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Ohtani Y, Tani H, Nomoto-Takahashi K, Yatomi T, Yonezawa K, Tomiyama S, Nagai N, Kusudo K, Honda S, Moriyama S, Nakajima S, Yamada T, Morisaki H, Iwabuchi Y, Jinzaki M, Yoshimura K, Eiro T, Tsugawa S, Ichijo S, Fujimoto Y, Miyazaki T, Takahashi T, Uchida H. Efficacy and safety of intravenous ketamine treatment in Japanese patients with treatment-resistant depression: A double-blind, randomized, placebo-controlled trial. Psychiatry Clin Neurosci 2024. [PMID: 39210712 DOI: 10.1111/pcn.13734] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/10/2024] [Revised: 07/17/2024] [Accepted: 08/10/2024] [Indexed: 09/04/2024]
Abstract
AIM Although the antidepressant effect of ketamine on treatment-resistant depression (TRD) has been frequently reported in North American and European countries, evidence is scarce among the Asian population. We aimed to evaluate the efficacy and safety of intravenous ketamine in Japanese patients with TRD. METHODS In this double-blind randomized placebo-controlled trial, 34 Japanese patients with TRD were randomized to receive either intravenous ketamine (0.5 mg/kg) or placebo, administered over 40 min, twice a week, for 2 weeks. The primary outcome was the change in the Montgomery Åsberg Depression Rating Scale (MADRS) total score from baseline to post-treatment. Secondary outcomes included changes in other depressive symptomatology scores and remission, response, and partial response rates. We also examined the association between baseline clinical demographic characteristics and changes in the MADRS total score. RESULTS Intention-to-treat analysis indicated no significant difference in the decrease in MADRS total score between the groups (-8.1 ± 10.0 vs -2.5 ± 5.2, t[32] = 2.02, P = 0.052), whereas per-protocol analysis showed a significant reduction in the ketamine group compared to the placebo group (-9.1 ± 10.2 vs -2.7 ± 5.3, t[29] = 2.22, P = 0.034). No significant group differences were observed in other outcomes. Adverse events were more frequent in the ketamine group than in the placebo group, and no serious adverse events were reported. A higher baseline MADRS total score and body mass index were associated with a greater reduction in the MADRS total score. CONCLUSION Intravenous ketamine outperformed placebo in Japanese patients with TRD who completed the study, suggesting that ketamine could alleviate depressive symptoms of TRD across diverse ethnic populations.
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Affiliation(s)
- Yohei Ohtani
- Department of Neuropsychiatry, Keio University School of Medicine, Tokyo, Japan
| | - Hideaki Tani
- Department of Neuropsychiatry, Keio University School of Medicine, Tokyo, Japan
| | | | - Taisuke Yatomi
- Department of Neuropsychiatry, Keio University School of Medicine, Tokyo, Japan
| | - Kengo Yonezawa
- Department of Neuropsychiatry, Keio University School of Medicine, Tokyo, Japan
| | - Sota Tomiyama
- Department of Neuropsychiatry, Keio University School of Medicine, Tokyo, Japan
| | - Nobuhiro Nagai
- Department of Neuropsychiatry, Keio University School of Medicine, Tokyo, Japan
- Department of Psychiatry, Minami-Hanno Hospital, Saitama, Japan
| | - Keisuke Kusudo
- Department of Neuropsychiatry, Keio University School of Medicine, Tokyo, Japan
| | - Shiori Honda
- Department of Neuropsychiatry, Keio University School of Medicine, Tokyo, Japan
| | - Sotaro Moriyama
- Department of Neuropsychiatry, Keio University School of Medicine, Tokyo, Japan
| | - Shinichiro Nakajima
- Department of Neuropsychiatry, Keio University School of Medicine, Tokyo, Japan
| | - Takashige Yamada
- Department of Anesthesiology, Keio University School of Medicine, Tokyo, Japan
| | - Hiroshi Morisaki
- Department of Anesthesiology, Keio University School of Medicine, Tokyo, Japan
| | - Yu Iwabuchi
- Department of Radiology, Keio University School of Medicine, Tokyo, Japan
| | - Masahiro Jinzaki
- Department of Radiology, Keio University School of Medicine, Tokyo, Japan
| | - Kimio Yoshimura
- Department of Health Policy and Management, Keio University School of Medicine, Tokyo, Japan
| | - Tsuyoshi Eiro
- Department of Physiology, Yokohama City University Graduate School of Medicine, Yokohama, Japan
| | - Sakiko Tsugawa
- Department of Neuropsychiatry, Keio University School of Medicine, Tokyo, Japan
- Department of Physiology, Yokohama City University Graduate School of Medicine, Yokohama, Japan
| | - Sadamitsu Ichijo
- Department of Physiology, Yokohama City University Graduate School of Medicine, Yokohama, Japan
| | - Yu Fujimoto
- Department of Physiology, Yokohama City University Graduate School of Medicine, Yokohama, Japan
| | - Tomoyuki Miyazaki
- Department of Physiology, Yokohama City University Graduate School of Medicine, Yokohama, Japan
| | - Takuya Takahashi
- Department of Physiology, Yokohama City University Graduate School of Medicine, Yokohama, Japan
| | - Hiroyuki Uchida
- Department of Neuropsychiatry, Keio University School of Medicine, Tokyo, Japan
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Cain A, Winstein CJ, Demers M. The Perspectives of Individuals with Chronic Stroke on Motor Recovery: A Qualitative Analysis. Healthcare (Basel) 2024; 12:1523. [PMID: 39120226 PMCID: PMC11312011 DOI: 10.3390/healthcare12151523] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/11/2024] [Revised: 07/26/2024] [Accepted: 07/30/2024] [Indexed: 08/10/2024] Open
Abstract
The priorities of individuals with chronic stroke are not always reflected in clinical practice. This study provides insight into meaningful factors related to long-term motor recovery in stroke survivors. Thirty individuals with chronic stroke participated in semi-structured interviews about movement, recovery, and barriers to and facilitators of mobility and paretic arm use. The interviews were analyzed using inductive thematic analysis. Three categories, the individual, environment, and task, defined five emergent themes. Individual: (1) mindset is a strong and consistent influencer of daily physical activity and overall recovery; (2) severe physical impairment limits physical activity and recovery, regardless of other factors; and (3) a negative perception of disability impacts mindset and willingness to move in public. Environment: (4) social and physical environments influence physical activity and recovery. Task: (5) participation in meaningful activities increases physical activity and promotes long-term recovery. Strategies to incorporate paretic arm use, exercise, and encouragement from others facilitate physical activity. Insufficient paretic limb function, environmental obstacles, and fear are barriers to physical activity. Neurorehabilitation must address the factors that are meaningful to stroke survivors. Building motor capacity is essential and must be integrated with factors such as a positive mindset and proper environment. Individual differences reinforce the need for personalized care.
