible pattern. 6 patients (26%) stopped working for the duration of treatment, one of whom has not returned since. There were no obvious differences in patients with Hodgkin’s Lymphoma as opposed to Non-Hodgkin’s Lymphoma. The response rate was much higher in those who had received intravenous chemotherapy than oral preparations, preventing analysis of any potential variation in experiences. The qualitative data obtained gives a clearer insight into the many issues faced by the patient when undergoing chemotherapy treatment. Familiar themes were identified in many cases, and these were grouped into 5 main theme categories: Diversion from the reality of diagnosis and treatment Psychological Issues Issues of retained normality Practical Issues Physical or medical issues. Difficulty in coping with the side-effects of treatment, particularly fatigue, were commonly cited. Emotional effects such as stress and anxiety were also alluded to. Despite this, those who continued to work reported benefit from retaining a normal lifestyle, gained support from co-workers and experienced a diversion of focus from treatment. Several of those who continued to work cited financial reasons for this decision. Feedback suggested that advice given by the health-care team was often lacking or inconsistent. This did not reflect our perception of current practice, so it may suggest that it is the way that information is given that is ineffective. Conclusion: The majority of patients continued to work during their treatment and there appear to be many benefits to this. Difficulties encountered related mainly to treatment side-effects, logistical and practical problems associated with undergoing chemotherapy. It is envisaged that a greater understanding of the impact that lymphoma and its treatment has on employment may improve the level of support that can be offered by the multi-disciplinary team. The curative nature of many Lymphomas demands that long-term complications of the disease and treatment are fully addressed at the time of diagnosis. Social, economic and employment welfare are integral aspects to be considered, especially in a group of individuals who are likely to be long-term survivors.


2021 ◽  
Vol 36 (6) ◽  
pp. 1095-1095
Author(s):  
Nicholas S Lackey ◽  
Natasha Nemanim ◽  
Alexander O Hauson ◽  
Eric J Connors ◽  
Anna Pollard ◽  
...  

Abstract Objective A previous meta-analysis utilized the Trail Making Test A (TMT-A) to measure the impact of heart failure (HF) on attention. A near medium effect size with moderate heterogeneity was observed, the HF group performed worse than healthy controls (HC). This study explores if the age of the HF group moderates differences in the performance of individuals with HF versus HC on TMT-A. Data Selection Two researchers searched eight databases, extracted data, and calculated effect sizes as part of a larger study. Inclusion criteria were: (a) adults with HF (New York Heart Association severity II or higher), (b) comparison to a HC group, (c) standardized neuropsychological/cognitive testing, and (d) adequate data to calculate effect sizes. Exclusion criteria were: (a) participants had other types of major organ failure, (b) the article was not in English, or (c) there was a risk of sample overlap with another included study. A total of six articles were included in this sub-study (Total HF n = 602 and HC n = 342). The unrestricted maximum likelihood computational model was used for the meta-regression. Data Synthesis Studies included in the meta-regression evidenced a statistically significant medium effect size estimate with moderate heterogeneity (k = 6, g = 0.636, p < 0.001, I2 = 56.85%). The meta-regression was statistically significant (slope = −0.0515, p = 0.0016, Qmodel = 9.86, df = 1, p = 0.0016). Conclusions Individuals with HF performed worse on the TMT-A than HC. Age accounted for a significant proportion of the observed heterogeneity in the meta-regression. Future research should examine the relationship of age on cognition in individuals with HF.


2021 ◽  
pp. 1-7
Author(s):  
Michael W. Kirkwood ◽  
David R. Howell ◽  
Brian L. Brooks ◽  
Julie C. Wilson ◽  
William P. Meehan III

While placebo effects are well recognized within clinical medicine, “nocebo effects” have received much less attention. Nocebo effects are problems caused by negative expectations derived from information or treatment provided during a clinical interaction. In this review, we examine how nocebo effects may arise following pediatric concussion and how they may worsen symptoms or prolong recovery. We offer several suggestions to prevent, lessen, or eliminate such effects. We provide recommendations for clinicians in the following areas: terminology selection, explicit and implicit messaging to patients, evidence-based recommendations, and awareness of potential biases during clinical interactions. Clinicians should consider the empirically grounded suggestions when approaching the care of pediatric patients with concussion.


