Luana Colloca

Karolina A. Wartolowska

Martina Amanzio

The nocebo effect and its consequences for clinical trials and clinical practice

Franklin G. Miller

The defining circumstances and reasons for promoting healing processes based on placebo and avoiding (undesirable) nocebo effects in clinical practice represent a challenge for translational and patient-oriented medicine. Exploiting placebos and placebo effects for the benefit of the patient requires a rigorous evaluation of potential benefits and harms associated with these interventions. Moreover, any attempts to harness placebo benefits and mitigate nocebo effects in clinical practice should be done consistently with professional norms and integrity, and ethical-legal requirements of informed consent. This chapter systematically discusses the complex issue of professional and ethical requirements in using placebos and placebo effects in pain-related research and practices. Within this scope, some important questions need to be addressed as well: (a) Can placebo analgesic effects produce clinically significant benefits? (b) What translational research is being done, or should be done? (c) What work is being done in this area to enable and encourage doctors to incorporate ethically the concept of placebo and nocebo effects into their work?

Chapter 27. Placebo and Nocebo: Ethical Challenges and Solutions

Placebo and Pain

The observation that cognitive factors, such as beliefs, expectations and prior experiences, not only modulate the perception of pain but also the therapeutic benefit and adverse effects of pharmacologic treatments is not new. However, to date, the contribution of cognitive factors to pharmacotherapy is still poorly understood and far from being systematically exploited to maximize treatment outcome. This chapter gives an overview on the contribution of placebo and nocebo mechanisms to the outcome of analgesic treatments, insights into the neurobiologic mechanisms by which both factors combine or interact, and discusses implications for clinical care and the design of clinical studies.

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

Paul Enck

Katja Weimer

Seetal Dodd

Placebo and Nocebo Effects in Psychiatry and Beyond

Magne Arve Flaten

Karin Meissner

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 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

From Bench to Bedside

Ted J. Kaptchuk

The placebo effect is a fascinating but elusive phenomena. Although no standard definition of the placebo effect exists, it is generally understood as consisting of responses of individuals to the psychosocial context of medical treatments or clinical encounters, as distinct from specific physiological effects of medical interventions. The Placebo is the first book to compile a selection of classic and contemporary published articles on the topic. Systematic investigation of the placebo effect emerged in the 1950s in response to the development of randomized controlled clinical trials that used “inert” placebo interventions as a pivotal element of scientific evaluation of novel drugs. In recent years, scientific and scholarly investigation of the placebo effect has increased dramatically, reflecting a growing interest in the connection between mind and body with respect to health, the development of brain imaging techniques, dissatisfaction with the reductionist and technological orientation of biomedicine, and growing attention to the use of complementary and alternative medical treatments. The Placebo is organized into three sections: the nature and significance of the placebo effect, experimental studies of the placebo effect, and ethical issues of placebos in research and in clinical practice. This comprehensive sourcebook will be invaluable to investigators and scholars alike.

A Reader

The Placebo

Luana Colloca

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