1
|
Wilhelm M, Hermann C, Rief W, Schedlowski M, Bingel U, Winkler A. Working with patients' treatment expectations - what we can learn from homeopathy. Front Psychol 2024; 15:1398865. [PMID: 38860049 PMCID: PMC11163137 DOI: 10.3389/fpsyg.2024.1398865] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/11/2024] [Accepted: 05/13/2024] [Indexed: 06/12/2024] Open
Abstract
The usual homeopathic remedy, "globules," does not contain any pharmacologically active ingredient. However, many patients and practitioners report beneficial effects of homeopathic treatment on various health outcomes. Experimental and clinical research of the last two decades analyzing the underlying mechanisms of the placebo effect could explain this phenomenon, with patients' treatment expectations as the predominant mechanism. Treatment expectations can be optimized through various factors, such as prior information, communication, and treatment context. This narrative review analyses how homeopathy successfully utilizes these factors. Subsequently, it is discussed what evidence-based medicine could learn from homeopathic practice to optimize treatment expectations (e.g., using an empathic, patient-centered communication style, deliberately selecting objects in practice rooms, or using clear treatment rituals and salient contextual stimuli) and thereby treatment effectiveness. Homeopathic remedy does not work beyond the placebo effect but is recommended or prescribed as an active treatment by those who believe in it. Thus, practitioners need to understand the manner in which homeopathy (as an example of inert treatment) works and are advised to reintegrate its underlying effective placebo mechanisms into evidence-based medicine. This promises to increase treatment efficacy, tolerability, satisfaction, and compliance with evidence-based treatments, and addresses the desires patients are trying to satisfy in homeopathy in an ethical, fully informed way that is grounded in evidence-based medicine.
Collapse
Affiliation(s)
- Marcel Wilhelm
- Department of Clinical Psychology, Philipps-University Marburg, Marburg, Germany
| | - Christiane Hermann
- Department of Clinical Psychology, Justus-Liebig-University Giessen, Giessen, Germany
| | - Winfried Rief
- Department of Clinical Psychology, Philipps-University Marburg, Marburg, Germany
| | - Manfred Schedlowski
- Institute of Medical Psychology and Behavioral Immunobiology, University Clinic Essen, Essen, Germany
- Department of Clinical Neuroscience, Osher Center for Integrative Medicine, Karolinska Institutet, Stockholm, Sweden
| | - Ulrike Bingel
- Department of Neurology, Center for Translational Neuro-and Behavioral Sciences, University Medicine Essen, Essen, Germany
- Translational Pain Research Unit, University Medicine Essen, Essen, Germany
| | - Alexander Winkler
- Department of Clinical Psychology, Justus-Liebig-University Giessen, Giessen, Germany
| |
Collapse
|
2
|
Gambazza S, Mariani A, Guarise R, Ferrari B, Carta F, Brivio A, Bizzarri S, Castellani C, Colombo C, Laquintana D. Short-term effects of positive expiratory pressure mask on ventilation inhomogeneity in children with cystic fibrosis: A randomized, sham-controlled crossover study. Pediatr Pulmonol 2024; 59:1354-1363. [PMID: 38362833 DOI: 10.1002/ppul.26915] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/02/2023] [Revised: 12/23/2023] [Accepted: 01/31/2024] [Indexed: 02/17/2024]
Abstract
BACKGROUND Can physiotherapy with a positive expiratory pressure (PEP) mask improve peripheral ventilation inhomogeneity, a typical feature of children with cystic fibrosis (cwCF)? To answer this question, we used the nitrogen multiple-breath washout (N2MBW) test to measure diffusion-convection-dependent inhomogeneity arising within the intracinar compartment (Sacin*VT). METHODS For this randomized, sham-controlled crossover trial, two N2MBW tests were performed near the hospital discharge date: one before and the other after PEP mask therapy (1 min of breathing through a flow-dependent PEP device attached to a face mask, followed by three huffs and one cough repeated 10 times) by either a standard (10-15 cmH20) or a sham (<5 cmH20) procedure on two consecutive mornings. Deception entailed misinforming the subjects about the nature of the study; also the N2MBW operators were blinded to treatment allocation. Study outcomes were assessed with mixed-effect models. RESULTS The study sample was 19 cwCF (ten girls), aged 11.4 (2.7) years. The adjusted Sacin*VT mean difference between the standard and the sham procedure was -0.015 (90% confidence interval [CI]: -∞ to 0.025) L-1. There was no statistically significant difference in Scond*VT and lung clearance index between the two procedures: -0.005 (95% CI: -0.019 to 0.01) L-1 and 0.49 (95% CI: -0.05 to 1.03) turnovers, respectively. CONCLUSION Our findings do not support evidence for an immediate effect of PEP mask physiotherapy on Sacin*VT with pressure range 10-15 cmH20. Measurement with the N2MBW and the crossover design were found to be time-consuming and unsuitable for a short-term study of airway clearance techniques.
Collapse
Affiliation(s)
- Simone Gambazza
- Healthcare Professions Department, Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico, Milan, Italy
| | - Alessandra Mariani
- Cystic Fibrosis Centre, Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico, Milan, Italy
| | - Riccardo Guarise
- Cystic Fibrosis Centre, University Hospital of Verona, Verona, Italy
| | - Beatrice Ferrari
- Rehabilitation Unit, Meyer Children's Hospital IRCCS, Florence, Italy
| | - Federica Carta
- Cystic Fibrosis Centre, Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico, Milan, Italy
| | - Anna Brivio
- Healthcare Professions Department, Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico, Milan, Italy
| | - Sofia Bizzarri
- Rehabilitation Unit, Meyer Children's Hospital IRCCS, Florence, Italy
| | - Chiara Castellani
- Rehabilitation Unit, Meyer Children's Hospital IRCCS, Florence, Italy
| | - Carla Colombo
- Cystic Fibrosis Centre, Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico, Milan, Italy
- Department of Pathophysiology and Transplantation, Università degli Studi di Milano, Milan, Italy
| | - Dario Laquintana
- Healthcare Professions Department, Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico, Milan, Italy
| |
Collapse
|
3
|
Jacob C, Olliges E, Haile A, Hoffmann V, Jacobi B, Steinkopf L, Lanz M, Wittmann M, Tschöp MH, Meissner K. Placebo effects on nausea and motion sickness are resistant to experimentally-induced stress. Sci Rep 2023; 13:9908. [PMID: 37336972 DOI: 10.1038/s41598-023-36296-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/31/2022] [Accepted: 05/31/2023] [Indexed: 06/21/2023] Open
Abstract
Nausea often occurs in stressful situations, such as chemotherapy or surgery. Clinically relevant placebo effects in nausea have been demonstrated, but it remains unclear whether stress has an impact on these effects. The aim of this experimental study was to investigate the interplay between acute stress and placebo effects in nausea. 80 healthy female volunteers susceptible to motion sickness were randomly assigned to either the Maastricht Acute Stress Test or a non-stress control condition, and to either placebo treatment or no treatment. Nausea was induced by a virtual vection drum and behavioral, psychophysiological as well as humoral parameters were repeatedly assessed. Manipulation checks confirmed increased cortisol levels and negative emotions in the stressed groups. In the non-stressed groups, the placebo intervention improved nausea, symptoms of motion sickness, and gastric myoelectrical activity (normo-to-tachy (NTT) ratio). In the stressed groups, the beneficial effects of the placebo intervention on nausea and motion sickness remained unchanged, whereas no improvement of the gastric NTT ratio was observed. Results suggest that placebo effects on symptoms of nausea and motion sickness are resistant to experimentally-induced stress. Stress most likely interfered with the validity of the gastric NTT ratio to measure nausea and thus the gastric placebo effect.