2020 ◽  
Vol 14 (6) ◽  
pp. 155798832097925
Author(s):  
Wellam F. Yu Ko ◽  
John L. Oliffe ◽  
Joan L. Bottorff

Prostate cancer is the most common malignancy diagnosed in North American men. Although medical advances have improved survival rates, men treated for prostate cancer experience side-effects that can reduce their work capacity, increase financial stress, and affect their career and/or retirement plans. Working-age males comprise a significant proportion of new prostate cancer diagnoses. It is important, therefore, to understand the connections between prostate cancer and men’s work lives. This scoping review aimed to summarize and disseminate current research evidence about the impact of prostate cancer treatment on men’s work lives. Electronic databases were searched to identify peer-reviewed articles published between 2006 and 2020 that reported on the impact of prostate cancer treatment on men’s work. Following scoping review guidelines, 21 articles that met inclusion criteria were identified and analyzed. Evidence related to the impact of prostate cancer on work was grouped under three themes: (1) work outcomes after prostate cancer treatment; (2) return to work considerations, and (3) impact of prostate cancer treatment on men’s finances. Findings indicate that men’s return to work may be more gradual than expected after prostate cancer treatment. Some men may feel pressured by financial stressors and masculine ideals to resume work. Diverse factors including older age and social benefits appear to play a role in shaping men’s work-related plans after prostate cancer treatment. The findings provide direction for future research and offer clinicians a synthesis of current knowledge about the challenges men face in resuming work in the aftermath of prostate cancer treatment.


2020 ◽  
Vol 29 (2) ◽  
pp. 236-245
Author(s):  
DIEN HO

Nocebo effects occur when an individual experiences undesirable physiological reactions caused by doxastic states that are not a treatment’s core or characteristic features.1 As Scott Gelfand2 points out, there are numerous studies that have shown that the disclosure of a treatment’s side effects to a patient increases the risk of the side effects. From an ethical point of view, nocebo effects caused by the disclosures of side effects present a challenging problem. On the one hand, clinicians’ duty to inform patients of the consequences (including possible side effects) of their treatments is critical in ensuring that patients’ autonomy is respected. Patients cannot act autonomously if relevant information is withheld from them (without their consent, perhaps). On the other hand, clinicians also ought to minimize harm to patients.


2015 ◽  
Vol 11 (01) ◽  
pp. 19 ◽  
Author(s):  
Martine T Puts ◽  
Brianne Tapscott ◽  
Margaret Fitch ◽  
Doris Howell ◽  
Johanne Monette ◽  
...  

Purpose:Cancer affects mostly older adults and although research has shown that a significant proportion of seniors do not receive treatment, little is known about the reasons why. Therefore, we conducted a systematic review of reasons why older adults accept or decline cancer treatments.Design:Systematic review of studies reporting on hypothetical cancer treatment scenarios in older patients published between inception of 10 databases and February 2013.Results:Of 17,343 abstracts reviewed, a total of 12 studies were included (sample size 21 to 511). The willingness to be treated varied by the benefits of treatment (ranging from never to always accepting the treatment), the particular side effects of treatment, and previous treatments received/previous treatment experiences (those who were treated previously were more likely to accept the same treatment). Results showed conflicting findings with regard to the impact of age, education (those with lower/higher age/education wanting more benefits before accepting), and family situation (no effect/those who were single were less likely to accept).Conclusion:Willingness among older adults to be treated was most influenced by the extent of benefits and side effects as well as prior treatment experiences. However, little is known about treatment preferences of the oldest old, those with multimorbidity, and preferences for newer agents.