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Affiliation(s)
- Amelia Cain
- Division of Biokinesiology and Physical Therapy, Herman Ostrow School of Dentistry, University of Southern California, Los Angeles, CA 90033, USA;
| | - Carolee J. Winstein
- Division of Biokinesiology and Physical Therapy, Herman Ostrow School of Dentistry, University of Southern California, Los Angeles, CA 90033, USA;
- Department of Neurology, Keck School of Medicine, University of Southern California, Los Angeles, CA 90033, USA
| | - Marika Demers
- École de Réadaptation, Université de Montréal, Montreal, QC H3N 1X7, Canada;
- Institut Universitaire de Réadaptation en Déficience Physique de Montréal, Centre for Interdisciplinary Research in Rehabilitation of Greater Montreal, CIUSSS Centre-Sud-de-l’Ile de Montréal, Montreal, QC H3S 1M9, Canada
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Grosso F, Barbiani D, Cavalera C, Volpato E, Pagnini F. Risk factors associated with nocebo effects: A review of reviews. Brain Behav Immun Health 2024; 38:100800. [PMID: 39021437 PMCID: PMC11252084 DOI: 10.1016/j.bbih.2024.100800] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/27/2023] [Revised: 05/02/2024] [Accepted: 05/21/2024] [Indexed: 07/20/2024] Open
Abstract
Objective This meta-review aims to identify and categorize the risk factors that are associated with nocebo effects. The nocebo effect can exert a negative impact on treatment outcomes and have detrimental outcomes on health. Learning more about its potential predictors and risk factors is a crucial step to mitigating it. Methods Literature review studies about the risk factors for nocebo effects were searched through five databases (PubMed, Scopus, The Cochrane Library, PsycINFO, and Embase) and through grey literature. Methodological validity and risk of bias were assessed. We conducted a thematic analysis of the results of the forty-three included reviews. Results We identified nine categories of risk factors: prior expectations and learning; socio-demographic characteristics; personality and individual differences; neurodegenerative conditions; inflammatory conditions; communication of information and patient-physician relationship; drug characteristics; setting; and self-awareness. We also highlighted the main biochemical and neurophysiological mechanisms underlying nocebo effects. Conclusions Nocebo effects arise from expectations of adverse symptoms, particularly when triggered by previous negative experiences. A trusting relationship with the treating physician and clear, tailored treatment instructions can act as protective factors against a nocebo effect. Clinical implications are discussed.
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Affiliation(s)
- Francesca Grosso
- Department of Psychology, Università Cattolica del Sacro Cuore, Milan, Italy
- IRCCS Fondazione Don Carlo Gnocchi, Milan, Italy
| | - Diletta Barbiani
- Department of Psychology, Università Cattolica del Sacro Cuore, Milan, Italy
| | - Cesare Cavalera
- Department of Psychology, Università Cattolica del Sacro Cuore, Milan, Italy
| | - Eleonora Volpato
- Department of Psychology, Università Cattolica del Sacro Cuore, Milan, Italy
- IRCCS Fondazione Don Carlo Gnocchi, Milan, Italy
| | - Francesco Pagnini
- Department of Psychology, Università Cattolica del Sacro Cuore, Milan, Italy
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Zegarra-Parodi R, D’Alessandro G, Baroni F, Swidrovich J, Mehl-Madrona L, Gordon T, Ciullo L, Castel E, Lunghi C. Epistemological Flexibility in Person-Centered Care: The Cynefin Framework for (Re)Integrating Indigenous Body Representations in Manual Therapy. Healthcare (Basel) 2024; 12:1149. [PMID: 38891224 PMCID: PMC11171789 DOI: 10.3390/healthcare12111149] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/21/2024] [Revised: 05/31/2024] [Accepted: 06/02/2024] [Indexed: 06/21/2024] Open
Abstract
BACKGROUND Chiropractic, osteopathy, and physiotherapy (COP) professionals regulated outside the United States traditionally incorporate hands-on procedures aligned with their historical principles to guide patient care. However, some authors in COP research advocate a pan-professional, evidence-informed, patient-centered approach to musculoskeletal care, emphasizing hands-off management of patients through education and exercise therapy. The extent to which non-Western sociocultural beliefs about body representations in health and disease, including Indigenous beliefs, could influence the patient-practitioner dyad and affect the interpretation of pillars of evidence-informed practice, such as patient-centered care and patient expectations, remains unknown. METHODS our perspective paper combines the best available evidence with expert insights and unique viewpoints to address gaps in the scientific literature and inform an interdisciplinary readership. RESULTS A COP pan-professional approach tends to marginalize approaches, such as prevention-oriented clinical scenarios traditionally advocated by osteopathic practitioners for patients with non-Western sociocultural health assumptions. The Cynefin framework was introduced as a decision-making tool to aid clinicians in managing complex clinical scenarios and promoting evidence-informed, patient-centered, and culturally sensitive care. CONCLUSION Epistemological flexibility is historically rooted in osteopathic care, due to his Indigenous roots. It is imperative to reintroduce conceptual and operative clinical frameworks that better address contemporary health needs, promote inclusion and equality in healthcare, and enhance the quality of manual therapy services beyond COP's Western-centered perspective.
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Affiliation(s)
| | - Giandomenico D’Alessandro
- Clinical-Based Human Research Department, Foundation Centre for Osteopathic Medicine (COME) Collaboration, 65121 Pescara, Italy;
- Research Department, A.T. Still Academy Italia (ATSAI), 70124 Bari, Italy
| | | | - Jaris Swidrovich
- Leslie Dan Faculty of Pharmacy, University of Toronto, Toronto, ON M5S 3M2, Canada;
| | | | - Travis Gordon
- College of Osteopathic Medicine, Michigan State University, East Lansing, MI 48824, USA;
| | - Luigi Ciullo
- Istituto Europeo per la Medicina Osteopatica (IEMO), 16122 Genova, Italy;
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Krahé C, Koukoutsakis A, Fotopoulou A. Updating beliefs about pain following advice: Trustworthiness of social advice predicts pain expectations and experience. Cognition 2024; 246:105756. [PMID: 38442585 PMCID: PMC7616089 DOI: 10.1016/j.cognition.2024.105756] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/10/2023] [Revised: 02/09/2024] [Accepted: 02/20/2024] [Indexed: 03/07/2024]
Abstract
Prior expectations influence pain experience. These expectations, in turn, rely on prior pain experience, but they may also be socially influenced. Yet, most research has focused on self rather than social expectations about pain, and hardly any studies examined their combined effects on pain. Here, we adopted a Bayesian learning perspective to investigate how explicitly communicated social expectations ('advice about pain tolerance') affect own pain expectations, and ultimately pain tolerance, under varying conditions of social epistemic uncertainty (trustworthiness of the advice). N = 72 female participants took part in a coldpressor (cold water) task before (self-learning baseline) and after (socially-influenced learning) receiving advice about their likely pain tolerance from a confederate, the trustworthiness of whom was experimentally manipulated. We used path analysis to test the hypothesis that social advice from a highly trustworthy confederate would influence participants' expectations about pain more than advice from a less trustworthy source, and that the degree of this social influence would in turn predict pain tolerance. We further used a simplified, Bayesian learning, computational approach for explicit belief updating to examine the role of latent parameters of precision optimisation in how participants subsequently changed their future pain expectations (prospective posterior beliefs) based on the combined effect of the confederate's advice on their own pain expectations, and their own task experience. Results confirmed that participants adjusted their pain expectations towards the confederate's advice more in the high- vs. low-trustworthiness condition, and this advice taking predicted their pain tolerance. Furthermore, the confederate's trustworthiness influenced how participants weighted the confederate's advice in relation to their own expectations and task experience in forming prospective posterior beliefs. When participants received advice from a less trustworthy confederate, their own sensory experience was weighted more highly than their socially-influenced prior expectations. Thus, explicit social advice appears to impact pain by influencing one's own pain expectations, but low social trustworthiness leads to these expectations becoming more malleable to novel, sensory learning.
