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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.
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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.
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Lücke C, Jenkner C, Graf E, Matthies S, Borel P, Sobanski E, Alm B, Rösler M, Retz W, Jacob C, Colla M, Huss M, Jans T, Kis B, Abdel-Hamid M, Müller HH, Lam AP, Berger M, Tebartz van Elst L, Philipsen A. Long-term improvement of quality of life in adult ADHD – results of the randomized multimodal COMPAS trial. INTERNATIONAL JOURNAL OF MENTAL HEALTH 2021. [DOI: 10.1080/00207411.2021.1910172] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
Affiliation(s)
- Caroline Lücke
- Department of Psychiatry and Psychotherapy, University of Bonn, Bonn, Germany
| | - Carolin Jenkner
- Clinical Trials Unit and Medical Faculty, University Medical Center – University of Freiburg, Freiburg, Germany
| | - Erika Graf
- Clinical Trials Unit and Medical Faculty, University Medical Center – University of Freiburg, Freiburg, Germany
| | - Swantje Matthies
- Department of Psychiatry and Psychotherapy, Faculty of Medicine, Medical Center – University of Freiburg, Freiburg, Germany
| | - Patricia Borel
- Department of Psychiatry and Psychotherapy, Faculty of Medicine, Medical Center – University of Freiburg, Freiburg, Germany
| | - Esther Sobanski
- Department of Psychiatry and Psychotherapy, Central Institute of Mental Health, Clinical Faculty Mannheim, University of Heidelberg, Mannheim, Germany
- Department of Child and Adolescent Psychiatry and Psychotherapy, University Medicine Mainz, Mainz, Germany
| | - Barbara Alm
- Department of Psychiatry and Psychotherapy, Central Institute of Mental Health, Clinical Faculty Mannheim, University of Heidelberg, Mannheim, Germany
| | - Michael Rösler
- Institute for Forensic Psychology and Psychiatry, Faculty of Medicine, Saarland University, Homburg, Germany
| | - Wolfgang Retz
- Institute for Forensic Psychology and Psychiatry, Faculty of Medicine, Saarland University, Homburg, Germany
- Department of Psychiatry and Psychotherapy, University Medical Center Mainz, Mainz, Germany
| | - Christian Jacob
- Clinic for Psychiatry and Psychotherapy, Medius Clinic, Kirchheim, Germany
| | - Michael Colla
- Clinic and Polyclinic for Psychiatry and Psychotherapy, University of Rostock, Rostock, Germany
- Department of Psychiatry, Psychotherapy and Psychosomatics, Psychiatric Hospital, University of Zurich, Zurich, Switzerland
| | - Michael Huss
- Department of Child and Adolescent Psychiatry and Psychotherapy, University Medicine Mainz, Mainz, Germany
| | - Thomas Jans
- Department of Child and Adolescent Psychiatry, Psychosomatics and Psychotherapy, University Hospital of Würzburg, Center of Mental Health, Würzburg, Germany
| | - Bernhard Kis
- Department of Psychiatry, Psychotherapy and Psychosomatics, St. Elisabeth-Hospital Niederwenigern, Contilia Group, Hattingen, Germany
- LVR Hospital Essen, Department of Psychiatry and Psychotherapy, Faculty of Medicine, University of Duisburg-Essen, Essen, Germany
- Department of Psychiatry and Psychotherapy, University Medical Center, Göttingen, Germany
| | - Mona Abdel-Hamid
- Department of Psychiatry and Psychotherapy, University Medical Center, Göttingen, Germany
| | - Helge H.O. Müller
- Department of Psychiatry and Psychotherapy, University of Bonn, Bonn, Germany
| | - Alexandra P. Lam
- Department of Psychiatry and Psychotherapy, University of Bonn, Bonn, Germany
| | - Mathias Berger
- Department of Psychiatry and Psychotherapy, Faculty of Medicine, Medical Center – University of Freiburg, Freiburg, Germany
| | - Ludger Tebartz van Elst
- Department of Psychiatry and Psychotherapy, Faculty of Medicine, Medical Center – University of Freiburg, Freiburg, Germany
| | - Alexandra Philipsen
- Department of Psychiatry and Psychotherapy, University of Bonn, Bonn, Germany
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Anlauf M, Hein L, Hense HW, Köbberling J, Lasek R, Leidl R, Schöne-Seifert B. Complementary and alternative drug therapy versus science-oriented medicine. GERMAN MEDICAL SCIENCE : GMS E-JOURNAL 2015; 13:Doc05. [PMID: 26161049 PMCID: PMC4480118 DOI: 10.3205/000209] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 05/20/2015] [Indexed: 12/12/2022]
Abstract
