International review of neurobiology
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Int. Rev. Neurobiol. · Jan 2018
ReviewOptimizing Placebo and Minimizing Nocebo to Reduce Pain, Catastrophizing, and Opioid Use: A Review of the Science and an Evidence-Informed Clinical Toolkit.
Pain, a noxious psychosensory experience, motivates escape behavior to assure protection and survival. Psychological factors alter the experience and trajectory of pain, as well as behavior and treatment response. In the context of pain, the placebo effect (expectation for pain relief) releases endogenous opioids and facilitates analgesia from exogenously administered opioids. ⋯ Interventions that minimize nocebo and optimize placebo may adaptively shape the central nervous system toward pain relief and potentially opioid reduction. Here we provide a critical description of catastrophizing and its impact on pain, placebo and nocebo effects. We also consider the importance of minimizing nocebo and optimizing placebo effects during prescription opioid tapering, and offer a clinical toolkit of resources to accomplish these goals clinically.
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Int. Rev. Neurobiol. · Jan 2018
Nocebo Responses in Brain Diseases: A Systematic Review of the Current Literature.
Placebo is an intervention with no therapeutic effect that is used as a control in randomized controlled trials (RCTs). Placebo effects and responses can produce a beneficial effect that cannot be attributed to the properties of the intervention itself, since it is usually inactive, and should, therefore, be due to the patient's expectations about treatment (placebo effects), or confounding factors such as natural history, co-interventions, biases, among other co-factors (placebo responses). However, adverse events (AEs) may occur when using a placebo intervention, a phenomenon that is called nocebo. ⋯ Pooled dropout rates because of AEs in the placebo groups (i.e., nocebo dropout rates) vary from 2% in multiple sclerosis RCTs to almost 10% in PD RCTs. Across all brain disorders, the nature of AEs reported in the placebo-treated subjects mirrors those reported by active drug-treated subjects, suggesting that awareness of drug side-effect profiles might have influenced patient expectations and, thus, nocebo responses. Unexplored brain diseases where nocebo should be studied further include mental disorders (i.e., schizophrenia and bipolar disorder), vascular disorders (i.e., acute ischemic stroke, vascular dementia), degenerative disorders (i.e., frontotemporal dementia, Lewy body dementia) and other systemic atrophies of the brain (i.e., hereditary ataxias).