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Affiliation(s)
- Charlotte Krahé
- Department of Psychology, Institute of Psychiatry, Psychology, and Neuroscience, King's College London, London, United Kingdom.
| | - Athanasios Koukoutsakis
- Research Department of Clinical, Educational and Health Psychology, University College London, London, United Kingdom
| | - Aikaterini Fotopoulou
- Research Department of Clinical, Educational and Health Psychology, University College London, London, United Kingdom
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Răducan-Florea IV, Leaşu FG, Dinu EA, Rogozea LM. The Nocebo Effect: A Bias in Clinical Practice-An Ethical Approach. Am J Ther 2024:00045391-990000000-00183. [PMID: 38557480 DOI: 10.1097/mjt.0000000000001730] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 04/04/2024]
Abstract
BACKGROUND The nocebo effect is often disregarded in medical practice and is certainly much less known than the placebo effect, although, in reality, both can influence therapeutic decision making and the quality of life of patients. However, the nocebo effect raises a number of issues not only of a practical nature related to clinical activity but also ethical dilemmas related to the observance of the patient's autonomy, nonmaleficence, or informed consent and the information on which it is based. AREAS OF UNCERTAINTY The ethical dilemmas raised by the nocebo effect revolve around how informed consent can be achieved, the accuracy and volume of information that is transmitted to the patient, and how to report negative side effects of therapeutic treatment. DATA SOURCES In September 2023, a narrative analysis of the literature was conducted using a combination of keywords such as nocebo, placebo, ethics, therapeutic relationship from PubMed, Scopus, Google Scholar, and so on, as well as from official documents developed at an international level (World Health Organization), for a period of 10 years (2012-2021). RESULTS Analyzing the articles that remarked upon the significant impact of ethics in nocebo research or in the therapeutic relationship, we can state that the existence of several relevant issues of interest have been detected regarding the ethical use of nocebo and its impact in research or in clinics and thus the need for proper knowledge and management of the impact of nocebo effects. The ethical paradox of obtaining informed consent with the 2 goals, first, the need for complete information and second, the preservation of the autonomy of the patient, respectively, that of "primum non-nocere" and of avoiding unnecessary harm by revealing probable adverse effects is a point of interest for numerous studies. The potential for a nocebo effect is present when we inform patients about the risks and benefits of treatment, there being a clear link between the moral and ethical duty to inform patients and the need to avoid situations that increase the nocebo impact on how the disease or the adverse effects of the treatment are perceived. Adapting information about the side effects of medicines should focus on ensuring a balance between transparency and caution, especially in patients with a high potential for nocebo effect. CONCLUSIONS The nocebo effect had for a long time been unknown or denied, although it can interfere with the results of the treatment used. As the nocebo phenomenon becomes increasingly known in medical practice, the clinical and ethical implications are identified by medical staff, and nocebo's adverse responses are no longer ignored.
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Affiliation(s)
| | - Florin G Leaşu
- Basic, Preventive and Clinical Sciences Department, Transilvania University, Brasov, Romania
| | - Eleonora A Dinu
- Basic, Preventive and Clinical Sciences Department, Transilvania University, Brasov, Romania
| | - Liliana M Rogozea
- Basic, Preventive and Clinical Sciences Department, Transilvania University, Brasov, Romania
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7
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Caliskan EB, Bingel U, Kunkel A. Translating knowledge on placebo and nocebo effects into clinical practice. Pain Rep 2024; 9:e1142. [PMID: 38533458 PMCID: PMC10965200 DOI: 10.1097/pr9.0000000000001142] [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] [Received: 04/19/2023] [Accepted: 12/18/2023] [Indexed: 03/28/2024] Open
Abstract
Introduction Positive and negative treatment expectations are powerful modulators of health and treatment outcomes. A substantial part of treatment success is due to contextual factors modulating patient's expectations towards a treatment. Consequently, treatment expectations should be a target of therapeutic interventions themselves. Objectives This article highlights the neurobiological underpinnings of treatment expectations as well as strategies to modulate contextual factors to optimize treatment outcomes in daily clinical settings. Methods This clinical update aligns with the 2022 IASP Global Year Translating Pain Knowledge into Practice and selectively reviews the best available evidence and practice. Results The effects of treatment expectations, also known as placebo and nocebo effects, are observed in various clinical conditions and physiological systems. However, most of our knowledge comes from the field of pain, where expectation effects substantially contribute to overall analgesic treatment outcomes. Experimental placebo analgesia paradigms provide the best illustration of how analgesic effects can be attributed not only to a pharmacological or specific treatment, but instead are the result of the expectation towards the treatment. The impact of expectations on treatment outcome is highly variable between individuals, and the identification of factors predicting an individual's response has proven to be challenging. Further research is required to provide personalized treatment strategies for the daily clinical practice. Conclusion Patient's previous experiences and expectations are powerful modulators of treatment efficacy, tolerability, and adherence. By providing a comprehensive overview of recent advances in this field, this review offers valuable insights for clinicians and researchers seeking to improve patient-clinician interaction.
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Affiliation(s)
- Elif Buse Caliskan
- Department of Neurology, Center for Translational Neuro- and Behavioral Sciences (C-TNBS), University Hospital Essen, University of Duisburg-Essen, Essen, Germany
| | - Ulrike Bingel
- Department of Neurology, Center for Translational Neuro- and Behavioral Sciences (C-TNBS), University Hospital Essen, University of Duisburg-Essen, Essen, Germany
| | - Angelika Kunkel
- Department of Neurology, Center for Translational Neuro- and Behavioral Sciences (C-TNBS), University Hospital Essen, University of Duisburg-Essen, Essen, Germany
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Chamani G, Zarei MR, Rad M, Mafi S. Comparison of low-level laser therapy and standard treatment for temporomandibular disorders: An assessment of therapeutic and placebo effects. J Oral Rehabil 2024; 51:657-665. [PMID: 38012102 DOI: 10.1111/joor.13634] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/22/2023] [Revised: 11/08/2023] [Accepted: 11/20/2023] [Indexed: 11/29/2023]
Abstract
BACKGROUND Despite extensive research on the use of low-power lasers for TMD treatment, the extent of their effectiveness remains uncertain. OBJECTIVE This study aimed to investigate the therapeutic or placebo effect of LLLT for TMD, and to compare it with standard treatment methods. A unique aspect of this study was the inclusion of a control group that received only standard treatment, allowing for an assessment of the placebo effect of LLLT. METHODS A total of 42 patients with TMD were referred to Kerman Dental School Pain Clinic and were randomly assigned to three groups: group A received LLLT, group B was a placebo group and group C was a control group that received only standard treatment. The laser groups received gallium-aluminium-arsenide laser treatment twice a week for 10 sessions. Patients' jaw movement rate indicators and VAS index were evaluated at the start of treatment, and indicators were re-recorded every week for 5 weeks. SPSS 21 was used for statistical analysis, including ANOVA and Tukey's post hoc tests for inter-group comparisons. The repeated measurement test was used to analyse the data. RESULTS All groups showed significant improvement in VAS indicators (p = .0001), lateral jaw movements (p = .0001), forward jaw movement (p = .007) but not for maximum mouth opening. No significant difference was observed between the groups at the end of the study (p = .000). CONCLUSION Our study provides insights into LLLT's effectiveness for TMD, suggesting it cannot replace standard treatment alone. These findings contribute to the literature and emphasise the importance of including a control group in future studies to assess the placebo effect of LLLT.