Collapse
Affiliation(s)
- Carmen Jacob
- Institute of Medical Psychology, Medical Faculty, LMU Munich, 80336, Munich, Germany
- Wessex Neurological Centre, University Hospital Southampton and Clinical Neurosciences, Clinical and Experimental Sciences, Faculty of Medicine, University of Southampton, Southampton General Hospital, Southampton, SO16 6YD, UK
| | - Elisabeth Olliges
- Institute of Medical Psychology, Medical Faculty, LMU Munich, 80336, Munich, Germany
- Department of Psychosomatic Medicine and Psychotherapy, Klinik Barmelweid AG, 5017, Barmelweid, Switzerland
- Division of Health Promotion, Coburg University of Applied Sciences and Arts, Friedrich-Streib-Str. 2, 96450, Coburg, Germany
| | - Anja Haile
- Institute of Medical Psychology, Medical Faculty, LMU Munich, 80336, Munich, Germany
| | - Verena Hoffmann
- Institute of Medical Psychology, Medical Faculty, LMU Munich, 80336, Munich, Germany
| | - Benjamin Jacobi
- Institute of Medical Psychology, Medical Faculty, LMU Munich, 80336, Munich, Germany
- Department of Psychiatry, University of Connecticut Health Center, H1010, Farmington, CT, 06030-1410, USA
| | - Leander Steinkopf
- Institute of Medical Psychology, Medical Faculty, LMU Munich, 80336, Munich, Germany
| | - Marina Lanz
- Institute of Medical Psychology, Medical Faculty, LMU Munich, 80336, Munich, Germany
| | - Marc Wittmann
- Institute for Frontier Areas of Psychology and Mental Health, 79098, Freiburg, Germany
| | - Matthias H Tschöp
- Institute for Diabetes and Obesity, Helmholtz Diabetes Center, Helmholtz Zentrum München, 85764, Neuherberg, Germany
- Division of Metabolic Diseases, Department of Medicine, Technische Universität München, 81675, Munich, Germany
| | - Karin Meissner
- Institute of Medical Psychology, Medical Faculty, LMU Munich, 80336, Munich, Germany.
- Division of Health Promotion, Coburg University of Applied Sciences and Arts, Friedrich-Streib-Str. 2, 96450, Coburg, Germany.
| |
Collapse
|
4
|
Fernandes A, David C, Pinto FJ, Costa J, Ferreira JJ, Caldeira D. The effect of catheter-based sham renal denervation in hypertension: systematic review and meta-analysis. BMC Cardiovasc Disord 2023; 23:249. [PMID: 37173636 PMCID: PMC10182607 DOI: 10.1186/s12872-023-03269-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/13/2022] [Accepted: 04/27/2023] [Indexed: 05/15/2023] Open
Abstract
BACKGROUND Renal denervation (RDN) has emerged in recent years as a possible treatment for hypertension. The first sham-controlled trial showed a small magnitude and non-significant in the blood pressure (BP) lowering effect, also due to a substantial decrease of BP in sham arm. Considering this, we aimed to quantify the magnitude of BP decrease within the sham arm of Randomized Controlled Trials (RCT) with RDN in patients with hypertension. METHODS Electronic databases were searched since inception until January 2022 for randomized sham-controlled trials which assessed the efficacy in lowering BP of the sham intervention for catheter-based RDN in adult patients with hypertension. The outcomes were change in ambulatory/office systolic and diastolic BP. RESULTS A total of 9 RCT were included in the analysis enrolling a total of 674 patients. Sham intervention showed a decrease in all evaluated outcomes. Office systolic BP had a reduction of -5.52 mmHg [95%CI -7.91, -3.13] and office diastolic BP of -2.13 mmHg [95%CI -3.08, -1.17]. Sham procedure for RDN also showed a reduction of -3.41 mmHg [95%CI -5.08, -1.75] in ambulatory systolic BP and - 2.44 mmHg [95%CI -3.31, -1.57] in ambulatory diastolic BP. CONCLUSION Despite recent data indicating that RDN might be an effective treatment for patients with resistant hypertension when compared to a sham intervention, our results indicate that the sham intervention for RDN also has a significant effect on lowering Office and Ambulatory (24-h) Blood Pressure in adult patients with hypertension. This highlights that BP itself might be sensitive to placebo-like effect and also brings further difficulties in establishing the BP lowering efficacy of invasive interventions due to the magnitude of the sham effect.
Collapse
Affiliation(s)
| | - Cláudio David
- Laboratory of Clinical Pharmacology and Therapeutics, Faculdade de Medicina, Universidade de Lisboa, Lisbon, Portugal
- Instituto de Medicina Molecular, Faculdade de Medicina, Universidade de Lisboa, Lisbon, Portugal
- Faculdade de Medicina, Centro Cardiovascular da Universidade de Lisboa (CCUL@RISE), Universidade de Lisboa, Lisbon, Portugal
| | - Fausto J Pinto
- Faculdade de Medicina, Centro Cardiovascular da Universidade de Lisboa (CCUL@RISE), Universidade de Lisboa, Lisbon, Portugal
- Cardiology Department, Hospital Santa Maria, Centro Hospitalar Univesitário Lisboa Norte (CHULN), Centro Académico de Medicina de Lisboa (CAML), Lisbon, Portugal
| | - João Costa
- Laboratory of Clinical Pharmacology and Therapeutics, Faculdade de Medicina, Universidade de Lisboa, Lisbon, Portugal
- Instituto de Medicina Molecular, Faculdade de Medicina, Universidade de Lisboa, Lisbon, Portugal
| | - Joaquim J Ferreira
- Laboratory of Clinical Pharmacology and Therapeutics, Faculdade de Medicina, Universidade de Lisboa, Lisbon, Portugal
- Instituto de Medicina Molecular, Faculdade de Medicina, Universidade de Lisboa, Lisbon, Portugal
| | - Daniel Caldeira
- Laboratory of Clinical Pharmacology and Therapeutics, Faculdade de Medicina, Universidade de Lisboa, Lisbon, Portugal.
- Faculdade de Medicina, Centro Cardiovascular da Universidade de Lisboa (CCUL@RISE), Universidade de Lisboa, Lisbon, Portugal.
- CNS - Campus Neurológico Sénior, Torres Vedras, Portugal.
