Placebo analgesia: Clinical applications
| Autor: | Herta Flor, Regine Klinger, Ulrike Bingel, Luana Colloca |
|---|---|
| Rok vydání: | 2014 |
| Předmět: |
Expectancy theory
Psychotherapist business.industry Clinical study design Analgesic Medizin Psychological intervention Pain Context (language use) Placebo Effect Placebo Article Anesthesiology and Pain Medicine Neurology medicine Acupuncture Humans Learning Pain Management Anxiety Neurology (clinical) Analgesia medicine.symptom business |
| Zdroj: | Pain. 155:1055-1058 |
| ISSN: | 0304-3959 |
| Popis: | 1. IntroductionOver the past 15 years, research into analgesic placebo effectshas been intense, and several psychological and neurobiologicalmechanisms have been discovered [10]. Placebo analgesia occurswhen alterations in pain perception appear that exceed the specificeffect of the pain treatment, be it pharmacological, psychological,or physical. Neurobiological studies have revealed great similaritybetween the molecular basis of drug action and the related placeboresponse, suggesting that a placebo can partially replace the verumand enhance its effects as detailed in our previous review onneurobiological mechanisms [10]. Core psychological mechanismsinclude expectancy [33,39] and learning such as classical condi-tioning and social learning [6,11,32], and these processes closelyinteract [7,27] with emotions and motivations (eg, anxiety, desirefor relief), somatic focus, or cognitions (eg, attitudes toward thetreatment) [8,15,17,32,33,35,37,39]. In line with these findings,Benedetti et al. [4] suggested that the effect of analgesic medica-tion has 2 components: a pharmacological and a psychologicalcomponent. In this sense, the analgesic placebo effect can be con-sidered to be ‘‘additive,’’ supplementing pain management andenhancinganalgesic medication beyondits purely pharmacologicaleffect within ethical borders. However, placebo effects not only oc-cur in pharmacological interventions, but are part of any analgesictreatment and thus, also of psychological interventions, physicaltherapy, or alternative medicine applications.A number of meta-analyses have demonstrated the efficacy ofplacebo analgesia [37,38], however, high variance is apparent indifferent study designs [20,21,37,38]. Furthermore, long-lastingefficacy of placebos has been demonstrated for psychological treat-ments (eg, [16]) or acupuncture [19]. The modifiability of theanalgesic placebo response led to proposals to make better use ofit in clinical practice [15,26,32] to optimize treatment outcomeand to provide patients with an additional placebo-based benefit.Here we propose several approaches how to exploit placebo mech-anisms to improve pharmacological and nonpharmacological paininterventions in a more systematic manner than what naturally oc-curs in clinical settings.2. Enhancing expectancyThe placebo effect can be produced by instructions and theanticipatory expectancy of pain relief [25] in the context of theinteraction and communication between health practioners andpatients [23,29]. The strength and certainty of positive expectan-cies will influence the magnitude of the placebo effect by increas-ing self-control beliefs and attention to positive effects, which can,in turn, reduce anxiety and stress [36].Placebo effects in pain treatment can be enhanced by informingthe patients about placebo mechanisms and by explaining their ef-fects to them. Such an educational informative approach ought toexplain the placebo effect based on the models of classical condi-tioning and expectancy, but also its neurobiological bases, withoutoverstraining the patient [31] (eg, the therapist can inform aboutpharmacological and psychologicaleffects of analgesics, emphasizelearning and the fact that placebos alter neurobiological processessuch as opioid release). The analgesic placebo effect can be usefullyapplied to enhance the patient’s knowledge and self-managementcompetence. For example, if patients understand the basic princi-ples of the placebo effect, they can attempt to shape the contextof taking medication to optimize its administration (eg, takingmedication attentively with focus on taste, smell, and look of thedrug, rather than inattentively). They can examine their ownexpectancies toward the drug and seek out additional informationin order to improve their attitude to the drug. In addition, healthcare providers can shape the context in which therapeutic inter-ventions are given and can thus influence the outcome via maxi-mizing expectancy. Kaptchuk et al. [23] showed that placeboacupuncture combined with a positive therapeutic relationship |
| Databáze: | OpenAIRE |
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