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Affiliation(s)
- Goli Chamani
- FAAOP Diplomat, American Board of Orofacial Pain Professor of Oral Medicine and Orofacial Pain Division of Oral Diagnostics and Rehabilitation Department of Dental Medicine, Karolinska Institute Scandinavian Center for Orofacial Neuroscience (SCON) Huddinge, Huddinge, Sweden
| | - Mohammad Reza Zarei
- Oral Medicine Department, Orofacial Pain Clinic, Kerman School of Dentistry, Kerman, Iran
| | - Maryam Rad
- Oral Medicine specialist, PhD by research in Epidemiology, Kerman, Iran
| | - Sahar Mafi
- Department of Oral Medicine, Faculty of Dentistry, Tehran Medical Sciences, Islamic Azad University of Tehran, Tehran, Iran
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Cetera GE, Facchin F, Viganò P, Merli CEM, Frassineti A, Fiorini J, Somigliana E, Vercellini P. "SO FAR AWAY" How Doctors Can Contribute to Making Endometriosis Hell on Earth. A Call for Humanistic Medicine and Empathetic Practice for Genuine Person-Centered Care. A Narrative Review. Int J Womens Health 2024; 16:273-287. [PMID: 38405184 PMCID: PMC10894706 DOI: 10.2147/ijwh.s440542] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/16/2023] [Accepted: 12/13/2023] [Indexed: 02/27/2024] Open
Abstract
"SO FAR AWAY" * How Doctors Can Contribute to Making Endometriosis Hell on Earth [* by Knopfler M. In Dire Straits. Brothers in Arms. Vertigo Records, U.K., 1985]. Abstract The distance physicians may create within the relationship with their patients by not having a humanistic approach to their practice may strongly influence clinical outcomes. The purpose of this paper is to convey the well-known narrative of patient dissatisfaction into pro-action by discussing the aspects of dehumanization, which may occur in the relationship between physicians and women with endometriosis. Eight dimensions of dehumanization are examined and related to everyday scenarios occurring in endometriosis care settings and the possible downstream consequences on patients' clinical outcomes are described. Objectification, which may come across as minimization of pain, may not only increase patients' perception of pain but also lead to undertreatment of unrecognized forms of endometriosis, especially among adolescents. Passivity, that is not favoring shared decision-making nor self-management, may compromise adherence to treatment, reducing patients' trust in physicians and quality of life. The same consequences may result from homogenization, that is giving for granted that all patients have the same access to care. Both isolation, ie not practicing therapeutic empathy, and loss of meaning, ie not supporting patients in the re-definition of their life plans, may affect women's psychological wellbeing and further increase pain perception. Ignoring women's personal journey by not providing clear information on the consequences endometriosis may have on their lives may favor women's self-silencing. Not promoting an un-biased communication and not setting aside scientific polarization are the main features of dislocation, which may jeopardize patient empowerment. Lastly, having a reductionist approach to the body may contribute to chronicization of pain, thus compromising quality of life. This considered, taking time to listen to women with endometriosis and tailoring decisions on the basis of their individual needs should be fostered as a moral duty. Physicians should always keep in mind that they are not only deliverers of treatment; they are a form of treatment themselves.
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Affiliation(s)
- Giulia Emily Cetera
- Gynecology Unit, Fondazione IRCCS Ca’ Granda Ospedale Maggiore Policlinico, Milan, Italy
- Academic Center for Research on Adenomyosis and Endometriosis, Department of Clinical Sciences and Community Health, Università degli Studi di Milano, Milan, Italy
| | - Federica Facchin
- Department of Psychology, Catholic University of the Sacred Heart, Milan, Italy
| | - Paola Viganò
- Academic Center for Research on Adenomyosis and Endometriosis, Department of Clinical Sciences and Community Health, Università degli Studi di Milano, Milan, Italy
- Infertility Center, Fondazione IRCCS Ca’ Granda Ospedale Maggiore Policlinico, Milan, Italy
| | | | - Annalisa Frassineti
- Associazione Progetto Endometriosi Organizzazione di Volontariato, Reggio Emilia, Italy
| | - Jessica Fiorini
- Associazione Progetto Endometriosi Organizzazione di Volontariato, Reggio Emilia, Italy
| | - Edgardo Somigliana
- Academic Center for Research on Adenomyosis and Endometriosis, Department of Clinical Sciences and Community Health, Università degli Studi di Milano, Milan, Italy
- Infertility Center, Fondazione IRCCS Ca’ Granda Ospedale Maggiore Policlinico, Milan, Italy
| | - Paolo Vercellini
- Gynecology Unit, Fondazione IRCCS Ca’ Granda Ospedale Maggiore Policlinico, Milan, Italy
- Academic Center for Research on Adenomyosis and Endometriosis, Department of Clinical Sciences and Community Health, Università degli Studi di Milano, Milan, Italy
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Caumo W, Lopes Ramos R, Vicuña Serrano P, da Silveira Alves CF, Medeiros L, Ramalho L, Tomeddi R, Bruck S, Boher L, Sanches PRS, Silva DP, Ls Torres I, Fregni F. Efficacy of Home-Based Transcranial Direct Current Stimulation Over the Primary Motor Cortex and Dorsolateral Prefrontal Cortex in the Disability Due to Pain in Fibromyalgia: A Factorial Sham-Randomized Clinical Study. THE JOURNAL OF PAIN 2024; 25:376-392. [PMID: 37689323 DOI: 10.1016/j.jpain.2023.09.001] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/31/2023] [Revised: 08/07/2023] [Accepted: 09/01/2023] [Indexed: 09/11/2023]
Abstract
This randomized, double-blind, controlled clinical trial compared the effectiveness of home-based-(HB) active transcranial direct current stimulation (a-tDCS) over the left dorsolateral prefrontal cortex (l-DLPFC) or primary motor cortex (M1) with their respective sham-(s)-tDCS to determine whether a-tDCS would be more effective than s-tDCS in reducing pain and improving disability due to pain. The study included 102 patients with fibromyalgia aged 30 to 65 years old randomly assigned to 1 of 4 tDCS groups using a ratio of 2:1:2:1. The groups included l-DLPFC (a-tDCS, n = 34) and (s-tDCS, n = 17), or tDCS on the M1 (a-tDCS, n = 34) or (s-tDCS, n = 17). Patients self-administered 20 sessions of tDCS, with 2 mA for 20 minutes each day under remote supervision after in-person training. The Mixed Model for Repeated Measurements revealed that a-tDCS on DLPFC significantly reduced pain scores by 36.53% compared to 25.79% in s-tDCS. From baseline to the fourth week of treatment, a-tDCS on M1 reduced pain scores by 45.89% compared to 22.92% over s-tDCS. A generalized linear model showed a significant improvement in the disability scale in the groups that received a-tDCS compared to s-tDCS over M1 20.54% versus 2.49% (χ2 = 11.06, df = 1, P < .001]), while on DLPFC the improvement was 14.29% and 5.77%, with a borderline significance (χ2 = 3.19, df = 1, P = .06]), respectively. A higher reduction in serum brain-derived neurotrophic factor from baseline to treatment end was positively correlated with decreased pain scores regardless of the treatment group. The application of a-tDCS over M1 increased the heat pain threshold and the function of the descending pain inhibitory system. PERSPECTIVE: These findings provide important insights: (1) HB-tDCS has effectively reduced pain scores and improved disability due to fibromyalgia. (2) The study provides evidence that HB-a-tDCS is a viable and effective therapeutic approach. (3) HB-a-tDCS over M1 improved the function of the descending pain inhibitory system and increased the heat pain threshold. Finally, our findings also emphasize that brain-derived neurotrophic factor, as an index of neuroplasticity, may serve as a valuable marker associated with changes in clinical pain measures. TRIAL REGISTRATION: Number NCT03843203.