- CEMBE (Centro de Estudos de Medicina Baseada na Evidência, Faculdade de Medicina da Universidade de Lisboa, Lisboa, Portugal.
| |
Collapse
|
5
|
Do Sports Compression Garments Alter Measures of Peripheral Blood Flow? A Systematic Review with Meta-Analysis. Sports Med 2023; 53:481-501. [PMID: 36622554 DOI: 10.1007/s40279-022-01774-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 10/01/2022] [Indexed: 01/10/2023]
Abstract
BACKGROUND One of the proposed mechanisms underlying the benefits of sports compression garments may be alterations in peripheral blood flow. OBJECTIVE We aimed to determine if sports compression garments alter measures of peripheral blood flow at rest, as well as during, immediately after and in recovery from a physiological challenge (i.e. exercise or an orthostatic challenge). METHODS We conducted a systematic literature search of databases including Scopus, SPORTDiscus and PubMed/MEDLINE. The criteria for inclusion of studies were: (1) original papers in English and a peer-reviewed journal; (2) assessed effect of compression garments on a measure of peripheral blood flow at rest and/or before, during or after a physiological challenge; (3) participants were healthy and without cardiovascular or metabolic disorders; and (4) a study population including athletes and physically active or healthy participants. The PEDro scale was used to assess the methodological quality of the included studies. A random-effects meta-analysis model was used. Changes in blood flow were quantified by standardised mean difference (SMD) [± 95% confidence interval (CI)]. RESULTS Of the 899 articles identified, 22 studies were included for the meta-analysis. The results indicated sports compression garments improve overall peripheral blood flow (SMD = 0.32, 95% CI 0.13, 0.51, p = 0.001), venous blood flow (SMD = 0.37, 95% CI 0.14, 0.60, p = 0.002) and arterial blood flow (SMD = 0.30, 95% CI 0.01, 0.59, p = 0.04). At rest, sports compression garments did not improve peripheral blood flow (SMD = 0.18, 95% CI - 0.02, 0.39, p = 0.08). However, subgroup analyses revealed sports compression garments enhance venous (SMD = 0.31 95% CI 0.02, 0.60, p = 0.03), but not arterial (SMD = 0.12, 95% CI - 0.16, 0.40, p = 0.16), blood flow. During a physiological challenge, peripheral blood flow was improved (SMD = 0.44, 95% CI 0.19, 0.69, p = 0.0007), with subgroup analyses revealing sports compression garments enhance venous (SMD = 0.48, 95% CI 0.11, 0.85, p = 0.01) and arterial blood flow (SMD = 0.44, 95% CI 0.03, 0.86, p = 0.04). At immediately after a physiological challenge, there were no changes in peripheral blood flow (SMD = - 0.04, 95% CI - 0.43, 0.34, p = 0.82) or subgroup analyses of venous (SMD = - 0.41, 95% CI - 1.32, 0.47, p = 0.35) and arterial (SMD = 0.12, 95% CI - 0.26, 0.51, p = 0.53) blood flow. In recovery, sports compression garments did not improve peripheral blood flow (SMD = 0.25, 95% CI - 0.45, 0.95, p = 0.49). The subgroup analyses showed enhanced venous (SMD = 0.67, 95% CI 0.17, 1.17, p = 0.009), but not arterial blood flow (SMD = 0.02, 95% CI - 1.06, 1.09, p = 0.98). CONCLUSIONS Use of sports compression garments enhances venous blood flow at rest, during and in recovery from, but not immediately after, a physiological challenge. Compression-induced changes in arterial blood flow were only evident during a physiological challenge.
Collapse
|
6
|
Meissner K. Placebo, nocebo: Believing in the field of medicine. FRONTIERS IN PAIN RESEARCH 2022; 3:972169. [PMID: 35965595 PMCID: PMC9372488 DOI: 10.3389/fpain.2022.972169] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/20/2022] [Accepted: 07/11/2022] [Indexed: 11/18/2022] Open
Affiliation(s)
- Karin Meissner
- Division of Health Promotion, Coburg University of Applied Sciences and Arts, Coburg, Germany
- Medical Faculty, Institute of Medical Psychology, Ludwig-Maximilians-University Munich, Munich, Germany
- *Correspondence: Karin Meissner
| |
Collapse
|
7
|
Holzer P. Gut Signals and Gut Feelings: Science at the Interface of Data and Beliefs. Front Behav Neurosci 2022; 16:929332. [PMID: 35874652 PMCID: PMC9296981 DOI: 10.3389/fnbeh.2022.929332] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/26/2022] [Accepted: 06/01/2022] [Indexed: 11/29/2022] Open
|
8
|
Göhler AC, Haas JW, Sperl MFJ, Hermann C, Winkler A. Placebo nasal spray protects female participants from experimentally induced sadness and concomitant changes in autonomic arousal. J Affect Disord 2021; 295:131-138. [PMID: 34438321 DOI: 10.1016/j.jad.2021.07.037] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/22/2021] [Revised: 07/06/2021] [Accepted: 07/12/2021] [Indexed: 11/25/2022]
Abstract
BACKGROUND To investigate the powerful placebo effects in antidepressant drug trials and their mechanisms, recent pioneering experimental studies showed that expectation manipulation combined with an active placebo attenuated induced sadness. In the present study, we aimed at extending these findings by assessing the psychophysiological response in addition to mere self-report. METHODS One hundred and thirteen healthy female students were randomly assigned to a drug expectation group (active placebo, positive treatment expectation), placebo expectation group (active placebo, no treatment expectation), or a no-treatment group (no placebo, no treatment expectation). After placebo intake, sadness was induced by self-deprecating statements using the Velten method combined with sad music, including a rumination phase. Sadness was measured using the Positive and Negative Affect Schedule Expanded Form (PANAS-X). Heart rate and skin conductance were assessed continuously. RESULTS After mood induction and after rumination, self-reported sadness was significantly lower, and skin conductance level was significantly higher, in the drug expectation group than in the no-treatment group. The mood induction was further accompanied by a heart rate deceleration within all groups. LIMITATIONS Generalizability is limited by sample selectivity and focusing on sadness as a symptom of depression, exclusively. CONCLUSION Expectation-induced placebo effects significantly influenced sadness-correlated changes in autonomic arousal, and not only subjectively reported sadness, indicating that placebo effects in the context of affect are not merely due to subjective response bias. The systematic modification of treatment expectation could be utilized in clinical practice to optimize current therapeutic approaches to improve mood regulation.
Collapse
Affiliation(s)
- Annelie C Göhler
- Department of Clinical Psychology and Psychotherapy, Justus-Liebig-University, Giessen, Germany
| | - Julia W Haas
- Division of Clinical Psychology and Psychotherapy, Department of Psychology, Philipps-University, Marburg, Germany
| | - Matthias F J Sperl
- Department of Clinical Psychology and Psychotherapy, Justus-Liebig-University, Giessen, Germany
| | - Christiane Hermann
- Department of Clinical Psychology and Psychotherapy, Justus-Liebig-University, Giessen, Germany
| | - Alexander Winkler
- Department of Clinical Psychology and Psychotherapy, Justus-Liebig-University, Giessen, Germany.
| |
Collapse
|
9
|
[Treatment expectations for postoperative pain]. Schmerz 2021; 36:157-165. [PMID: 34459995 PMCID: PMC9156456 DOI: 10.1007/s00482-021-00575-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 07/12/2021] [Indexed: 11/30/2022]
Abstract
Hintergrund Präoperative Behandlungserwartungen haben einen deutlichen Einfluss auf die postoperativen Schmerzen und Behandlungsergebnisse. Positive Erwartungen sind ein wichtiger Mechanismus von Placeboeffekten und negative Erwartungen ein wichtiger Mechanismus von Noceboeffekten. Fragestellung Welchen Einfluss haben Behandlungserwartungen, wie werden diese im klinischen Setting erhoben und wie können diese Erkenntnisse in der klinischen Praxis umgesetzt werden? Material und Methoden Es wurde eine Literatursuche für klinische Studien mit den Schlagwörtern „expectation“ AND („postoperative“ OR „surgery“) durchgeführt. Ausgewählt wurden alle aktuellen englischen und deutschen Artikel. Zusätzlich wurden die Literaturverzeichnisse der gefundenen Artikel untersucht und mit aufgenommen. Ergebnisse Insgesamt 158 Artikel wurden gefunden, von denen 49 Artikel Erwartungen erheben und ein postoperatives Behandlungsergebnis einbeziehen. Die meisten Artikel untersuchen Erwartungen in der Baseline-Erhebung, um nachzuweisen, dass sich Gruppen in Gruppenvergleichen präoperativ nicht voneinander unterscheiden. Die Studien, die den Einfluss von Erwartungen prospektiv untersuchen, verwenden sehr unterschiedliche Messverfahren, um das Konstrukt „Erwartung“ zu erheben. Somit ist ein Vergleich zwischen den Studien schwer möglich. Es gibt wenige Studien, die untersuchen, ob und wie die Erwartungen perioperativ beeinflusst werden können, und die praxisrelevante Interventionen zu deren Veränderung entwickelt haben. Schlussfolgerung Für eine fundierte Untersuchung der Behandlungserwartung sollten in klinischen Studien valide und reliable Messverfahren verwendet werden. Weitere Studien sollten sich mit Interventionsmöglichkeiten auseinandersetzen, damit Behandlungserwartungen auch in die klinische Standardbehandlung einbezogen werden können.
