Placebo and Pain

Placebo and Pain

From Bench to Bedside

1st Edition - August 28, 2013

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  • Editors: Luana Colloca, Magne Flaten, Karin Meissner
  • eBook ISBN: 9780123979315
  • Hardcover ISBN: 9780123979285

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Description

The placebo effect continues to fascinate scientists, scholars, and clinicians, resulting in an impressive amount of research, mainly in the field of pain. While recent experimental and clinical studies have unraveled salient aspects of the neurobiological substrates and clinical relevance of pain and placebo analgesia, an authoritative source remained lacking until now. By presenting and integrating a broad range of research, Placebo and Pain enhances readers’ knowledge about placebo and nocebo effects, reexamines the methodology of clinical trials, and improves the therapeutic approaches for patients suffering from pain. Review for Placebo and Pain:“This ambitious book is the first comprehensive and unified presentation of the placebo and nocebo phenomena in the area of pain. Written by the international leading experts in the field, the book provides an accurate up-to-date [work] on placebo and pain dealing with current perspectives and future challenging issues.”--Ted Kaptchuk, Associate Professor of Medicine, Harvard Medical School

Key Features

  • Contains historical aspects of the placebo effect
  • Discusses biological and psychological mechanisms of placebo analgesic responses
  • Reviews implications of the placebo effect for clinical research and pain management
  • Includes methodological and ethical aspects of the placebo effect

Readership

Researchers and graduate students in pain neuroscience, neurology, neurosurgery, pain management and anesthesiology

Table of Contents

  • Preface

    Contributors

    Chapter 1. Historical Aspects of Placebo Analgesia

    Abstract

    Introduction

    Definitions and Conceptualization

    Placebos as Controls

    Placebos as a Treatment

    Placebo in the Early 20th Century

    Placebo as More Than Just an Experimental Control

    The Emergence of the Study of Placebo Mechanisms

    Using History to Further Explore Placebo Analgesia

    References

    Chapter 2. Neurochemistry of Placebo Analgesia: Opioids, Cannabinoids and Cholecystokinin

    Abstract

    Introduction

    Some Types of Placebo Analgesia are Mediated by Endogenous Opioids

    Endocannabinoids are Involved in Some Types of Placebo Analgesia

    Nocebo Hyperalgesia is Mediated by Cholecystokinin

    Conclusions

    References

    Chapter 3. Placebo Analgesia in Rodents

    Abstract

    Acknowledgments

    Introduction

    The Placebo Effect in Animals

    Studying Placebo Analgesia in Animal Models

    Dissection of Placebo Analgesia in Mice

    Placebo Analgesia Affects the Behavioral Despair Tests in Mice

    The Opioid Receptors Involved in the Placebo Response in Rats

    The Pros and Cons of Studying Placebo in the Animal Model

    Conclusion and Future Directions

    References

    Chapter 4. Molecular Mechanisms of Placebo Responses in Humans

    Abstract

    Acknowledgments

    Introduction

    Placebo-Induced Activation of Regional Endogenous Opioid Neurotransmission

    Dopaminergic Mechanisms in the Formation of Placebo Analgesic Effects

    Theories of Placebo Analgesia and Placebo-Induced Activation of Regional Endogenous Opioid Neurotransmission

    Personality Predictors of Placebo-Induced Activation of Regional Endogenous Opioid Neurotransmission

    Conclusions

    References

    Chapter 5. How does EEG Contribute to Our Understanding of the Placebo Response?: Insights from the Perspective of Bayesian Inference

    Abstract

    Theoretical Models of Placebo Analgesia

    EEG Measures of Pain and its Anticipation

    Pain Anticipation and its Role in Pain Perception

    EEG Studies of Placebo Analgesia

    Conclusion

    References

    Chapter 6. Spinal Mechanisms of Placebo Analgesia and Nocebo Hyperalgesia: Descending Inhibitory and Facilitatory Influences

    Abstract

    Introduction

    Pain and Placebo have Dynamic Interactions

    Facilitatory Mechanisms

    Inhibitory Mechanisms

    Conclusion

    References

    Chapter 7. Spinal and Supraspinal Mechanisms of Placebo Analgesia

    Abstract

    Acknowledgments

    Introduction

    The Anatomy of Descending Pain Control

    Descending Control in Placebo Analgesia

    Placebo Analgesia and the Spinal Cord

    Conclusions and Open Questions

    References

    Chapter 8. Positive and Negative Emotions and Placebo Analgesia

    Abstract

    Emotion and Motivation

    Reduction in Negative Emotions: Methodologic Issues and Empirical Studies

    Individual Differences in Negative Emotions and the Effectiveness of Placebo Interventions on Pain

    Negative Emotions Reduce the Effectiveness of Opioids

    Placebo Analgesia, Emotions, and Opioid Activity

    The Nocebo Response: Negative Placebo Effect or Separate Process?