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Affiliation(s)
- Wolnei Caumo
- Post-Graduate Program in Medical Sciences, School of Medicine, Universidade Federal do Rio Grande do Sul (UFRGS), Porto Alegre, Rio Grande do Sul, Brazil; Laboratory of Pain and Neuromodulation at Hospital de Clínicas de Porto Alegre (HCPA), Porto Alegre, Rio Grande do Sul, Brazil; Pain and Palliative Care Service at HCPA, UFRGS, Porto Alegre, Rio Grande do Sul, Brazil; Department of Surgery, School of Medicine, Porto Alegre, Rio Grande do Sul, Brazil
| | - Rael Lopes Ramos
- Post-Graduate Program in Medical Sciences, School of Medicine, Universidade Federal do Rio Grande do Sul (UFRGS), Porto Alegre, Rio Grande do Sul, Brazil
| | - Paul Vicuña Serrano
- Post-Graduate Program in Medical Sciences, School of Medicine, Universidade Federal do Rio Grande do Sul (UFRGS), Porto Alegre, Rio Grande do Sul, Brazil
| | - Camila Fernanda da Silveira Alves
- Post-Graduate Program in Medical Sciences, School of Medicine, Universidade Federal do Rio Grande do Sul (UFRGS), Porto Alegre, Rio Grande do Sul, Brazil; Laboratory of Pain and Neuromodulation at Hospital de Clínicas de Porto Alegre (HCPA), Porto Alegre, Rio Grande do Sul, Brazil
| | - Liciane Medeiros
- Post-Graduate Program in Medical Sciences, School of Medicine, Universidade Federal do Rio Grande do Sul (UFRGS), Porto Alegre, Rio Grande do Sul, Brazil; Pain Pharmacology and Neuromodulation Laboratory, Preclinical Investigations, Experimental Research Center, Hospital de Clínicas de Porto Alegre (HCPA), Porto Alegre, Rio Grande do Sul, Brazil; Postgraduate Program in Health and Human Development, La Salle University, Canoas, Rio Grande do Sul, Brazil
| | - Leticia Ramalho
- Post-Graduate Program in Medical Sciences, School of Medicine, Universidade Federal do Rio Grande do Sul (UFRGS), Porto Alegre, Rio Grande do Sul, Brazil
| | - Rafalea Tomeddi
- Laboratory of Pain and Neuromodulation at Hospital de Clínicas de Porto Alegre (HCPA), Porto Alegre, Rio Grande do Sul, Brazil
| | - Samara Bruck
- Laboratory of Pain and Neuromodulation at Hospital de Clínicas de Porto Alegre (HCPA), Porto Alegre, Rio Grande do Sul, Brazil
| | - Lucas Boher
- Laboratory of Pain and Neuromodulation at Hospital de Clínicas de Porto Alegre (HCPA), Porto Alegre, Rio Grande do Sul, Brazil; Pain and Palliative Care Service at HCPA, UFRGS, Porto Alegre, Rio Grande do Sul, Brazil; Department of Surgery, School of Medicine, Porto Alegre, Rio Grande do Sul, Brazil
| | - Paulo R S Sanches
- Laboratory of Biomedical Engineer at HCPA, Porto Alegre, Rio Grande do Sul, Brazil
| | - Danton P Silva
- Laboratory of Biomedical Engineer at HCPA, Porto Alegre, Rio Grande do Sul, Brazil
| | - Iraci Ls Torres
- Post-Graduate Program in Medical Sciences, School of Medicine, Universidade Federal do Rio Grande do Sul (UFRGS), Porto Alegre, Rio Grande do Sul, Brazil; Pain Pharmacology and Neuromodulation Laboratory, Preclinical Investigations, Experimental Research Center, Hospital de Clínicas de Porto Alegre (HCPA), Porto Alegre, Rio Grande do Sul, Brazil
| | - Felipe Fregni
- Laboratory of Neuromodulation and Center for Clinical Research Learning, Physics and Rehabilitation Department, Spaulding Rehabilitation Hospital, Boston, Massachusetts
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Bechrakis NE, Gass P. Leadership in ophthalmology by humanity and competence. DIE OPHTHALMOLOGIE 2024; 121:40-47. [PMID: 38189959 DOI: 10.1007/s00347-023-01970-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Accepted: 12/07/2023] [Indexed: 01/09/2024]
Abstract
Leadership in healthcare institutions has a direct impact on the practice of the medical and nursing professions. The respective leadership style that is cultivated in a medical institution therefore has a direct impact on the personnel and thus a direct impact on the treatment of patients, in both senses of the word. Leadership in healthcare should therefore inspire, motivate, and guide healthcare workers to use their individual and collective skills as well as the available resources in the best possible way for the benefit of patients. This is the task and obligation of all those working in the healthcare system. The German Society of Ophthalmology (DOG) has established a leadership academy for ophthalmologists to meet the requirements of the modern healthcare market for leadership qualifications.
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Affiliation(s)
- Nikolaos E Bechrakis
- Klinik für Augenheilkunde, Universitätsmedizin Essen, Hufelandstr. 55, 45417, Essen, Germany.