Collapse
|
10
|
Brivio A, Orenti A, Barbisan M, Buonpensiero P, Ros M, Gambazza S. Home physiotherapists assisting follow-up treatment in cystic fibrosis: a multicenter observational study. Monaldi Arch Chest Dis 2021; 91. [PMID: 33926178 DOI: 10.4081/monaldi.2021.1619] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/23/2020] [Accepted: 01/11/2021] [Indexed: 11/23/2022] Open
Abstract
Inhaled therapies are relatively simple and easy to be managed however ineffective use of aerosols when self-administered may occur. We described variation of the number of clinic visits, lung function and number of antibiotic courses performed over 12 months in participants with cystic fibrosis (CF), when supervised or not by physiotherapists (PTs) at home. Participants in 8 Italian CF centers with a prescription of dry-powder antibiotic choose whether to be supervised at home (PT-FU) or not (non-PT-FU), in adjunct to routine clinic visits. PTs assisted participants with their inhaled therapies regimen and reviewed the airway clearance program in use. Mixed-effect regression models were fitted to evaluate the variation of selected endpoints over time. A total of 163 participants were included. Lung function declined over time in both groups, at higher extent in the non-PT-FU group at 6 months (-1.8, 95%CI: -4.4 to 0.7 % predicted), without reaching statistical significance, whereas in the PT-FU group only, nearly one visit less was recorded (p=0.027). Regardless the type of supervision adopted, the number of antibiotic courses did not change compared to the previous year. We counted 19/90 (21.1%) drop-out in the PT-FU, double compared to the group followed up at the clinics (p=0.065). Participants under a course of an inhaled antibiotic therapy showed a 1-year decline in lung function, whereas only the group receiving home supervision counted nearly one visit less at the CF center, whose clinical relevance should be further discussed.
Collapse
Affiliation(s)
- Anna Brivio
- Cystic Fibrosis Centre and U.O.C. Direzione delle Professioni Sanitarie, Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico, Milan .
| | - Annalisa Orenti
- Department of Clinical Sciences and Community Health, Laboratory of Medical Statistics, Epidemiology and Biometry G. A. Maccacaro, University of Milan.
| | - Mauro Barbisan
- UOS Fibrosi Cistica, Hospital S. Maria di Ca' Foncello, Treviso.
| | - Paolo Buonpensiero
- Department of Translational Medical Sciences, Cystic Fibrosis Centre, Federico II University of Naples.
| | - Mirco Ros
- UOS Fibrosi Cistica, Hospital S. Maria di Ca' Foncello, Treviso.
| | - Simone Gambazza
- Cystic Fibrosis Centre, Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico, Milan; 3Department of Clinical Sciences and Community Health, Laboratory of Medical Statistics, Epidemiology and Biometry G. A. Maccacaro, University of Milan .
| |
Collapse
|
11
|
Daniali H, Flaten MA. Placebo Analgesia, Nocebo Hyperalgesia, and the Cardiovascular System: A Qualitative Systematic Review. Front Physiol 2020; 11:549807. [PMID: 33101048 PMCID: PMC7544987 DOI: 10.3389/fphys.2020.549807] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/05/2020] [Accepted: 08/17/2020] [Indexed: 12/31/2022] Open
Abstract
Background: Placebo/nocebo effects involve the autonomic nervous system, including cardiac activity, but studies have reported inconsistent findings on how cardiac activity is modulated following a placebo/nocebo effect. However, no systematic review has been conducted to provide a clear picture of cardiac placebo responses. Objective: The main goal of the present study is to review the effects of placebo analgesia and nocebo hyperalgesia on cardiac activity as measured by blood pressure, heart rate, and heart rate variability. Methods: Using several Boolean keyword combinations, the PubMed, EMBASE, PsycINFO, Cochrane Review Library, and ISI Web of Knowledge databases were searched until January 5, 2020, to find studies that analyzed blood pressure, heart rate, or heart rate variability indexes following a placebo analgesic/nocebo hyperalgesic effect. Results: Nineteen studies were found, with some reporting more than one index of cardiac activity; eight studies were on blood pressure, 14 studies on heart rate, and six on heart rate variability. No reliable association between placebo/nocebo effects and blood pressure or heart rate was found. However, placebo effects reduced, and nocebo effects increased low-frequency heart rate variability, and heart rate variability significantly predicted placebo effects in two studies. Conclusion: Placebo/nocebo effects can have reliable effects on heart rate variability, but not on heart rate and blood pressure.
Collapse
Affiliation(s)
| | - Magne Arve Flaten
- Department of Psychology, Norwegian University of Science and Technology, Trondheim, Norway
| |
Collapse
|
12
|
Meissner K, Lutter D, von Toerne C, Haile A, Woods SC, Hoffmann V, Ohmayer U, Hauck SM, Tschoep MH. Molecular classification of the placebo effect in nausea. PLoS One 2020; 15:e0238533. [PMID: 32966280 PMCID: PMC7511022 DOI: 10.1371/journal.pone.0238533] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/30/2020] [Accepted: 08/18/2020] [Indexed: 12/12/2022] Open
Abstract
In this proof-of-concept study, we tested whether placebo effects can be monitored and predicted by plasma proteins. In a randomized controlled design, 90 participants were exposed to a nauseating stimulus on two separate days and were randomly allocated to placebo treatment or no treatment on the second day. Significant placebo effects on nausea, motion sickness, and (in females) gastric activity could be verified. Using label-free tandem mass spectrometry, 74 differentially regulated proteins were identified as correlates of the placebo effect. Gene ontology (GO) enrichment analyses identified acute-phase proteins and microinflammatory proteins to be involved, and the identified GO signatures predicted day-adjusted scores of nausea indices in the placebo group. We also performed GO enrichment analyses of specific plasma proteins predictable by the experimental factors or their interactions and identified 'grooming behavior' as a prominent hit. Finally, Receiver Operator Characteristics (ROC) allowed to identify plasma proteins differentiating placebo responders from non-responders, comprising immunoglobulins and proteins involved in oxidation reduction processes and complement activation. Plasma proteomics is a promising tool to identify molecular correlates and predictors of the placebo effect in humans.