    Clinical Implications

    Conclusion and Future Perspectives

    References

    Chapter 9. Placing Placebo in Normal Brain Function with Neuroimaging

    Abstract

    Acknowledgments

    References

    Chapter 10. Brain Predictors of Individual Differences in Placebo Responding

    Abstract

    Acknowledgments

    Brain Predictors of Individual Differences in Placebo Responding

    Personality and Brain Predictors of Placebo Analgesia

    Limitations of Studies on Individual Differences in PA

    Solutions

    How Can Brain Imaging Studies Find Brain Predictors of PA? Recommendations and Conclusions

    References

    Chapter 11. Placebo Responses, Antagonistic Responses, and Homeostasis

    Abstract

    Placebo Responses and Homeostasis

    Theoretical Background

    Classical Conditioning and Pain

    Conditioning with Administration of Painkillers to Pain-Free Subjects

    Conditioning with the Administration of Painkillers as the Unconditioned Stimulus to Individuals in Pain

    Conditioning with Reduction in, or Absence of, Pain as the US

    Conditioning with an Increase in Pain as the US

    Active Placebo

    Compensatory Responses and the Nocebo Effect

    Summary and conclusions

    References

    Chapter 12. Placebo Analgesia, Nocebo Hyperalgesia, and Acupuncture

    Abstract

    Is Acupuncture a form of Placebo Treatment?

    Challenges and Issues in Placebo/Sham Acupuncture Studies

    Subjective and Objective Measurements in Acupuncture and Placebo Studies

    Contribution of Neuroimaging to Acupuncture and Placebo/Nocebo Response

    Summary and Future Directions

    References

    Chapter 13. The Relevance of Placebo and Nocebo Mechanisms for Analgesic Treatments

    Abstract

    Placebo and Nocebo in Pain Treatments: Behavioral Evidence

    Understanding the Neural Mechanisms Underlying the Effects of Expectation and Learning on Drug Efficacy

    Modulating Expectations to Optimize Analgesic Outcome

    Exploiting Learning Mechanisms to Optimize Analgesic Outcome

    Future Aims and Challenges

    Conclusion

    References

    Chapter 14. How Placebo Responses are Formed: From Bench to Bedside

    Abstract

    Acknowledgments

    Introduction

    Instructional Learning

    Associative Learning

    Social Learning

    Expectations

    Evolutionary Principles Behind Placebo Analgesia

    Conclusion

    Conflicts of Interest

    References

    Chapter 15. Methodologic Aspects of Placebo Research

    Abstract

    Acknowledgment

    Methodology of Studies Investigating Placebo Analgesia and Nocebo Hyperalgesia

    Induced Pain and Clinical Pain

    Quantification of Pain

    Response Bias

    Design

    Within-Subjects Versus Between-Subjects Designs

    The Pre-Test

    Researchers’ and Subjects’ Perception of the Treatment Allocation

    Single-Blind Versus Double-Blind Designs

    Induction of Placebo Analgesia by Classic Conditioning: Methodological Issues

    Measurement of Expectations

    Conclusion

    References

    Chapter 16. Balanced Placebo Design, Active Placebos, and Other Design Features for Identifying, Minimizing and Characterizing the Placebo Response

    Abstract

    Acknowledgment

    Introduction

    Minimize versus Maximize

    The ‘Additive Model’ Assumptions

    The Balanced Placebo Design

    The Balanced Cross-Over Design

    The ‘Delayed Response’ Test

    Active Placebos

    Effective Blinding

    No-Treatment and Waiting-List Controls

    The Free-Choice Paradigm

    Ethics of Placebo Research

    Summary

    References

    Chapter 17. Psychological Processes that can Bias Responses to Placebo Treatment for Pain

    Abstract

    Theoretical Model

    Demand Characteristics

    The Hawthorne Effect

    Response Shift

    Returning to the Theoretical Model

    Importance of Objective Outcomes

    Conclusions and Future Directions

    References

    Chapter 18. Against ‘Placebo.’ The Case for Changing our Language, and for the Meaning Response

    Abstract

    A Summary of the Argument

    A Brief Review of the Data

    Conclusions

    References

    Chapter 19. Placebo Effects in Complementary and Alternative Medicine: The Self-Healing Response

    Abstract

    Background

    Is CAM ‘All Placebo’? A Note on Specificity and the Efficacy Paradox

    Jerome D Frank’s Model of General Healing Effects or Common Factors in Therapy

    The Common Myth

    The Ritual

    Relationship and the Alleviation of Anxiety

    Insignia of Power

    Empowering Patients and Mobilizing Resources

    Summing Up: The Specificity of Nonspecific Effects and the Elegance of Reducing Side-Effects by ‘Placebo’