- Deutsche Ophthalmologische Gesellschaft, Platenstraße 1, 80336, München, Germany.
| | - Philip Gass
- Deutsche Ophthalmologische Gesellschaft, Platenstraße 1, 80336, München, Germany
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12
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Parsamanesh P, Vysochyn M. A Psychological Exploration of the Power of Our Mindset and Its Influence on Physiological Health. Cureus 2024; 16:e52505. [PMID: 38371054 PMCID: PMC10874242 DOI: 10.7759/cureus.52505] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 01/17/2024] [Indexed: 02/20/2024] Open
Abstract
The brain is the control center for our bodies and determines our emotions, thoughts, and actions. From a psychological perspective, the mind can assist humans in manifesting a more remarkable life for themselves or hinder their abilities and result in unfulfilled potential. Considering the power of the mind, it is interesting to study the psychology of the mind and its direct influence on our physiological health. In medical terms, this effect is known as the placebo effect, where the mind and body connect on a stronger level and can assist in the betterment of an individual's physiological health. On the contrary, the mind can also assist in deteriorating one's physiological health by believing the medical intervention will cause them harm, known as the nocebo effect. Therefore, the mind holds much power when studying how deeply it is connected to and can influence one's physiological health. A comprehensive literature review was conducted using the Medical Subject Headings (MeSH) terms "Mindset," "Influence," and "Health" on the PubMed database. The initial search generated 115 results and was narrowed by assessing each article and applying specific inclusion and exclusion criteria. As a result, nine articles were carefully selected for this review.
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13
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Descamps E, Boussac M, Joineau K, Payoux P. Changes of cerebral functional connectivity induced by foot reflexology in a RCT. Sci Rep 2023; 13:17139. [PMID: 37816799 PMCID: PMC10564852 DOI: 10.1038/s41598-023-44325-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/20/2023] [Accepted: 10/06/2023] [Indexed: 10/12/2023] Open
Abstract
Non-Pharmacological Interventions (NPIs) are increasingly being introduced into healthcare, but their mechanisms are unclear. In this study, 30 healthy participants received foot reflexology (FR) and sham massage, and went through a resting-state functional magnetic resonance imaging (rs-fMRI) to evaluate NPIs effect on brain. Rs-fMRI revealed an effect of both NPIs on functional connectivity with changes occurring in the default-mode network, the sensorimotor network and a Neural Network Correlates of Pain (NNCP-a newly discovered network showing great robustness). Even if no differences were found between FR and SM, this study allowed to report brain biomarkers of well-being as well as the safety of NPIs. In further research, it could be relevant to study it in patients to look for a true reflexology induced-effect dependent of patient reported outcomes. Overall, these findings enrich the understanding of the neural correlates of well-being experienced with NPIs and provided insight into the basis of the mechanisms of NPIs.
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Affiliation(s)
- Emeline Descamps
- Inserm Unité ToNIC, UMR 1214, CHU PURPAN - Pavillon BAUDOT, Place du Dr Joseph Baylac, 31024, Toulouse CEDEX 3, France.
- CNRS, Toulouse, France.
| | - Mathilde Boussac
- Inserm Unité ToNIC, UMR 1214, CHU PURPAN - Pavillon BAUDOT, Place du Dr Joseph Baylac, 31024, Toulouse CEDEX 3, France.
| | - Karel Joineau
- Inserm Unité ToNIC, UMR 1214, CHU PURPAN - Pavillon BAUDOT, Place du Dr Joseph Baylac, 31024, Toulouse CEDEX 3, France
| | - Pierre Payoux
- Inserm Unité ToNIC, UMR 1214, CHU PURPAN - Pavillon BAUDOT, Place du Dr Joseph Baylac, 31024, Toulouse CEDEX 3, France
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14
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Olbort C, Pfanne F, Schwahn C, Bernhardt O. Training of the lateral pterygoid muscle in the treatment of temporomandibular joint disc displacement with reduction: A randomised clinical trial. J Oral Rehabil 2023; 50:921-930. [PMID: 37226632 DOI: 10.1111/joor.13517] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/12/2022] [Revised: 05/04/2023] [Accepted: 05/16/2023] [Indexed: 05/26/2023]
Abstract
BACKGROUND Disc displacement with reduction (DDwR) therapy should be performed only when pain or discomfort is presented. Data on treatment options for painful DDwR are very limited. OBJECTIVE The aim was to investigate whether isometric training of the lateral pterygoid muscle (LPM) is equivalent to stabilisation appliance therapy with regard to the treatment of painful DDwR. The training program is based on the science of Janda. METHODS This was a prospective, randomised study with a comparative treatment group. Sixty patients (≥18 years) with DDwR and pain were randomly assigned to two groups: (1) muscle training and (2) stabilisation appliance. The following variables were recorded at baseline examination and after 2, 4 and 6 months: changes in orofacial pain, clicking sounds of the temporomandibular joint (TMJ), force degrees for the lateral movement of the mandible and interincisal opening distance. p values of <.05 were considered statistically significant but 95% confidence intervals were also presented. RESULTS A decrease in orofacial pain intensity was seen in both groups (p < .0001). Registered TMJ clicking disappeared after 6 months of treatment in 37% (n = 11) of the patients in the training group and in 27% (n = 8) of the appliance group (p = .0009 and p = .0047). Muscle training showed 27 improvements in Janda force degrees at the end of the study (p < .0001). CONCLUSION Muscle training and appliance therapy improved mouth opening and reduced pain intensity in both patient groups. Muscle training might be a promising option in the treatment of patients suffering from painful DDwR.
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Affiliation(s)
- Christin Olbort
- Dental Practice, with Focus on Temporomandibular Disorders, Competence Centre, Steina, Germany
| | - Falk Pfanne
- Dental Practice, with Focus on Temporomandibular Disorders, Competence Centre, Steina, Germany
| | - Christian Schwahn
- Department of Prosthetic Dentistry, Gerodontology and Biomaterials, University Medicine Greifswald, Greifswald, Germany
| | - Olaf Bernhardt
- Department of Restorative Dentistry, Periodontology, Endodontology, Preventive Dentistry and Pediatric Dentistry, University Medicine Greifswald, Greifswald, Germany
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15
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Bechrakis NE, Gass P. [Leadership in ophthalmology by humanity and competence]. DIE OPHTHALMOLOGIE 2023; 120:887-897. [PMID: 37582889 DOI: 10.1007/s00347-023-01909-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Accepted: 07/27/2023] [Indexed: 08/17/2023]
Abstract
Leadership in healthcare institutions has a direct impact on the practice of the medical and nursing professions. The respective leadership style that is cultivated in a medical institution therefore has a direct impact on the personnel and thus a direct impact on the treatment of patients, in both senses of the word. Leadership in healthcare should therefore inspire, motivate, and guide healthcare workers to use their individual and collective skills as well as the available resources in the best possible way for the benefit of patients. This is the task and obligation of all those working in the healthcare system. The German Society of Ophthalmology (DOG) has established a leadership academy for ophthalmologists to meet the requirements of the modern healthcare market for leadership qualifications.
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Affiliation(s)
- Nikolaos E Bechrakis
- Klinik für Augenheilkunde, Universitätsmedizin Essen, Hufelandstr. 55, 45417, Essen, Deutschland.
