scholarly journals Zsigeri fájdalom, nocebo-hatások, placebo-analgézia

2021 ◽  
Vol 2 (2) ◽  
pp. 227-237
Author(s):  
György Bárdos
Keyword(s):  
Placebo Group ◽  
Placebo Effect ◽  
Visceral Pain ◽  
Endogenous Opioids ◽  
Network Activity ◽  
Nocebo Effect ◽  
Top Down ◽  
Placebo Analgesia ◽  
Modification System ◽  
Nocebo Effects

Összefoglaló. A belső szervek működési zavarai gyakran származnak viselkedési, lelki vagy pszichoszociális okokból, amelyeknek nem mindig vagyunk tudatában. Minthogy ebben a folyamatban egy bonyolult neuronális hálózat játssza a fő szerepet, ezeknek a zavaroknak a diagnózisa és terápiája számos tényező manipulálását igényli. A funkcionális gyomor-bélhuzam rendellenességek (FGID), például az irritábilisbél-szindróma (IBS), jellemző példái ennek: olyan működési zavarokról van szó, amelyek mögött jól detektálható szervi vagy biokémiai elváltozásokat nem találnak. Ilyenkor szükségesnek tűnik a komplex megközelítés, amely többféle szakember együttműködését kívánja meg. Szerepe lehet a pszichés vagy életmód terápiának, a gyógyszeres és fizikai kezelésnek is, és – ahogy ebben a cikkben megmutatjuk – a placebo-terápiának is. Summary. Functional disorders of the internal organs frequently are results of behavioral, mental or psycho-social dysfunctions, although we are usually not conscious about it. A typical example isirritable bowel syndrome (IBS), a characteristic functional gastro-intestinal disorder (FGID), which is regularly accompanied by abdominal pain and irregular intestinal motility and defecation. It has been shown that this disorder cannot be due to a single factor, nor is it a result of a local cause. Recently researchers have proven that malfunction of a complicated neuronal network, including several brain sites, may be responsible for IBS. It is believed now that IBS is the consequence of several nocebo-effects. IBS is a typical source of visceral pain or discomfort, a source that is frequently difficult to identify. Main factors are stimuli originating from the gastro-intestinal tract, passing through the spinal cord and reaching several brain structures, including cortical and sub-cortical sites. It has been shown that some structures become thicker while others thinner as a result of lasting visceral pain, resulting in altered top-down effects on the visceral organs. Several hormones accompany these processes resulting in a complicated network activity. Recent research has revealed that IBS requires a complex approach, optimally provided by a therapeutic team of physicians, psychologist/psychiatrist, associates, and even the patient himself/herself. They may apply or suggest medicines, physiotherapy, lifestyle modifications, alimentary changes etc. An important feature is that the nocebo-effect plays an important role in the generation of IBS, thus one may think the opposite phenomenon, placebo-effect could be used in the therapeutic process. And really, placebo-analgesia is a method frequently used in the therapy of IBS. Placebo-analgesia affects brain processes, including pain processing, release of hormones, including endogenous opioids, the primary pain-decreasing factors. A top-down pain-modification system exists which can be affected and activated by the placebo-analgesia thus counteracting the nocebo-effects and improving the condition of the individual. The placebo phenomenon is interesting in itself, too. By now, the major question is not the existence of the placebo-effect but the mechanisms behind it. Recently, as brain-mapping techniques have gained their role in research, a lot of new information proves that the placebo-effect (as well as the nocebo-effect) is a complex phenomenon that involves several different brain sites, including the brain cortex and the limbic system, respectively.P The placebo-effect is widely used in clinical practice, first of all as a reference treatment when new drugs or medicines are tested for their effectivity. There are numerous ethical problems in this area, recently, for example, when testing Covid-19 vaccines. The main problem is whether it is legal to keep a non-treated population, whether the placebo-group should be treated immediately after the trial ends, whether the members of the placebo-group should get adequate information.

The molecular basis for the placebo effect

2018 ◽  
Author(s):  
Lesley Bromley
Keyword(s):  
Placebo Effect ◽  
Endogenous Opioids ◽  
Physiological Data ◽  
Therapeutic Action ◽  
Nocebo Effect ◽  
Placebo Analgesia ◽  
Major Review ◽  
Scientific Validation ◽  
Robust Evidence ◽  
Scientific Framework

The landmark paper discussed in this chapter is ‘The neurobiology of placebo analgesia: From endogenous opioids to cholecystokinin’, published by Benedetti and Amanzio in 1997. This major review considered the placebo and nocebo effect in a more scientific framework compared to previous treatise of a nebulous concept whose only role is to act as a comparator for controlled trials. By expounding robust evidence, Benedetti and Amanzio added credence to the placebo effect, with not just psychological but also physiological data, acknowledging it as an effective therapeutic action. Furthermore, the importance of endogenous opioids and cholecystokinin in the mechanism of placebo were put into sharp relief, giving an intuitive basis and scientific validation to this effect.