Collapse
Affiliation(s)
- Karin Meissner
- Institute of Medical Psychology, Faculty of Medicine, LMU Munich, Munich, Germany
- Division of Health Promotion, Coburg University of Applied Sciences, Coburg, Germany
| | - Dominik Lutter
- Institute of Diabetes and Obesity, Helmholtz Diabetes Center, Helmholtz Zentrum München, German Research Center for Environmental Health (GmbH), Neuherberg, Germany
- German Center for Diabetes Research (DZD), Neuherberg, Germany
| | - Christine von Toerne
- Research Unit Protein Science, Helmholtz Zentrum München, German Research Center for Environmental Health (GmbH), Neuherberg, Germany
| | - Anja Haile
- Institute of Medical Psychology, Faculty of Medicine, LMU Munich, Munich, Germany
| | - Stephen C. Woods
- Department of Psychiatry and Behavioral Neuroscience, Metabolic Diseases Institute, University of Cincinnati, Cincinnati, Ohio, United States of America
| | - Verena Hoffmann
- Institute of Medical Psychology, Faculty of Medicine, LMU Munich, Munich, Germany
| | - Uli Ohmayer
- Research Unit Protein Science, Helmholtz Zentrum München, German Research Center for Environmental Health (GmbH), Neuherberg, Germany
| | - Stefanie M. Hauck
- Research Unit Protein Science, Helmholtz Zentrum München, German Research Center for Environmental Health (GmbH), Neuherberg, Germany
| | - Matthias H. Tschoep
- Institute of Diabetes and Obesity, Helmholtz Diabetes Center, Helmholtz Zentrum München, German Research Center for Environmental Health (GmbH), Neuherberg, Germany
- German Center for Diabetes Research (DZD), Neuherberg, Germany
- Division of Metabolic Diseases, Department of Medicine, Technische Universität München, Munich, Germany
| |
Collapse
|
13
|
Efverman A. Treatment expectations seem to affect bowel health when using acupuncture during radiotherapy for cancer: Secondary outcomes from a clinical randomized sham-controlled trial. Complement Ther Med 2020; 52:102404. [PMID: 32951698 DOI: 10.1016/j.ctim.2020.102404] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/26/2018] [Revised: 02/27/2020] [Accepted: 04/07/2020] [Indexed: 12/18/2022] Open
Abstract
OBJECTIVE To investigate if frequent stools ("diarrhoea"), infrequent stools ("constipation"), capacity in daily activities and Quality of Life (QoL) differed between patients treated with verum or sham acupuncture, and if patients with more positive treatment expectations differed regarding frequent stools and infrequent stools from patients with less positive treatment expectations. METHODS In this randomized sham controlled trial, 200 patients received verum traditional penetrating acupuncture or sham acupuncture using a telescopic non-penetrating sham-needle 2-3 times a week during abdominal-pelvic radiotherapy (12 needling sessions during median 5 radiotherapy weeks). The patients registered stool frequency once a week, and registered capacity in daily activities and QoL at the start and end of radiotherapy, and at a one-month follow-up. RESULTS In the verum acupuncture group, 29 of 96 answering patients (30 %) experienced frequent stools and 7 (7 %) experienced infrequent stools at least one week of radiotherapy. In the sham acupuncture group, 21 of 97 (22 %) experienced frequent stools (p = 0.175) and 10 (10 %) experienced infrequent stools (p = 0.613). Patients with low treatment expectancy were more likely than other patients to experience frequent stools (60 % versus 26 %, p = 0.014) but not to experience infrequent stools (25 % versus 12 %, p = 0.334). CONCLUSION Penetrating acupuncture was not effective for frequent stools or for infrequent stools and did not improve capacity in daily activities or QoL in patients undergoing pelvic-abdominal irradiation for cancer more than non-penetrating acupuncture. Since patients with low acupuncture treatment expectations were more likely to experience frequent stools compared to other patients, non-specific treatment effects warrant further studies.
Collapse
Affiliation(s)
- Anna Efverman
- Department of Caring Science, Faculty of Health and Occupational Studies, University of Gävle, Gävle, Sweden.
| |
Collapse
|
14
|
Cornwall HL, Edwards BA, Curran JF, Boyce S. Coffee to go? The effect of coffee on resolution of ileus following abdominal surgery: A systematic review and meta-analysis of randomised controlled trials. Clin Nutr 2020; 39:1385-1394. [PMID: 31253438 DOI: 10.1016/j.clnu.2019.06.003] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/31/2018] [Revised: 06/02/2019] [Accepted: 06/05/2019] [Indexed: 12/25/2022]
Abstract
BACKGROUND & AIMS Ileus following abdominal surgery is a common postoperative complication. It is a source of considerable morbidity to patients and prolongs hospital stay. There is limited evidence to support the use of coffee to promote resolution of post-operative ileus. METHODS We performed a systematic review, a risk of bias assessment, and meta-analysis of randomised controlled trials that compared the effect of coffee consumption with control intervention on gastrointestinal motility after abdominal surgery. We searched PubMed, EMBASE, CINAHL, ISI Web of Science, clinicaltrials.gov, Cochrane Library, CENTRAL, WHO ICTRP, and Google Scholar, from inception to 24th February 2018. RESULTS Data from seven studies were extracted (606 patients). 31% were men. 69% were women. 342 underwent colorectal resection, 114 gynaecological resection and 150 elective caesarean section. Estimates from meta-analysis revealed that coffee consumption reduced time to defecation by 14.8 h (95% CI: -11.9, -17.7) after colorectal resection and 17.8 h (95% CI: -13.6, -22.0) after gynaecological resection, but had no significant effect after caesarean section. Coffee also reduced time to first bowel sound, and time to tolerance of solid food, but not time to first reported flatus. No measures of ileus were increased by coffee consumption. Complications and length of hospital stay were similar for coffee and control groups. Coffee was well-tolerated with no adverse effects. Cost was low. CONCLUSIONS Risk of bias was moderate or high across studies. Assessed with GRADE criteria, there is low to moderate quality evidence that coffee accelerates postoperative recovery of gastrointestinal function after colorectal and gynaecological surgery. PROSPERO REGISTRATION NUMBER CRD42018087962.
Collapse
Affiliation(s)
- Hannah L Cornwall
- Oxford Clinical School, Division of Medical Sciences, University of Oxford, John Radcliffe Hospital, Headley Way, Headington, Oxford, OX3 9DU, UK.
| | - Ben A Edwards
- Oxford Clinical School, Division of Medical Sciences, University of Oxford, John Radcliffe Hospital, Headley Way, Headington, Oxford, OX3 9DU, UK.
| | - John F Curran
- Oxford University Hospitals NHS Foundation Trust, John Radcliffe Hospital, Headley Way, Headington, Oxford, OX3 9DU, UK.
| | - Stephen Boyce
- Department of Colorectal Surgery, Churchill Hospital, Old Road, Headington, Oxford, OX3 7LE, UK.