This opinion deals critically with the so-called complementary and alternative medical (CAM) therapy on the basis of current data. From the authors' perspective, CAM prescriptions and most notably the extensive current endeavours to the "integration" of CAM into conventional patient care is problematic in several respects. Thus, several CAM measures are used, although no specific effects of medicines can be proved in clinical studies. It is extensively explained that the methods used in this regard are those of evidence-based medicine, which is one of the indispensable pillars of science-oriented medicine. This standard of proof of efficacy is fundamentally independent of the requirement of being able to explain efficacy of a therapy in a manner compatible with the insights of the natural sciences, which is also essential for medical progress. Numerous CAM treatments can however never conceivably satisfy this requirement; rather they are justified with pre-scientific or unscientific paradigms. The high attractiveness of CAM measures evidenced in patients and many doctors is based on a combination of positive expectations and experiences, among other things, which are at times unjustified, at times thoroughly justified, from a science-oriented view, but which are non-specific (context effects). With a view to the latter phenomenon, the authors consider the conscious use of CAM as unrevealed therapeutic placebos to be problematic. In addition, they advocate that academic medicine should again systematically endeavour to pay more attention to medical empathy and use context effects in the service of patients to the utmost. The subsequent opinion discusses the following after an introduction to medical history: the definition of CAM; the efficacy of most common CAM procedures; CAM utilisation and costs in Germany; characteristics of science-oriented medicine; awareness of placebo research; pro and contra arguments about the use of CAM, not least of all in terms of aspects related to medical ethics.
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Affiliation(s)
- Manfred Anlauf
- Medical Care Centre Cuxhaven GmbH, Medical Office for Internal Medicine, Cuxhaven, Germany
| | - Lutz Hein
- Albert-Ludwigs-Universität (University), Institute for Experimental and Clinical Pharmacology and Toxicology, Department 2, Freiburg i. Br., Germany
| | - Hans-Werner Hense
- University of Münster, Institute for Epidemiology and Social Medicine, Münster, Germany
| | | | | | - Reiner Leidl
- Ludwig-Maximilians-Universität (University), Institute for Health Economics and Health Care Management, Munich, Germany
- Helmholtz Research Centre, Institute for Health Economics and Health Care Management, Munich, Germany
| | - Bettina Schöne-Seifert
- University of Münster, Institute for Ethics, History and Theory of Medicine, Münster, Germany
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Tozzi P. A unifying neuro-fasciagenic model of somatic dysfunction - Underlying mechanisms and treatment - Part II. J Bodyw Mov Ther 2015; 19:526-43. [PMID: 26118526 DOI: 10.1016/j.jbmt.2015.03.002] [Citation(s) in RCA: 27] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/03/2014] [Revised: 02/20/2015] [Accepted: 02/24/2015] [Indexed: 02/07/2023]
Abstract
This paper offers an extensive review of the main fascia-mediated mechanisms underlying various therapeutic processes of clinical relevance for manual therapy. The concept of somatic dysfunction is revisited in light of the several fascial influences that may come into play during and after manual treatment. A change in perspective is thus proposed: from a nociceptive model that for decades has viewed somatic dysfunction as a neurologically-mediated phenomenon, to a unifying neuro-fascial model that integrates neural influences into a multifactorial and multidimensional interpretation of manual therapeutic effects as being partially, if not entirely, mediated by the fascia. By taking into consideration a wide spectrum of fascia-related factors - from cell-based mechanisms to cognitive and behavioural influences - a model emerges suggesting, amongst other results, a multidisciplinary-approach to the intervention of somatic dysfunction. Finally, it is proposed that a sixth osteopathic 'meta-model' - the connective tissue-fascial model - be added to the existing five models in osteopathic philosophy as the main interface between all body systems, thus providing a structural and functional framework for the body's homoeostatic potential and its inherent abilities to heal.