scholarly journals Placebo and nocebo effects in youth: subjective thermal discomfort can be modulated by a conditioning paradigm utilizing mental states of low and high self-efficacy

2021 ◽  
pp. 204946372110200
Author(s):  
Ella Weik ◽  
Regula Neuenschwander ◽  
Karin Jensen ◽  
Tim F Oberlander ◽  
Christine Tipper
Keyword(s):  
Placebo Effect ◽  
Self Efficacy ◽  
Group Analysis ◽  
Structured Interview ◽  
Thermal Stimulus ◽  
Nocebo Effect ◽  
Conditioning Paradigm ◽  
Significant Difference ◽  
Nocebo Effects ◽  
Subjective Discomfort

Introduction: Conditioning is a key mechanism of placebo and nocebo effects in adults, but little is known about these effects in youth. This study investigated whether personalized verbal cues evoking a sense of high or low self-efficacy can induce conditioned placebo and nocebo effects on subjective discomfort of noxious heat in youth. Methods: In a structured interview, 26 adolescents (13–18 years) described personal situations in which they experienced a sense of high, low or neutral self-efficacy. Participants were then asked to recall these memories during a conditioning paradigm, in which a high thermal stimulus applied to the forearm was repeatedly paired with a low self-efficacy cue and a low thermal stimulus with a high self-efficacy cue. In a testing phase, high, low and neutral self-efficacy cues were paired with the same moderate temperature. We hypothesized that conditioned high and low self-efficacy cues would induce conditioned placebo and nocebo responses to moderate temperatures. Results: Moderate temperatures were rated as more uncomfortable when paired with the conditioned low compared with the neutral self-efficacy cue (nocebo effect). While in the whole-group analysis, there was no significant difference between ratings of moderate thermal stimuli paired with high compared with neutral self-efficacy cues (placebo effect), a sub-group of participants with a greater range of emotional valence between high and neutral self-efficacy cues revealed a significant placebo effect. The strength of the nocebo effect was associated with higher anxiety and lower hope. Conclusion: Conditioned associations using internal self-efficacy states can change subjective discomfort of thermal sensations.

scholarly journals Unethical informed consent caused by overlooking poorly measured nocebo effects

2020 ◽  
pp. medethics-2019-105903
Author(s):  
Jeremy Howick
Keyword(s):  
Clinical Trials ◽  
Clinical Practice ◽  
Informed Consent ◽  
Natural History ◽  
Adverse Events ◽  
Placebo Effect ◽  
Nocebo Effect ◽  
Control Groups ◽  
Nocebo Effects ◽  
Negative Outcome

Unlike its friendly cousin the placebo effect, the nocebo effect (the effect of expecting a negative outcome) has been almost ignored. Epistemic and ethical confusions related to its existence have gone all but unnoticed. Contrary to what is often asserted, adverse events following from taking placebo interventions are not necessarily nocebo effects; they could have arisen due to natural history. Meanwhile, ethical informed consent (in clinical trials and clinical practice) has centred almost exclusively on the need to inform patients about intervention risks with patients to preserve their autonomy. Researchers have failed to consider the harm caused by the way in which the information is conveyed. In this paper, I argue that the magnitude of nocebo effects must be measured using control groups consisting of untreated patients. And, because the nocebo effect can produce harm, the principle of non-maleficence must be taken into account alongside autonomy when obtaining (ethical) informed consent and communicating intervention risks with patients.

scholarly journals Placebo effects in chronic pain conditions. Can placebo components enhance the efficacy of active treatments?

2016 ◽  
Vol 12 (23) ◽  
Author(s):  
Ina Skyt ◽  
Lene Vase
Keyword(s):  
Chronic Pain ◽  
Clinical Practice ◽  
Healthy Volunteers ◽  
Placebo Effect ◽  
Brain Activation ◽  
Review Literature ◽  
Endogenous Opioids ◽  
Placebo Effects ◽  
Placebo Analgesia ◽  
Chronic Pain Conditions

The conceptualization of the placebo phenomenon has changed. Previously placebo was seen as an inactive agent, but today placebo effects are viewed as related to patients’ perception of a treatment. During the last decades, the mechanisms underlying placebo analgesia effects have been specified and it has been shown that patients’ perception of a treatment is influenced by previous experiences, the patient-practitioner relationship as well as expectations and emotions. These factors are, in turn, associated with altered brain activation and release of endogenous opioids, thereby demonstrating that placebo analgesia has a psycho-neurobiological basis. The placebo effect has primarily been investigated in relation to healthy volunteers, but here we review literature on placebo mechanisms in relation to chronic pain states as this is important for an understanding of how placebo factors can be optimized in clinical practice. We outline some of the ethical discussions concerning the use of placebo in clinical practice and we illustrate how patients perception of a treatment contribute to the efficacy of active treatments, thereby showing how focus on patients perception of a treatment may help optimize the outcome of standard active pain treatments in ethically appropriate ways.