- Deutsche Ophthalmologische Gesellschaft, Platenstraße 1, 80336 München, Deutschland.
| | - Philip Gass
- Deutsche Ophthalmologische Gesellschaft, Platenstraße 1, 80336 München, Deutschland
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16
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Li RJ, Zhang QQ, Feng YQ, Pei QQ, He XX, Chen FP, Wang DK, Liu XH, Liu JS, Hou XH, Bai T. Nocebo response intensity and influencing factors in the randomized clinical trials of functional dyspepsia: A systematic review and meta-analysis. J Dig Dis 2023; 24:440-451. [PMID: 37577771 DOI: 10.1111/1751-2980.13216] [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: 02/01/2023] [Revised: 05/28/2023] [Accepted: 08/07/2023] [Indexed: 08/15/2023]
Abstract
OBJECTIVES In this study we aimed to evaluate the nocebo response rate in patients with functional dyspepsia (FD) and to explore its influencing factors. METHODS A literature search of the EMBASE, PubMed, and Cochrane Library databases was conducted for all articles published up to March 2021. Randomized, parallel-designed, placebo-controlled trials on pharmacological interventions for patients with FD were included. A meta-analysis that utilized random effects to analyze the incidence of adverse events (AEs) among participants who were given placebo was conducted, and the correlation between trial characteristics and the magnitude of the nocebo response rate was analyzed. RESULTS Altogether, 27 studies including 1866 paitents were deemed eligible and included in the analysis. The total nocebo response rate was 26% (95% confidence interval [CI] 18%-33%). The most frequently reported AEs included nasopharyngitis (9%), constipation (6%), headache (5%), and diarrhea (3%). There were significant differences in nocebo response rates among studies conducted in different country or region, treatment duration, types of medication, sponsorship and different versions of the Rome criteria used for FD diagnosis. While number of centers engaged in the study, types of FD diagnosis and dosing frequency were not significantly associated with the nocebo response rate. CONCLUSIONS Patients with FD exhibit notable nocebo response strength in clinical trials. The researchers should adopt a more careful approach when analyzing the relationships between AEs and interventions in such trials.
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Affiliation(s)
- Rui Jie Li
- Division of Gastroenterology, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, Hubei Province, China
| | - Qing Qing Zhang
- Division of Gastroenterology, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, Hubei Province, China
| | - Yu Qing Feng
- Division of Gastroenterology, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, Hubei Province, China
| | - Qiao Qiao Pei
- Division of Gastroenterology, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, Hubei Province, China
| | - Xuan Xuan He
- Division of Gastroenterology, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, Hubei Province, China
| | - Fu Ping Chen
- Division of Gastroenterology, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, Hubei Province, China
| | - Dong Ke Wang
- Division of Gastroenterology, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, Hubei Province, China
| | - Xing Huang Liu
- Division of Gastroenterology, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, Hubei Province, China
| | - Jin Song Liu
- Division of Gastroenterology, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, Hubei Province, China
| | - Xiao Hua Hou
- Division of Gastroenterology, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, Hubei Province, China
| | - Tao Bai
- Division of Gastroenterology, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, Hubei Province, China
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Boyer L, Auquier P, Yon DK, Llorca PM, Fond G. Reducing Health Inequalities in Individuals with Severe Mental Disorders: Harnessing Real-World Data and Patient-Reported Measures. J Clin Med 2023; 12:4481. [PMID: 37445517 DOI: 10.3390/jcm12134481] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/07/2023] [Revised: 06/13/2023] [Accepted: 06/21/2023] [Indexed: 07/15/2023] Open
Abstract
Mental disorders are the leading cause of diminished lifespans worldwide and make up 5 of the top 10 most significant causes of disability [...].
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Affiliation(s)
- Laurent Boyer
- CEReSS-Health Service Research and Quality of Life Center, Aix-Marseille University, 13005 Marseille, France
| | - Pascal Auquier
- CEReSS-Health Service Research and Quality of Life Center, Aix-Marseille University, 13005 Marseille, France
| | - Dong Keon Yon
- Center for Digital Health, Medical Science Research Institute, Kyung Hee University College of Medicine, Seoul 130-701, Republic of Korea
- Department of Pediatrics, Kyung Hee University Medical Center, Kyung Hee University College of Medicine, Seoul 130-701, Republic of Korea
| | - Pierre-Michel Llorca
- Department of Psychiatry B, CHU Clermont-Ferrand, Institut Pascal, Axe TGI, CNRS-UMR 6602, Université Clermont Auvergne, 63011 Clermont-Ferrand, France
| | - Guillaume Fond
- CEReSS-Health Service Research and Quality of Life Center, Aix-Marseille University, 13005 Marseille, France
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18
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Gosmann NP, Costa MDA, Jaeger MDB, Frozi J, Spanemberg L, Manfro GG, Cortese S, Cuijpers P, Pine DS, Salum GA. Incidence of adverse events and comparative tolerability of selective serotonin reuptake inhibitors, and serotonin and norepinephrine reuptake inhibitors for the treatment of anxiety, obsessive-compulsive, and stress disorders: a systematic review and network meta-analysis. Psychol Med 2023; 53:3783-3792. [PMID: 37278215 DOI: 10.1017/s0033291723001630] [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] [Indexed: 06/07/2023]
Abstract
Selective serotonin reuptake inhibitors (SSRIs) and serotonin and norepinephrine reuptake inhibitors (SNRIs) show similar efficacy as treatments for anxiety, obsessive-compulsive, and stress-related disorders. Hence, comparisons of adverse event rates across medications are an essential component of clinical decision-making. We aimed to compare patterns of adverse events associated with SSRIs and SNRIs in the treatment of children and adults diagnosed with these disorders through a network meta-analysis. We searched MEDLINE, PsycINFO, Embase, Cochrane, websites of regulatory agencies, and international registers from inception to 09 September 2022, for randomized controlled trials assessing the efficacy of SSRIs or SNRIs. We analyzed the proportion of participants experiencing at least one adverse event and incidence rates of 17 specific adverse events. We estimated incidence rates and odds ratios through network meta-analysis with random effects and three-level models. We analyzed 799 outcome measures from 80 studies (n = 21 338). Participants in medication groups presented higher rates of adverse events (80.22%, 95% CI 76.13-83.76) when compared to placebo groups (71.21%, 67.00-75.09). Nausea was the most common adverse event (25.71%, CI 23.96-27.54), while weight change was the least common (3.56%, 1.68-7.37). We found higher rates of adverse events of medications over placebo for most medications, except sertraline and fluoxetine. We found significant differences between medications for overall tolerability and for autonomic, gastrointestinal, and sleep-related symptoms. Adverse events are a common reason that patients discontinue SSRIs and SNRIs. Results presented here guide clinical decision-making when clinicians weigh one medication over another. This might improve treatment acceptability and compliance.