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Affiliation(s)
- Paolo Tozzi
- School of Osteopathy C.R.O.M.O.N., Rome, Italy; C.O.ME. Collaboration, Pescara, Italy.
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Use of functional imaging across clinical phases in CNS drug development. Transl Psychiatry 2013; 3:e282. [PMID: 23860483 PMCID: PMC3731782 DOI: 10.1038/tp.2013.43] [Citation(s) in RCA: 42] [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: 02/20/2013] [Accepted: 03/15/2013] [Indexed: 12/20/2022] Open
Abstract
The use of novel brain biomarkers using nuclear magnetic resonance imaging holds potential of making central nervous system (CNS) drug development more efficient. By evaluating changes in brain function in the disease state or drug effects on brain function, the technology opens up the possibility of obtaining objective data on drug effects in the living awake brain. By providing objective data, imaging may improve the probability of success of identifying useful drugs to treat CNS diseases across all clinical phases (I-IV) of drug development. The evolution of functional imaging and the promise it holds to contribute to drug development will require the development of standards (including good imaging practice), but, if well integrated into drug development, functional imaging can define markers of CNS penetration, drug dosing and target engagement (even for drugs that are not amenable to positron emission tomography imaging) in phase I; differentiate objective measures of efficacy and side effects and responders vs non-responders in phase II, evaluate differences between placebo and drug in phase III trials and provide insights into disease modification in phase IV trials.
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Das Arzt-Patient-Verhältnis im Sinn patientenzentrierter Medizin. Bundesgesundheitsblatt Gesundheitsforschung Gesundheitsschutz 2012; 55:1085-92. [DOI: 10.1007/s00103-012-1535-y] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
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Quality of life and related dimensions in cancer patients treated with mistletoe extract (iscador): a meta-analysis. EVIDENCE-BASED COMPLEMENTARY AND ALTERNATIVE MEDICINE 2011; 2012:219402. [PMID: 21747894 PMCID: PMC3124023 DOI: 10.1155/2012/219402] [Citation(s) in RCA: 36] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 12/17/2010] [Accepted: 04/19/2011] [Indexed: 11/18/2022]
Abstract
Objectives. The aim of this meta-analysis was to determine the effectiveness of the fermented plant extract Iscador, produced from the white-berry European mistletoe, in the treatment of patients with cancer with respect to quality-of-life- (QoL-) associated measures. Methods. We searched databases such as PubMed/Medline, Excerpta Medica Database (EMBASE), CAMbase, and other for controlled clinical studies on parameters associated with QoL. Outcome data were extracted and converted into standardized mean differences and their standard errors. Results. Thirteen prospective and controlled studies which met the inclusion/exclusion criteria reported positive effects in favor of the Iscador application. A random-effect meta-analysis estimated the overall treatment effect at standardized mean difference = 0.56 (CI: 0.41 to 0.71, P < .0001). However, the methodological quality of the studies was poor. Conclusions. The analyzed studies give some evidence that Iscador treatment might have beneficial short-time effects on QoL-associated dimensions and psychosomatic self-regulation.