| |
Collapse
|
15
|
Aichner S, Haile A, Hoffmann V, Olliges E, Tschöp MH, Meissner K. The Role of Tactile Stimulation for Expectation, Perceived Treatment Assignment and the Placebo Effect in an Experimental Nausea Paradigm. Front Neurosci 2019; 13:1212. [PMID: 31798402 PMCID: PMC6863803 DOI: 10.3389/fnins.2019.01212] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/12/2019] [Accepted: 10/28/2019] [Indexed: 12/25/2022] Open
Abstract
Introduction Tactile stimulation during a placebo treatment could enhance its credibility and thereby boost positive treatment expectations and the placebo effect. This experimental study aimed to investigate the interplay between tactile stimulation, expectation, and treatment credibility for the placebo effect in nausea. Methods Ninety healthy participants were exposed to a 20-min vection stimulus on two separate days and were randomly allocated to one of three groups on the second day after the baseline period: Placebo transcutaneous electrical nerve stimulation (TENS) with tactile stimulation (n = 30), placebo TENS without tactile stimulation (n = 30), or no intervention (n = 30). Placebo TENS was performed for 20 min at a dummy acupuncture point on both forearms. Expected and perceived nausea severity and further symptoms of motion sickness were assessed at baseline and during the evaluation period. At the end of the experiment, participants in the placebo groups guessed whether they had received active or placebo treatment. Results Expected nausea decreased significantly more in the placebo groups as compared to the no treatment control group (interaction day × group, F = 6.60, p = 0.003, partial η2 = 0.20), with equal reductions in the two placebo groups (p = 1.0). Reduced expectation went along with a significant placebo effect on nausea (interaction day × group, F = 22.2, p < 0.001, partial η2 = 0.35) with no difference between the two placebo groups (p = 1.0). Twenty-three out of 29 participants in the tactile placebo group (79%) but only 14 out of 30 participants (47%) in the non-tactile placebo group believed that they had received the active intervention (p = 0.015). Bang’s blinding index (BI) indicated random guessing in the non-tactile placebo group (BI = 0; 95% CI, −0.35 to 0.35) and non-random guessing in the direction of an “opposite guess” in the tactile placebo group (BI = −0.52; 95% CI, −0.81 to −0.22). Conclusion Tactile stimulation during placebo TENS did not further enhance positive treatment expectations and the placebo effect in nausea but increased the credibility of the intervention. Further trials should investigate the interaction between perceived treatment assignment, expectation, and the placebo effect during the course of a trial.
Collapse
Affiliation(s)
- Simone Aichner
- Institute of Medical Psychology, Faculty of Medicine, LMU Munich, Munich, Germany
| | - Anja Haile
- Institute of Medical Psychology, Faculty of Medicine, LMU Munich, Munich, Germany
| | - Verena Hoffmann
- Institute of Medical Psychology, Faculty of Medicine, LMU Munich, Munich, Germany
| | - Elisabeth Olliges
- Institute of Medical Psychology, Faculty of Medicine, LMU Munich, Munich, Germany.,Division of Health Promotion, Coburg University of Applied Sciences, Coburg, Germany
| | - Matthias H Tschöp
- Institute for Diabetes and Obesity, Helmholtz Diabetes Center, Helmholtz Zentrum München, Munich, Germany.,German Center for Diabetes Research (DZD), Munich, Germany.,Division of Metabolic Diseases, Department of Medicine, Technische Universität München, Munich, Germany
| | - Karin Meissner
- Institute of Medical Psychology, Faculty of Medicine, LMU Munich, Munich, Germany.,Division of Health Promotion, Coburg University of Applied Sciences, Coburg, Germany
| |
Collapse
|
16
|
Beedie C, Benedetti F, Barbiani D, Camerone E, Lindheimer J, Roelands B. Incorporating methods and findings from neuroscience to better understand placebo and nocebo effects in sport. Eur J Sport Sci 2019; 20:313-325. [PMID: 31573836 PMCID: PMC10181912 DOI: 10.1080/17461391.2019.1675765] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/18/2022]
Abstract
Placebo and nocebo effects are a factor in sports performance. However, the majority of published studies in sport science are descriptive and speculative regarding mechanisms. It is therefore not unreasonable for the sceptic to argue that placebo and nocebo effects in sport are illusory, and might be better explained by variations in phenomena such as motivation. It is likely that, in sport at least, placebo and nocebo effects will remain in this empirical grey area until researchers provide stronger mechanistic evidence. Recent research in neuroscience has identified a number of consistent, discrete and interacting neurobiological and physiological pathways associated with placebo and nocebo effects, with many studies reporting data of potential interest to sport scientists, for example relating to pain, fatigue and motor control. Findings suggest that placebos and nocebos result in activity of the opioid, endocannabinoid and dopamine neurotransmitter systems, brain regions including the motor cortex and striatum, and measureable effects on the autonomic nervous system. Many studies have demonstrated that placebo and nocebo effects associated with a treatment, for example an inert treatment presented as an analgesic or stimulant, exhibit mechanisms similar or identical to the verum or true treatment. Such findings suggest the possibility of a wide range of distinct placebo and nocebo mechanisms that might influence sports performance. In the present paper, we present some of the findings from neuroscience. Focussing on fatigue as an outcome and caffeine as vehicle, we propose three approaches that researchers in sport might incorporate in their studies in order to better elucidate mechanisms of placebo/nocebo effects on performance.
Collapse
Affiliation(s)
- Christopher Beedie
- School of Psychology, University of Kent, Canterbury, UK
- CHX Performance, London, UK
| | - Fabrizio Benedetti
- Medicine and Physiology of Hypoxia, Plateau Rosà, Italy/Switzerland
- Neuroscience Dept, University of Turin Medical School, Turin, Italy
| | - Diletta Barbiani
- Neuroscience Dept, University of Turin Medical School, Turin, Italy
| | | | - Jacob Lindheimer
- Department of Veterans Affairs, William S. Middleton Veterans Memorial Hospital, Madison, WI, USA
- Department of Kinesiology, University of Wisconsin–Madison, Madison, WI, USA
| | - Bart Roelands
- Department of Human Physiology, Vije Universiteit Brussels, Belgium
| |
Collapse
|
17
|
Elsenbruch S, Roderigo T, Enck P, Benson S. Can a Brief Relaxation Exercise Modulate Placebo or Nocebo Effects in a Visceral Pain Model? Front Psychiatry 2019; 10:144. [PMID: 30949080 PMCID: PMC6437034 DOI: 10.3389/fpsyt.2019.00144] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/22/2019] [Accepted: 02/27/2019] [Indexed: 12/12/2022] Open
Abstract
Translational research aiming to elucidate mediators and moderators of placebo and nocebo effects is highly relevant. This experimental study tested effects of a brief progressive muscle relaxation (PMR) exercise, designed to alter psychobiological stress parameters, on the magnitude of placebo and nocebo effects in a standardized psychosocial treatment context. In 120 healthy volunteers (60 men, 60 women), pain expectation, pain intensity, and pain unpleasantness in response to individually-calibrated rectal distensions were measured with visual analog scales during a baseline. Participants were then randomized to exercise PMR (relaxation group: N = 60) or a simple task (control group: N = 60), prior to receiving positive (placebo), negative (nocebo) or neutral suggestions regarding an intravenous administration that was in reality saline in all groups. Identical distensions were repeated (test). State anxiety, salivary cortisol, heart rate, and blood pressure were assessed repeatedly. Data were analyzed using analysis of covariance, planned Bonferroni-corrected group comparisons, as well as exploratory correlational and mediation analyses. Treatment suggestions induced group-specific changes in pain expectation, with significantly reduced expectation in placebo and increased expectation in nocebo groups. PMR had no discernable effect on pain expectation, state anxiety or cortisol, but led to significantly lower heart rate and systolic blood pressure. Relaxation significantly interacted with positive treatment suggestions, which only induced placebo analgesia in relaxed participants. No effects of negative suggestions were found in planned group comparisons, irrespective of relaxation. Exploratory correlation and mediation analyses revealed that pain expectation was a mediator to explain the association between treatment suggestions and pain-related outcomes. Clearly, visceral pain modulation is complex and involves many cognitive, emotional, and possibly neurobiological factors that remain to be fully understood. Our findings suggest that a brief relaxation exercise may facilitate the induction of placebo analgesia by positive when compared to neutral treatment suggestions. They underscore the contribution of relaxation and stress as psychobiological states within the psychosocial treatment context-factors which clearly deserve more attention in translational studies aiming to maximize positive expectancy effects in clinical settings.