2018 ◽  
Vol 21 (11) ◽  
pp. 1496-1505
Author(s):  
Phillipa K Reihana ◽  
Neville M Blampied ◽  
Julia J Rucklidge

Abstract Introduction Many smokers do not achieve abstinence using current smoking cessation options. This randomized controlled trial (RCT) investigated a novel nutritional supplement to assist with quitting smoking. Methods Following a baseline phase where cigarettes per day and nicotine dependence were measured, participants (n = 107) were randomized to placebo (n = 50) or micronutrient conditions (n = 57). A 4-week pre-quit phase permitted titration up to 12 capsules/day. During the quit phase (12 weeks), participants were registered with a public Quitline while consuming micronutrients or placebo. Carbon monoxide levels were measured to confirm smoking cessation. Results Forty-five (42%) participants completed the trial. Treatment and placebo groups did not differ on the primary outcome of continuous abstinence at 12 weeks using intention-to-treat analysis; however, 28% of the micronutrient-treated group had quit versus 18% for placebo (odds ratio [OR] = 1.78, 95% confidence interval [CI] = 0.71 to 4.48), with number needed to treat = 10. Comparison of cigarette consumption (cigarettes per day) between micronutrient and placebo groups showed that those taking micronutrients reported reduced consumption throughout the trial, notably at pre-quit weeks 1 and 4, and at quit phase week 4. There were no serious adverse events, blinding was successful, and there were no substantive group differences in side effects or dropout rate. Conclusion This is the first RCT investigating the impact of micronutrients on smoking reduction, finding that micronutrients reduced harm through reduction in number of cigarettes smoked relative to placebo. The small sample and high dropout rate limit confidence in the conclusions and generalizability of the study; however, assessed by number needed to treat, micronutrients are comparable to other smoking cessation treatments but with fewer side effects. Future research using larger and longer trials including cost-effectiveness and biomarker measures is encouraged. Implications Micronutrients are being increasingly studied for the treatment of psychiatric conditions, but direct application of micronutrients as a treatment for addictions is novel. There is extensive evidence that micronutrients alleviate stress. Given that tobacco smoking is often used to cope with stress, taking micronutrients may moderate the stress of withdrawal and increase the chance of a successful quit attempt. This study is the first known RCT to investigate the use of micronutrients to support smoking cessation. Treatments that are safe, effective, relatively inexpensive, and readily available are needed and micronutrient supplements offer one such possible alternative.


2018 ◽  
Vol 35 (1) ◽  
pp. 32-39 ◽  
Author(s):  
Sumitava Mukherjee ◽  
Arvind Sahay

Purpose This research aimed to find whether information about a product can give rise to negative perceptions even in inert situations (nocebo effects), and to understand how price levels impact such judgments. Design/methodology/approach In all experiments, participants were exposed to negative product information in the form of potential side-effects. In an initial study, a higher non-discounted versus a discounted price frame was presented for a health drink after customers were exposed to negative aspects. Then, in experiment 1, price (high vs low) and exposure to information (no information vs negative information) was manipulated for skin creams where participants physically evaluated the cream. In experiment 2, price was manipulated at three levels (low, high, discounted) orthogonally with product information (no negative information vs with negative information) to get a more nuanced understanding. Findings In the initial study, after exposure to negative information, the non-discounted group had more positive ratings for the drink. Study 1 showed that reading about negative information resulted in a nocebo effect on perception of dryness (side-effect). Moreover, when no information was presented, perception of dryness by low and high price groups were similar but in the face of negative information, perception of dryness by low-price group was more pronounced compared to a high-price group. Study 2 conceptually replicated the effect and also confirmed that not only discounts (commonly linked with product quality), but absolute price levels also show a similar effect. Practical implications Nocebo effects have been rarely documented in consumer research. This research showed how simply reading generically about potential side effects gives rise to nocebo effects. In addition, even though marketers might find it tempting to lower prices when there is negative information about certain product categories, such an action could backfire. Originality/value To the best of our knowledge, the link between observable nocebo effects and its link with pricing actions is a novel research thread. We were able to show a nocebo effect on product perception after reading about negative information and also find that a higher price can mitigate the nocebo effect to some extent.