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Domnick C, Lorenz J, Hauck M. Somatotopy of placebo analgesia is independent of spatial attention. J Pain Res 2011; 4:79-83. [PMID: 21559353 PMCID: PMC3085266 DOI: 10.2147/jpr.s16610] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/23/2011] [Indexed: 11/23/2022] Open
Abstract
Placebo analgesia is being increasingly appraised as an effective support of pharmacological and surgical treatments of pain. The understanding of its neurobiological and psychological basis is therefore of high clinical relevance. It has been shown that placebo analgesia is somatotopically organized and relies on endogenous opioids. However, it is not clear whether temporal fluctuations of cue-dependent spatial attention account for the site specificity of placebo analgesia or whether a somatotopic placebo effect is possible without an attentional focus on the respective location. To address this issue we induced placebo expectations for one specific foot in healthy subjects, the other foot serving as a control location. The feet were stimulated in random order by painful laser stimuli. Half of the pulses were cued for stimulus location, whereas in the other half of trials the subjects were naïve about the location. We found that about half of the subjects exhibited a somatotopic placebo effect that was statistically independent of the spatial cue. We suggest that, after the induction of an initial expectation, placebo analgesia is spatially specific but does not necessarily depend on momentary fluctuations of spatial attention. This result rather suggests that the somatotopy of placebo analgesia relies on the creation of spatially guided expectations or conditioning, but can be maintained without ongoing monitoring of the affected body part.
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Affiliation(s)
- Claudia Domnick
- Department of Neurophysiology and Pathophysiology, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | - Jürgen Lorenz
- Faculty of Life Sciences, Hamburg University of Applied Sciences, Hamburg, Germany
| | - Michael Hauck
- Department of Neurophysiology and Pathophysiology, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
- Department of Neurology, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
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Neuss H, Schomaker M, Raue W, Koplin G, Haase O. Continuous local analgesic therapy reduces pain after radical inguinal/iliacal lymph node dissection. Langenbecks Arch Surg 2010; 396:323-9. [PMID: 21188598 DOI: 10.1007/s00423-010-0735-x] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/03/2010] [Accepted: 12/12/2010] [Indexed: 11/24/2022]
Abstract
BACKGROUND To optimize postoperative pain therapy after a radical inguinal/iliacal lymph node dissection (RILND), we investigated the influence of a continuous application of a local anaesthetic via a subfascial wound catheter in the abdominal wall in addition to a standardized systemic analgesia. MATERIALS AND METHODS Between July 2007 and December 2009, 50 patients with stage III/IV of melanoma disease received, in an observational study, a systemic analgesic therapy. Of these patients, 30 were additionally treated with a subfascial catheter. Main outcome criterion was the pain under mobilisation at the first postoperative morning registered via a visual analogue score. Minor criteria were the analgesic requirement, the specific (surgical) complications and the day of discharge. RESULTS Patients treated with the subfascial catheter had significant less pain at the first postoperative morning in rest (p = 0.02) and after mobilisation (p = 0.03) without increased morbidity (p = 0.45). Less patients of the treatment group needed a supplementary analgesic medication (p = 0.01) and were able to leave hospital earlier than patients of the control group (p = 0.01). CONCLUSIONS A subfascially placed pain catheter enhances postoperative pain therapy after RILND.
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Affiliation(s)
- Heiko Neuss
- Department of General, Visceral, Thoracic and Vascular Surgery, Medical Faculty of the Humboldt University Berlin, Charité, Campus Mitte Schumannstrasse 20/21, Berlin, Germany.
