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Review
, 139, 107-128

Clinical Use of Placebo Effects in Patients With Pain Disorders

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Review

Clinical Use of Placebo Effects in Patients With Pain Disorders

Regine Klinger et al. Int Rev Neurobiol.

Abstract

The analgesic placebo effect is well documented by numerous studies. Many important influencing factors, however, are yet to be discovered. In the arena of placebo effects and clinical implications, expectancies play a central role. Expectancies are shaped by processes of classical and social learning as well as verbal instructions and are strongly related to emotional factors. Expectancies trigger a cascade of endogenous opioids and non-opioids, which alter the experience of pain. For clinical application it is important to know, that placebo research yields ethical possibilities to use placebo effects without deception and without using placebos. Since placebo effects contribute to responses to active analgesics, it is feasible to enhance patients' benefits from pain treatments by increasing the additional placebo effect. There are several possibilities to use the placebo effects via shaping and adapting information about analgesic medication and via associating medication intake with a positive context. A positive patient-clinician communication atmosphere is very important to generate clinically meaningful placebo effects in pain medicine.

Keywords: Analgesic placebo effects; Clinical use; Expectancies; Mechanisms of placeboeffects; Pain; Pain disorders; Placebo effect; Placebo hypoalgesia.

Figures

Fig. 1
Fig. 1
If a pain reduction is yielded via both, a verum as well as a placebo, this is not a synonym for the existence of a placebo effect: A pain reduction via a placebo does not automatically indicate the true effectiveness of a placebo. The outcome could result from the natural course of the disease or spontaneous healing. A real placebo effect is the significant predominant difference between the level of pain reduction via a placebo and the pain level reported by a Natural History Group (NH).
Fig. 2
Fig. 2
Placebo analgesia occurs when alterations in pain perception appear that exceed the specific effect of the pain treatment, be it pharmacological, psychological, or physical. Placebo effects are mediated through expectation, which are modulated by a variety of psychological mechanisms including learning by instructions; learning by experience and social observational learning. These mechanisms trigger the endogenous release of opioids and non-opioids.

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