Collapse
Affiliation(s)
- Sigrid Elsenbruch
- Institute of Medical Psychology and Behavioral Immunobiology, University Hospital Essen, Essen, Germany
| | - Till Roderigo
- Institute of Medical Psychology and Behavioral Immunobiology, University Hospital Essen, Essen, Germany
| | - Paul Enck
- Department of Internal Medicine VI, University Hospital Tuebingen, Tuebingen, Germany
| | - Sven Benson
- Institute of Medical Psychology and Behavioral Immunobiology, University Hospital Essen, Essen, Germany
| |
Collapse
|
18
|
Meeuwis SH, van Middendorp H, van Laarhoven AIM, Veldhuijzen DS, Lavrijsen APM, Evers AWM. Effects of Open- and Closed-Label Nocebo and Placebo Suggestions on Itch and Itch Expectations. Front Psychiatry 2019; 10:436. [PMID: 31293458 PMCID: PMC6598628 DOI: 10.3389/fpsyt.2019.00436] [Citation(s) in RCA: 19] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/20/2018] [Accepted: 06/03/2019] [Indexed: 12/12/2022] Open
Abstract
Placebo and nocebo effects have been shown to influence subjective symptoms such as itch. These effects can be induced by influencing outcome expectations through, for example, combining the application of an inert substance (e.g., a cream) with verbal suggestions on the anticipated effects of this substance. Interestingly, placebo effects also occur when it is known that a treatment is inert (i.e., open-label placebo). However, no study to date has examined the efficacy of negative and positive verbal suggestions under similar open-label and closed-label (i.e., concealed placebo/nocebo) conditions in itch. A randomized controlled between-subjects study design was applied in which healthy volunteers (n = 92) were randomized to 1) an open-label positive verbal suggestion group, 2) a closed-label positive verbal suggestion group, 3) an open-label negative verbal suggestion group, or 4) a closed-label negative verbal suggestion group. Verbal suggestions were made regarding the topical application of an inert substance. Itch was evoked experimentally by histamine iontophoresis at baseline and again following suggestions. Itch expectations, self-reported itch during and following iontophoresis, and skin response parameters were measured. Positive suggestions were found to result in significantly lower expected itch than were negative suggestions in both open- and closed-label conditions. No effects of the suggestions on itch during iontophoresis were found, but significantly lower itch was reported in the 4 min following iontophoresis in the (combined open- and closed-label) positive compared with negative verbal suggestion groups. In addition, a smaller increase in skin temperature was found in the positive compared with negative suggestion groups. The findings illustrate a potential role of (open- and closed-label) placebo for optimizing expectations and treatment effects for itch in clinical practice. Clinical Trial Registration: Netherlands Trial Register, trial number: NTR6530.
Collapse
Affiliation(s)
- Stefanie H Meeuwis
- Health, Medical and Neuropsychology Unit, Faculty of Social and Behavioural Sciences, Institute of Psychology, Leiden University, Leiden, Netherlands.,Leiden Institute for Brain and Cognition, Leiden University Medical Center, Leiden, Netherlands
| | - Henriët van Middendorp
- Health, Medical and Neuropsychology Unit, Faculty of Social and Behavioural Sciences, Institute of Psychology, Leiden University, Leiden, Netherlands.,Leiden Institute for Brain and Cognition, Leiden University Medical Center, Leiden, Netherlands
| | - Antoinette I M van Laarhoven
- Health, Medical and Neuropsychology Unit, Faculty of Social and Behavioural Sciences, Institute of Psychology, Leiden University, Leiden, Netherlands.,Leiden Institute for Brain and Cognition, Leiden University Medical Center, Leiden, Netherlands.,Department of Psychiatry, Leiden University Medical Center, Leiden, Netherlands
| | - Dieuwke S Veldhuijzen
- Health, Medical and Neuropsychology Unit, Faculty of Social and Behavioural Sciences, Institute of Psychology, Leiden University, Leiden, Netherlands.,Leiden Institute for Brain and Cognition, Leiden University Medical Center, Leiden, Netherlands
| | | | - Andrea W M Evers
- Health, Medical and Neuropsychology Unit, Faculty of Social and Behavioural Sciences, Institute of Psychology, Leiden University, Leiden, Netherlands.,Leiden Institute for Brain and Cognition, Leiden University Medical Center, Leiden, Netherlands.,Department of Psychiatry, Leiden University Medical Center, Leiden, Netherlands
| |
Collapse
|
19
|
Olliges E, Schneider S, Schmidt G, Sinnecker D, Müller A, Burgdorf C, Braun S, Holdenrieder S, Ebell H, Ladwig KH, Meissner K, Ronel J. Placebo and Nocebo Effects in Patients With Takotsubo Cardiomyopathy and Heart-Healthy Controls. Front Psychiatry 2019; 10:549. [PMID: 31428002 PMCID: PMC6688659 DOI: 10.3389/fpsyt.2019.00549] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/14/2018] [Accepted: 07/15/2019] [Indexed: 12/03/2022] Open
Abstract
The etiology of takotsubo cardiomyopathy (TTC)-a rare, reversible, and acquired form of cardiac diseases-is not yet fully explained. An exaggerated activation of the sympathetic-nervous-system (SNS) following stressful psychosocial life events is discussed to be of key importance. In this experimental study, we tested whether TTC patients, compared to heart-healthy controls, respond more strongly to supporting placebo interventions and stressful nocebo interventions targeting cardiac function. In a single experimental session, 20 female TTC patients and 20 age matched (mean age 61.5 years, ± 12.89) catheter-confirmed heart-healthy women were examined. Saline solution was administered three times i.v. to all participants, with the verbal suggestion they receive an inert substance with no effects on the heart (neutral condition), a drug that would support cardiac functions (positive condition), and a drug that would burden the heart (negative condition). Systolic and diastolic blood pressure (DBP/SBP), heart rate (HR), endocrine markers cortisol (µg/dl), copeptin (pmol/l), and subjective stress ratings (SUD) were assessed to examine alterations of the SNS and the hypothalamic-pituitary-adrenal axis (HPA). Before and after each intervention SUD was rated. One pre and three post serum cortisol and copeptin samples were assessed, and a long-term electrocardiogram as well as non-invasive, continuous blood pressure was recorded. The study design elucidated a significant increase of SUD levels as a response to the nocebo intervention, while perceived stress remained unaffected during the preceding neutral and positive interventions. Increasing SUD levels were accompanied by higher SBP and an anticipatory increase of HR shortly prior to the nocebo intervention. SBP increased also as a response to positive verbal suggestions (Bonferroni-corrected p-values > .05). Alterations of cortisol and copeptin due to the interventions and significant placebo effects failed to appear. Interestingly no differences between TCC patients and controls could be found.These findings do not support the assumption of an exaggerated activation of the SNS as a discriminatory factor for TTC. Since especially the nocebo intervention revealed negative subjective and objective effects, our results underscore the urgent need to consider carefully the impact of verbal suggestions in the interaction with cardiac patients in daily clinical routine. This study is registered at the Deutsches Register Klinischer Studien (DRKS00009296).