    References

    Chapter 20. Conceptualizations and Magnitudes of Placebo Analgesia Effects Across Meta-Analyses and Experimental Studies

    Abstract

    Acknowledgment

    Introduction

    Developments in the Conceptualizations and Definitions of Placebo Effects

    Meta-Analyses of Placebo Analgesia Effects

    Experimental Studies of Factors Influencing the Magnitude of Placebo Analgesia Effects

    Current Status of Meta-Analyses of the Magnitude of Placebo Analgesia Effects

    References

    Chapter 21. The Contribution of Desire, Expectation, and Reduced Negative Emotions to Placebo Anti-Hyperalgesia in Irritable Bowel Syndrome

    Abstract

    Acknowledgment

    Introduction

    Evidence for Visceral and Somatic Hyperalgesia in IBS Patients

    Visceral and Somatic Hyperalgesia is Dynamically Maintained by Tonic Peripheral Impulse Input

    Animal Models of Hyperalgesia in IBS

    Psychologic Contributions to Hyperalgesia and Anti-Hyperalgesia in IBS

    Central Nervous System Modulation of Pain in IBS

    Neurochemical Basis of Anti-Hyperalgesia in Placebo Anti-Hyperalgesic Mechanisms

    A Synergistic Interaction between Peripheral Impulse Input and Central Facilitation?

    References

    Chapter 22. The Wound that Heals: Placebo, Pain and Surgery

    Abstract

    Background

    Placebo and Brain Stimulation for the Treatment of Pain

    Conclusions

    References

    Chapter 23. What are the Best Placebo Interventions for the Treatment of Pain?

    Abstract

    Introduction

    The Efficacy Paradox

    Hypotheses from the Literature

    Evidence from Direct Comparisons

    Evidence from Indirect Comparisons

    Discussion

    Implications for Clinical Trial Methodology and Decision-Making

    Conclusions and Future Directions

    References

    Chapter 24. How Communication between Clinicians and Patients may Impact Pain Perception

    Abstract

    Introduction

    The Impact of Expectancy in Clinical Studies

    The Impact of Emotional Communication

    Promoting Patient Involvement and Common Ground: The Patient-Centered Interview

    Psychosocial Interventions in Pain Management

    Discussion and Conclusion; Suggestions for Future Research

    References

    Chapter 25. Nocebos in Daily Clinical Practice: The Potential Side Effects of the Treatment Context and the Patient–Doctor Interaction on Pain in Clinical Populations

    Abstract

    Introduction

    Beliefs About Illnesses and Medications

    Communicating a Diagnosis and Test Results

    Initiating a Treatment

    Treatment Implementation

    The Role of Treatment Experience

    Conclusions

    References

    Chapter 26. The Potential of the Analgesic Placebo Effect in Clinical Practice – Recommendations for Pain Management

    Abstract

    Acknowledgment

    Introduction

    Placebo Responses in Patients

    Comparison of Placebo Effects in Healthy Controls and Patients

    Use of Placebo Effects in Clinical Practice

    Placebo Analgesia: Interactions with Attitudes Towards Medication and Prior Experience

    Summary

    References

    Chapter 27. Placebo and Nocebo: Ethical Challenges and Solutions

    Abstract

    Acknowledgments

    Introduction

    Towards Placebos in Clinical Practice

    Clinicians’ Attitudes Towards Placebos

    Patients’ Attitudes Towards Placebos

    Placebos and the Declaration of Helsinki

    The Dilemma of Deception

    The Impact of the Clinician–Patient Relationship

    The Nocebo and its Implications for how Doctors Consult with their Patients

    What Translational Research is Being Done, or Should be Done?

    References

    Index

    Color Plates

Product details

  • No. of pages: 312
  • Language: English
  • Copyright: © Academic Press 2013
  • Published: August 28, 2013
  • Imprint: Academic Press
  • eBook ISBN: 9780123979315
  • Hardcover ISBN: 9780123979285

About the Editors

Luana Colloca

Affiliations and Expertise

National Institutes of Health, Bethesda, Maryland, USA

Magne Flaten

Professor of Biological Psychology and Depatment Chair of Psychology at the Norwegian University of Science and Technology, Dr. Flaten’s reserach focuses on biological psychology, psychology of learning, behavioral medicine, and pain. He serves as a board member for European Psychologist and European Journal of Behavior Analysis and served as Chair for the Organizing Committee of the International Conference on Imaging in Neuroscience 2007-2009. Dr. Flaten chaired the 2011 symposium on placebo and pain at the annual Society for Neuroscience meeting.

Affiliations and Expertise

Department of Psychology, University of Tromsø, Norway

Karin Meissner

Affiliations and Expertise

Institute of Medical Psychology, Ludwig-Maximilians-University Munich, Muenchen, Germany

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