Placebo, nocebo, and contextual effects

2016 ◽  
Author(s):  
Abhishek Abhishek ◽  
Michael Doherty
Keyword(s):  
Placebo Effect ◽  
Contextual Effects ◽  
Symptomatic Improvement ◽  
Contextual Effect ◽  
Patient Specific ◽  
Nocebo Effect ◽  
Descending Inhibition ◽  
Placebo Analgesia ◽  
Negative Beliefs ◽  
Specific Factors

Placebo effect is an example of ‘contextual’ effect and is the symptomatic improvement experienced by patients who have unknowingly received a placebo (inactive treatment) instead of an active drug. It occurs due to patient-specific factors such as expectation of improvement and is influenced by the context in which the treatment is delivered. Nocebo effect is the opposite of placebo effect and includes worsening of symptoms or incident adverse effects due to expectancy or negative contextual or practitioner influence. Placebo effect has been demonstrated in a range of musculoskeletal conditions, including osteoarthritis (OA), as well as other conditions such as Parkinson’s disease, irritable bowel syndrome, and asthma. In OA, the placebo effect is strongest for subjective outcomes like pain. In fact, the effect size (ES) of placebo analgesia in OA clinical trials (0.51) is clinically significant and higher than the ES (defined by the additional improvement above placebo) obtained from non-pharmacological (0.25) and pharmacological (0.39) treatments. A number of patient- and intervention-specific and contextual factors influence the magnitude of placebo-induced improvements. Placebo analgesia is real, not a ‘trick of the mind’, and results from central mechanisms that increase descending inhibition of pain. Contextual effects are an integral part of everyday clinical practice. While patient- and intervention-specific determinants cannot be changed easily, healthcare practitioners should optimize the physician-specific factors that enhance positive contextual response and minimize nocebo response. Such a strategy that will increase the overall improvement is particularly relevant for OA where there is no ‘cure’ and a predominance of negative beliefs.

scholarly journals Associative learning and extinction of conditioned threat predictors across sensory modalities

2021 ◽  
Vol 4 (1) ◽  
Author(s):  
Laura. R. Koenen ◽  
Robert. J. Pawlik ◽  
Adriane Icenhour ◽  
Ljubov Petrakova ◽  
Katarina Forkmann ◽  
...  
Keyword(s):  
Visceral Pain ◽  
Neural Correlates ◽  
Imaging Studies ◽  
Somatic Pain ◽  
Healthy Humans ◽  
Sensory Modalities ◽  
The Face ◽  
Nocebo Effects ◽  
Conditioned Responses ◽  
Clinical Conditions

AbstractThe formation and persistence of negative pain-related expectations by classical conditioning remain incompletely understood. We elucidated behavioural and neural correlates involved in the acquisition and extinction of negative expectations towards different threats across sensory modalities. In two complementary functional magnetic resonance imaging studies in healthy humans, differential conditioning paradigms combined interoceptive visceral pain with somatic pain (study 1) and aversive tone (study 2) as exteroceptive threats. Conditioned responses to interoceptive threat predictors were enhanced in both studies, consistently involving the insula and cingulate cortex. Interoceptive threats had a greater impact on extinction efficacy, resulting in disruption of ongoing extinction (study 1), and selective resurgence of interoceptive CS-US associations after complete extinction (study 2). In the face of multiple threats, we preferentially learn, store, and remember interoceptive danger signals. As key mediators of nocebo effects, conditioned responses may be particularly relevant to clinical conditions involving disturbed interoception and chronic visceral pain.

S1807 Cognitive Coping Mechanism of Limbic/Paralimbic System in the Modulation of Placebo Analgesia in Visceral Pain: A 3t-fMRI Study

2008 ◽  
Vol 134 (4) ◽  
pp. A-273-A-274
Author(s):  
Hsueh-Chieh Lu ◽  
Ching-Liang Lu ◽  
David M. Niddam ◽  
Jen-Chuen Hsieh ◽  
Full-Young Chang ◽  
...  
Keyword(s):  
Visceral Pain ◽  
Coping Mechanism ◽  
Cognitive Coping ◽  
Placebo Analgesia ◽  
Fmri Study ◽  
Paralimbic System

Enhancing and Directing the Placebo Effect

2021 ◽  
Keyword(s):  
Placebo Group ◽  
Placebo Effect ◽  
The Body ◽  
Cure Rate ◽  
Phase 3 ◽  
The Real ◽  
French Physician

Phase 3 0f Pfizer’s covid vaccine contained 40,000 test subjects. 20,000 were given the real vaccine and 20,000 had their placebo (the ability of the body to heal itself) tricked into thinking that they got the real vaccine. After a while, they all were injected with the covid-19 virus. Only 95 out of 20,000 in the placebo group got ill. A French physician in the 1920’s treated his patients with self-hypnosis and had 98% cure rate. I believe that his method found a way to enhance and direct people’s placebo so that no medicine was needed.

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