Collapse
Affiliation(s)
- Elisabeth Olliges
- Institute of Medical Psychology, Medical Faculty, LMU Munich, Munich, Germany
| | - Simon Schneider
- Medizinische Klinik und Poliklinik I, Klinikum rechts der Isar, Technische Universitaet Munich, Munich, Germany
| | - Georg Schmidt
- Medizinische Klinik und Poliklinik I, Klinikum rechts der Isar, Technische Universitaet Munich, Munich, Germany
| | - Daniel Sinnecker
- Medizinische Klinik und Poliklinik I, Klinikum rechts der Isar, Technische Universitaet Munich, Munich, Germany.,German Centre for Cardiovascular Research (DZHK), partner site Munich Heart Alliance, Munich, Germany
| | - Alexander Müller
- Medizinische Klinik und Poliklinik I, Klinikum rechts der Isar, Technische Universitaet Munich, Munich, Germany
| | - Christof Burgdorf
- Klinik für Herz- und Kreislauferkrankungen, Deutsches Herzzentrum Munich, Technische Universitaet Munich, Munich, Germany.,Department of Cardiology, Heart and Vascular Centre Bad Bevensen, Bad Bevensen, Germany
| | - Siegmund Braun
- Institute of Laboratory Medicine, Deutsches Herzzentrum Munich, Technische Universitaet Munich, Munich, Germany
| | - Stefan Holdenrieder
- Institute of Laboratory Medicine, Deutsches Herzzentrum Munich, Technische Universitaet Munich, Munich, Germany
| | | | - Karl-Heinz Ladwig
- Department of Psychosomatic Medicine and Psychotherapy, Klinikum rechts der Isar, Technische Universitaet Munich, Munich, Germany.,Department of Epidemiology II, Helmholtz Zentrum, Munich, Germany
| | - Karin Meissner
- Institute of Medical Psychology, Medical Faculty, LMU Munich, Munich, Germany.,Division of Health Promotion, Coburg University of Applied Sciences, Coburg, Germany
| | - Joram Ronel
- Department of Psychosomatic Medicine and Psychotherapy, Klinikum rechts der Isar, Technische Universitaet Munich, Munich, Germany.,Department of Psychosomatic Medicine, Klinik Barmelweid AG, Barmelweid, Switzerland
| |
Collapse
|
20
|
Regular Intake of a Usual Serving Size of Flavanol-Rich Cocoa Powder Does Not Affect Cardiometabolic Parameters in Stably Treated Patients with Type 2 Diabetes and Hypertension-A Double-Blinded, Randomized, Placebo-Controlled Trial. Nutrients 2018; 10:nu10101435. [PMID: 30301127 PMCID: PMC6213512 DOI: 10.3390/nu10101435] [Citation(s) in RCA: 21] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/06/2018] [Revised: 09/23/2018] [Accepted: 09/28/2018] [Indexed: 12/27/2022] Open
Abstract
Regular cocoa consumption has been shown to improve blood pressure (BP), insulin sensitivity, and lipid levels in patients with type 2 diabetes (T2D), using up to 100 g of chocolate or 54 g of cocoa. These effects, attributed to cocoa flavanols, would be beneficial for patients with T2D if they could be achieved by a usual serving size of flavanol-rich cocoa. Forty-two hypertensive patients with T2D (stable pharmacological treatment, with good adjustment for glucose metabolism, lipids, and BP) ingested capsules with 2.5 g/day of a flavanol-rich cocoa or cocoa-free capsules for 12 weeks in a double-blinded, randomized, placebo-controlled study with parallel group design. Participants had to maintain diet, lifestyle, and medication. Before and after intervention, fasting blood samples were collected; BP and nutritional status were investigated. Cocoa treatment did not affect BP, nor glucose metabolism (glucose, HbA1c, insulin, HOMA-IR) and lipids (triglycerides, total cholesterol, low-density lipoprotein cholesterol, high-density lipoprotein cholesterol). Body weight, fat mass, and nutrient supply remained unchanged. Changes in the placebo group did not occur. Regular intake of a usual serving size of flavanol-rich cocoa does not improve cardiometabolic parameters in stably treated patients with T2D and hypertension. As the medication modulates partly the same targets as cocoa flavanols, future studies should focus on the preventive effect of cocoa against diabetes and other cardiometabolic diseases in individuals with preexisting abnormalities that do not require any pharmacological treatment.
Collapse
|
21
|
Polich G, Iaccarino MA, Kaptchuk TJ, Morales-Quezada L, Zafonte R. Placebo Effects in Traumatic Brain Injury. J Neurotrauma 2018; 35:1205-1212. [PMID: 29343158 PMCID: PMC6016098 DOI: 10.1089/neu.2017.5506] [Citation(s) in RCA: 35] [Impact Index Per Article: 5.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/18/2022] Open
Abstract
In recent years, several randomized controlled trials evaluating pharmaceutical treatments for traumatic brain injury (TBI) have failed to demonstrate efficacy over placebo, with both active and placebo arms improving at comparable rates. These findings could be viewed in opposing ways, suggesting on the one hand failure of the tested outcome, but on the other, representing evidence of robust placebo effects in TBI. In this article, we examine several of the primary psychological processes driving placebo effects (verbal suggestion, cognitive re-framing, interpersonal interactions, conditioning, therapeutic alliance, anxiety reduction) as well as placebo neurobiology (top-down cortical regulation, reward system activation, dopaminergic and serotonergic neurotransmission). We then extrapolate from the literature to explore whether something inherent in TBI makes it particularly responsive to placebos. Viewed as such here, placebos may indeed represent a powerful and effective treatment for a variety of post-TBI complaints.
Collapse
Affiliation(s)
- Ginger Polich
- Department of Physical Medicine and Rehabilitation, Harvard Medical School, Spaulding Rehabilitation Hospital, Charlestown, Massachusetts
| | - Mary Alexis Iaccarino
- Department of Physical Medicine and Rehabilitation, Harvard Medical School, Spaulding Rehabilitation Hospital, Charlestown, Massachusetts
- MassGeneral Hospital for Children Sport Concussion Program, Boston, Massachusetts
- Red Sox Foundation and Massachusetts General Hospital Home Base Program, Boston, Massachusetts
| | - Ted J. Kaptchuk
- Program in Placebo Studies and Therapeutic Encounter, Harvard Medical School, Beth Israel Deaconess Medical Center, Boston, Massachusetts
| | - Leon Morales-Quezada
- Department of Physical Medicine and Rehabilitation, Harvard Medical School, Spaulding Rehabilitation Hospital, Charlestown, Massachusetts
| | - Ross Zafonte
- Department of Physical Medicine and Rehabilitation, Harvard Medical School, Spaulding Rehabilitation Hospital, Charlestown, Massachusetts
- Red Sox Foundation and Massachusetts General Hospital Home Base Program, Boston, Massachusetts
| |
Collapse
|
22
|
Similarities between the renal artery and pulmonary vein denervation trials: Do we have to use sham procedures for atrial fibrillation catheter ablation trials? Int J Cardiol 2016; 211:55-7. [DOI: 10.1016/j.ijcard.2016.02.158] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/31/2016] [Accepted: 02/29/2016] [Indexed: 12/18/2022]
|
23
|
Meissner K, Merrow M. Macht der Worte. Anaesthesist 2014; 63:814-5. [DOI: 10.1007/s00101-014-2395-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
|