Soil Research ◽  
2002 ◽  
Vol 40 (3) ◽  
pp. 397 ◽  
Author(s):  
Cuan Petheram ◽  
Glen Walker ◽  
Rodger Grayson ◽  
Tomas Thierfelder ◽  
Lu Zhang

This work investigated the potential for developing generic relationships from measurements of recharge made in previous studies that would allow the assessment of the impact of land-use change on recharge. Forty-one studies that measured recharge from across Australia were reviewed to generate a database. Studies were characterised on the basis of broad soil type (sand or non-sand), land-use/vegetation (annual, perennial, or trees), and annual rainfall. Attempts to develop quantitative recharge relationships met with limited success because of the limited geographical coverage of the studies, lack of details on the study sites, and high variability in the data. Nevertheless, the following relationships for annual vegetation were statistically valid: Ln(recharge) = –19.03 + 3.63 ln(rainfall) [for sandy soils]; F(1, 96) = 149.03; R2 = 0.60 Ln(recharge) = –12.65 + 2.41 ln(rainfall) [for non-sandy soils]; F(1,151) = 46.87; R2 = 0.23 The low degree of explanation of rainfall for the annual non-sand data suggests that it is likely that soil structure becomes more important for higher clay content soils. Recharge under trees was negligible compared with that under annuals. These relationships should not be used in areas such as those where: preferential pathway flow is the dominant recharge mechanism, rainfall is summer dominant, lateral hydraulic gradients are high, water holding capacities are very low, or there are fresh, high-yielding aquifers. Collectively, the results show that: (1) rainfall explains a significant proportion of the observed recharge variation; (2) there is a significant difference between mean recharge under trees and annual vegetation; (3) there is a significant difference between mean recharge under annual vegetation on sand soils and non-sand soils; (4) the land-use groups had a greater influence on recharge than the broad soil groups used in this study; (5) there is a lack of annual recharge measurements under perennial pastures/crops, under trees in high rainfall zones (i.e. >600 mm/year) and in areas of summer dominant rainfall; (6) across a broad range of locations, recharge is higher under shallow-rooted annual vegetation than deep-rooted vegetation; and (7) the estimator of Zhang et al. (1999) for 'excess water' may provide a useful indication of the upper limit to the long-term average recharge measurements. Large variation in the data resulted from disparity in the recharge techniques used, the coarse soil categories used, failure to account for land management factors, and complications due to macropores and shallow water tables. It is proposed that the value of the information presented here may be enhanced in future studies by incorporating information from qualitative studies, particularly paired-site studies, and by drawing information from unsaturated zone and groundwater modelling studies, particularly comparisons of different land-uses at similar locations. Furthermore, the results of this study can be used to identify gaps in knowledge and, hence, target areas for future research such as annual recharge measurements beneath perennial vegetation. dryland salinity, groundwater management, deep drainage.


2020 ◽  
Vol 29 (4) ◽  
pp. 2097-2108
Author(s):  
Robyn L. Croft ◽  
Courtney T. Byrd

Purpose The purpose of this study was to identify levels of self-compassion in adults who do and do not stutter and to determine whether self-compassion predicts the impact of stuttering on quality of life in adults who stutter. Method Participants included 140 adults who do and do not stutter matched for age and gender. All participants completed the Self-Compassion Scale. Adults who stutter also completed the Overall Assessment of the Speaker's Experience of Stuttering. Data were analyzed for self-compassion differences between and within adults who do and do not stutter and to predict self-compassion on quality of life in adults who stutter. Results Adults who do and do not stutter exhibited no significant differences in total self-compassion, regardless of participant gender. A simple linear regression of the total self-compassion score and total Overall Assessment of the Speaker's Experience of Stuttering score showed a significant, negative linear relationship of self-compassion predicting the impact of stuttering on quality of life. Conclusions Data suggest that higher levels of self-kindness, mindfulness, and social connectedness (i.e., self-compassion) are related to reduced negative reactions to stuttering, an increased participation in daily communication situations, and an improved overall quality of life. Future research should replicate current findings and identify moderators of the self-compassion–quality of life relationship.


Sign in / Sign up

Export Citation Format

Share Document