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- Evers, AWM, et al.
(författare)
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Implications of Placebo and Nocebo Effects for Clinical Practice: Expert Consensus
- 2018
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Ingår i: Psychotherapy and psychosomatics. - : S. Karger AG. - 1423-0348 .- 0033-3190. ; 87:4, s. 204-210
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Tidskriftsartikel (refereegranskat)abstract
- <b><i>Background:</i></b> Placebo and nocebo effects occur in clinical or laboratory medical contexts after administration of an inert treatment or as part of active treatments and are due to psychobiological mechanisms such as expectancies of the patient. Placebo and nocebo studies have evolved from predominantly methodological research into a far-reaching interdisciplinary field that is unravelling the neurobiological, behavioural and clinical underpinnings of these phenomena in a broad variety of medical conditions. As a consequence, there is an increasing demand from health professionals to develop expert recommendations about evidence-based and ethical use of placebo and nocebo effects for clinical practice. <b><i>Methods:</i></b> A survey and interdisciplinary expert meeting by invitation was organized as part of the 1st Society for Interdisciplinary Placebo Studies (SIPS) conference in 2017. Twenty-nine internationally recognized placebo researchers participated. <b><i>Results:</i></b> There was consensus that maximizing placebo effects and minimizing nocebo effects should lead to better treatment outcomes with fewer side effects. Experts particularly agreed on the importance of informing patients about placebo and nocebo effects and training health professionals in patient-clinician communication to maximize placebo and minimize nocebo effects. <b><i>Conclusions:</i></b> The current paper forms a first step towards developing evidence-based and ethical recommendations about the implications of placebo and nocebo research for medical practice, based on the current state of evidence and the consensus of experts. Future research might focus on how to implement these recommendations, including how to optimize conditions for educating patients about placebo and nocebo effects and providing training for the implementation in clinical practice.
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- Evers, AWM, et al.
(författare)
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What Should Clinicians Tell Patients about Placebo and Nocebo Effects? Practical Considerations Based on Expert Consensus
- 2020
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Ingår i: Psychotherapy and psychosomatics. - : S. Karger AG. - 1423-0348 .- 0033-3190. ; 90:1, s. 49-56
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Tidskriftsartikel (refereegranskat)abstract
- <b><i>Introduction:</i></b> Clinical and laboratory studies demonstrate that placebo and nocebo effects influence various symptoms and conditions after the administration of both inert and active treatments. <b><i>Objective:</i></b> There is an increasing need for up-to-date recommendations on how to inform patients about placebo and nocebo effects in clinical practice and train clinicians how to disclose this information. <b><i>Methods:</i></b> Based on previous clinical recommendations concerning placebo and nocebo effects, a 3-step, invitation-only Delphi study was conducted among an interdisciplinary group of internationally recognized experts. The study consisted of open- and closed-ended survey questions followed by a final expert meeting. The surveys were subdivided into 3 parts: (1) informing patients about placebo effects, (2) informing patients about nocebo effects, and (3) training clinicians how to communicate this information to the patients. <b><i>Results:</i></b> There was consensus that communicating general information about placebo and nocebo effects to patients (e.g., explaining their role in treatment) could be beneficial, but that such information needs to be adjusted to match the specific clinical context (e.g., condition and treatment). Experts also agreed that training clinicians to communicate about placebo and nocebo effects should be a regular and integrated part of medical education that makes use of multiple formats, including face-to-face and online modalities. <b><i>Conclusions:</i></b> The current 3-step Delphi study provides consensus-based recommendations and practical considerations for disclosures about placebo and nocebo effects in clinical practice. Future research is needed on how to optimally tailor information to specific clinical conditions and patients’ needs, and on developing standardized disclosure training modules for clinicians.
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- Taneja, P, et al.
(författare)
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Modulation of experimental facial pain via somatosensory stimuli targeting sensations of different valence
- 2020
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Ingår i: Journal of Oral Rehabilitation. - : John Wiley & Sons. - 1365-2842 .- 0305-182X. ; 47:6, s. 720-730
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Tidskriftsartikel (refereegranskat)abstract
- BACKGROUND: Knowledge of pain modulation from orofacial somatosensory stimuli with different valence (pleasant-unpleasant) is limited.OBJECTIVES: To investigate: (1) The modulatory effects of painful, pleasant and unpleasant somatosensory stimuli on 2 models of experimental facial pain, (2) If modulation could be changed by blocking peripheral nerves via application of a local anesthetic: EMLA, or blocking endogenous opioid receptors via naltrexone, (3) If pain ratings were significantly correlated with participant psychological profiles.METHODS: 38 healthy women received experimental facial skin burning pain or jaw myalgia for four randomised sessions on different days. The painful region was stimulated with mechanical or thermal painful, pleasant, unpleasant and control stimuli, with ratings recorded before and during stimulation. Sessions differed in pre-treatment: EMLA/naltrexone/placebo tablet/cream.RESULTS: Significant effects of thermal or mechanical stimuli (P<0.017), but not session (P>0.102), were found on pain ratings for both models. In myalgia, painful cold resulted in a greater reduction in pain ratings than unpleasant cold, pleasant cold, control and pleasant warmth (P<0.004). Decreases in pain ratings from painful, unpleasant and pleasant mechanical stimuli was greater than control (P<0.002). In burning pain, painful cold resulted in a greater reduction in pain ratings than all but one of the other thermal stimuli (P<0.033). The pleasant mechanical stimulus reduced pain ratings more than all other mechanical stimuli (P≤0.003). There were no significant correlations between pain and psychometrics.CONCLUSION: Valence targeted thermal and mechanical stimuli modulated experimental myalgia and skin burning pain (P<0.017). Partially blocking peripheral afferents or opioid receptors did not affect modulation.
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- Wu, CZ, et al.
(författare)
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The Potential of Nano-Porous Surface Structure for Pain Therapeutic Applications: Surface Properties and Evaluation of Pain Perception
- 2020
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Ingår i: APPLIED SCIENCES-BASEL. - : MDPI AG. - 2076-3417. ; 10:13
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Tidskriftsartikel (övrigt vetenskapligt/konstnärligt)abstract
- The objective of this study was to evaluate the biomaterial properties of nano-modified surface acupuncture needles and the effect of such needles on human pain perception by using pressure pain threshold (PPT) measurements. It is known that changing a material’s surface nano-topography or nanostructure has strong effects on its physical, chemical, and biological surface properties. However, there is no information in the literature about the stimulation characteristics of acupuncture needles with nano-topography or nanostructured surfaces. Based on the knowledge on nanostructured surfaces, it may be possible to potentiate the effects of acupuncture needle stimulation. The pressure pain sensitivity of the masseter muscle in the orofacial region was studied in 21 healthy volunteers in two randomized, double-blinded sessions: an active session of manual acupuncture manipulation with nano-modified surface needles, and an inactive session of sham acupuncture stimulation to control for possible placebo effects. Three acupuncture points were selected from classical Chinese medicine literature: LI4 (Hegu) on the hand, ST6 (Jiache) on the lower masseter region, and ST7 (Xiaguan) on the upper masseter region. PPT measurements, perceived sensations, and pain from the acupuncture were recorded. The results showed discrete yet significant differences in PPT values between the active and inactive acupuncture treatments and significantly higher pain scores from active acupuncture stimulation than from sham acupuncture. These results indicate subtle but significant effects of acupuncture stimulation with nano-modified surface needles, compared to sham acupuncture in healthy participants.
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