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Inner Correspondence and Peacefulness with Practices among Participants in Eurythmy Therapy and Yoga: A Validation Study. EVIDENCE-BASED COMPLEMENTARY AND ALTERNATIVE MEDICINE 2010; 2011. [PMID: 20953427 PMCID: PMC2952301 DOI: 10.1155/2011/329023] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 01/20/2010] [Revised: 04/14/2010] [Accepted: 07/01/2010] [Indexed: 11/17/2022]
Abstract
Several mind body medicine interventions require an active participation of the practitioners. We intended to develop a questionnaire to operationalize and measure the “inner correspondence” of individuals practicing Yoga or Eurythmy Therapy. In an anonymous cross-sectional study we enrolled 501 individuals (61% yoga). Exploratory factor analysis (study 1) of the 12-item instrument (Cronbach's alpha = .84) pointed to a 3-factor solution, with one major scale and good internal consistency (alpha = .83) and two minor scales with weak internal consistency. To improve the quality of the main scale, we added 8 new items which were tested in a sample of 135 individuals (study 2: 71% Yoga). Factor analysis confirmed a 12-item single factor (alpha = .95), that is, Inner Correspondence/Peaceful Harmony with Practices (ICPH). The scale correlated strongly with mindfulness (FMI; r > .50), moderately with life and patient satisfaction (BMLSS; r between .32 and .43), and weakly negative with symptom score (VAS; r = −.23). In conclusion, the scale ICPH was confirmed as a relevant tool to measure the inner correspondence and feelings of peacefulness with practices. It can be used in clinical studies to assess the efficacy of mind-body practices involving physical movements.
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Gaul C, Busch V. [Impact of physiotherapy, massages and lymphatic drainage in migraine therapy]. Schmerz 2010; 23:347-54. [PMID: 19562382 DOI: 10.1007/s00482-009-0814-5] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
Abstract
Physical treatment, spinal manipulative therapy and massages are often recommended to treat migraine as a prophylactic therapy. Clinical experience and theoretical concepts support their usefulness. However, data on these therapies are scarce. On the basis of the available studies, it is impossible to determine whether or not these therapies are effective. There is a lack of well-designed prospective, randomized controlled trials with a sufficiently long follow-up to observe these therapies. Due to the high acceptance of physical treatment on the one hand and preconceptions about drug treatment on the other, these types of therapies may be an alternative option for some patients if their efficacy is established. A cost-benefit analysis of theses therapies should consider the long amount of time required for them compared with drug intake.
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Affiliation(s)
- C Gaul
- Klinik und Poliklinik für Neurologie, Westdeutsches Kopfschmerzzentrum, Universitätsklinikum Essen, Hufelandstr. 26, 45147, Essen, Deutschland.
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Breidert M, Hofbauer K. Placebo: misunderstandings and prejudices. DEUTSCHES ARZTEBLATT INTERNATIONAL 2009; 106:751-5. [PMID: 20019863 PMCID: PMC2795335 DOI: 10.3238/arztebl.2009.0751] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/16/2009] [Accepted: 05/28/2009] [Indexed: 12/12/2022]
Abstract
BACKGROUND The role of placebos is often misunderstood, leading both to overvaluation and to inappropriate disdain. The effect of a placebo that contains no pharmacologically active substance is often confused with the effect of administration by a physician. The aim of this article is to review the current data on placebos, evaluate these data critically, and provide a well-founded and understandable explanation of the effects that placebos do and do not possess. METHODS Selective literature review. RESULTS Recent studies employing modern imaging techniques have provided objective correlates of the effect of placebo administration for certain indications. A recent paper even suggested a genetic basis for it. Two main mechanisms underlie the effect of placebo administration: conditioned reflexes, which are subconscious, and the patient's expectations, which are conscious. Further factors include the physician's personality and the setting in which the treatment takes place. CONCLUSIONS The mechanisms of action of placebo administration, with which positive therapeutic effects can be achieved with little effort, should be consciously exploited by physicians when giving their patients pharmacologically active medications as well.
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Affiliation(s)
- Matthias Breidert
- Medizinische Klinik I, Kliniken im Naturpark Altmühltal, Klinik Kösching Krankenhausstr. 19 85092 Kösching, Germany
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Enck P, Zipfel S, Klosterhalfen S. Der Placeboeffekt in der Medizin. Bundesgesundheitsblatt Gesundheitsforschung Gesundheitsschutz 2009; 52:635-42. [DOI: 10.1007/s00103-009-0849-x] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/14/2022]
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