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Affiliation(s)
- Natan Pereira Gosmann
- Section of Negative Affect and Social Processes, Hospital de Clínicas de Porto Alegre, Universidade Federal do Rio Grande do Sul, Porto Alegre, Brazil
- Anxiety Disorders Outpatient Program, Hospital de Clínicas de Porto Alegre, Universidade Federal do Rio Grande do Sul, Porto Alegre, Brazil
- Postgraduate Program in Psychiatry and Behavioral Sciences, Hospital de Clínicas de Porto Alegre, Universidade Federal do Rio Grande do Sul, Porto Alegre, Brazil
| | - Marianna de Abreu Costa
- Anxiety Disorders Outpatient Program, Hospital de Clínicas de Porto Alegre, Universidade Federal do Rio Grande do Sul, Porto Alegre, Brazil
| | - Marianna de Barros Jaeger
- Anxiety Disorders Outpatient Program, Hospital de Clínicas de Porto Alegre, Universidade Federal do Rio Grande do Sul, Porto Alegre, Brazil
| | - Júlia Frozi
- Section of Negative Affect and Social Processes, Hospital de Clínicas de Porto Alegre, Universidade Federal do Rio Grande do Sul, Porto Alegre, Brazil
| | - Lucas Spanemberg
- School of Medicine, Pontifícia Universidade Católica do Rio Grande do Sul, Porto Alegre, Brazil
| | - Gisele Gus Manfro
- Anxiety Disorders Outpatient Program, Hospital de Clínicas de Porto Alegre, Universidade Federal do Rio Grande do Sul, Porto Alegre, Brazil
- Postgraduate Program in Psychiatry and Behavioral Sciences, Hospital de Clínicas de Porto Alegre, Universidade Federal do Rio Grande do Sul, Porto Alegre, Brazil
| | - Samuele Cortese
- School of Psychology, Faculty of Environmental and Life Sciences, University of Southampton, Southampton, UK
| | - Pim Cuijpers
- Department of Clinical, Neuro and Developmental Psychology, Amsterdam Public Health Research Institute, Vrije Universiteit Amsterdam, Amsterdam, Netherlands
| | - Daniel Samuel Pine
- Emotion and Development Branch, Section on Development and Affective Neuroscience, National Institute of Mental Health, Bethesda, USA
| | - Giovanni Abrahão Salum
- Section of Negative Affect and Social Processes, Hospital de Clínicas de Porto Alegre, Universidade Federal do Rio Grande do Sul, Porto Alegre, Brazil
- Postgraduate Program in Psychiatry and Behavioral Sciences, Hospital de Clínicas de Porto Alegre, Universidade Federal do Rio Grande do Sul, Porto Alegre, Brazil
- Child Mind Institute, New York, New York, USA
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Gossenheimer AN, de Freitas MB, Pádua Borges RD, Pohlmann L, Dalzochio M, Todendi P, Ziegelmann PK, Telo GH, Schaan EBD. The power of the placebo effect in diabetes: A systematic review and meta-analysis. Prim Care Diabetes 2023; 17:221-228. [PMID: 37003927 DOI: 10.1016/j.pcd.2023.03.006] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/30/2022] [Revised: 02/16/2023] [Accepted: 03/22/2023] [Indexed: 04/03/2023]
Abstract
This review aims to identify the magnitude of the placebo effect in people with type 2 diabetes mellitus. Literature research was conducted Medline, Embase and Virtual Health Library for studies published between the date of inception and June 2021. The eligibility criteria included randomized controlled trials, showing comparison to placebo, having participants with type 2 diabetes mellitus, and having glycated hemoglobin (HbA1c) as the primary outcome. Meta-analysis was conducted with the effect of changing HbA1c in relation to the baseline. Exploration of heterogeneity was performed.The meta-analysis showed an increase in the average of HbA1c compared to the baseline of 0.14% (95% CI: 0.07-0.21). There was a significant difference between follow-up times (p = 0.03) and between administration routes (p = 0.01), with an increase in HbA1c in the oral route [0.15% (95% CI: 0.07-0.23)]. The meta-regression of the year of publication showed a significant downward trend (p = 0.01) of the increase in HbA1c compared to the baseline.In this study, the expected placebo effect of Hba1c reduction was not found; instead, higher Hba1c levels were observed in the control groups, although this effect was reduced over the years. Registration: PROSPERO ID CRD42020172797.
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Affiliation(s)
- Agnes Nogueira Gossenheimer
- Department of Internal Medicine, Faculty of Medicine, Graduate Program in Medical Sciences: Endocrinology, Federal University of Rio Grande do Sul, Porto Alegre, Brazil.
| | | | | | | | | | - Pâmela Todendi
- Department of Internal Medicine, Faculty of Medicine, Graduate Program in Medical Sciences: Endocrinology, Federal University of Rio Grande do Sul, Porto Alegre, Brazil
| | - Patrícia Klarmann Ziegelmann
- Department of Statistics and the Postgraduate Program in Cardiology and Cardiovascular Sciences at Federal University of Rio Grande do Sul, Porto Alegre, Brazil
| | - Gabriela H Telo
- School of Medicine, Graduate Program in Medicine and Health Sciences, Pontifical Catholic University of Rio Grande do Sul, Porto Alegre, Brazil
| | - E Beatriz D Schaan
- Department of Internal Medicine, Faculty of Medicine, Graduate Program in Medical Sciences: Endocrinology, Federal University of Rio Grande do Sul, Porto Alegre, Brazil; Endocrine Division, Hospital de Clínicas de Porto Alegre, Porto Alegre, Brazil
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Aran A, Harel M, Ovadia A, Shalgy S, Cayam-Rand D. Mediators of Placebo Response to Cannabinoid Treatment in Children with Autism Spectrum Disorder. J Clin Med 2023; 12:jcm12093098. [PMID: 37176538 PMCID: PMC10179251 DOI: 10.3390/jcm12093098] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/14/2023] [Revised: 04/20/2023] [Accepted: 04/21/2023] [Indexed: 05/15/2023] Open
Abstract
The placebo response has a substantial impact on treatment outcome. However, data regarding mediators of the placebo response in children with autism spectrum disorder (ASD) are sparse. This retrospective study investigated possible mediators of the placebo response among participants of a placebo-controlled trial of cannabinoid treatment for behavioral problems in children with ASD (CBA trial, age 5-21 years). We used a specifically designed questionnaire to explore possible mediators of the placebo response in 88 participants of the CBA trial who received a placebo and had valid outcome scores. The parents of 67 participants completed the questionnaire. The placebo response was positively associated with the child's comprehension of the treatment purpose (p = 0.037). There was also a trend for participants who had a relative aggravation of symptoms before treatment onset to improve following placebo treatment (p = 0.053). No other domains, including parental expectations, previous positive experience with similar treatments (behavioral conditioning), parental locus of control, quality of the patient-physician relationships, and adherence to study medications were associated with placebo-response. This finding suggests that efforts to explain the treatment purpose to children with disabilities may enhance treatment efficacy in clinical practice and decrease differences in the placebo response between study arms. Contrary to our hypothesis, parental expectations regarding cannabinoid treatment were not associated with the placebo response.
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Affiliation(s)
- Adi Aran
- Neuropediatric Unit, Shaare Zedek Medical Center, Jerusalem 9103102, Israel
- Faculty of Medicine, Hebrew University of Jerusalem, Jerusalem 9112102, Israel
| | - Moria Harel
- Neuropediatric Unit, Shaare Zedek Medical Center, Jerusalem 9103102, Israel
| | - Aminadav Ovadia
- Psychology Department, Yezreel Valley College, Yezreel Valley 1930600, Israel
| | - Shulamit Shalgy
- Psychology Department, Yezreel Valley College, Yezreel Valley 1930600, Israel
| | - Dalit Cayam-Rand
- Neuropediatric Unit, Shaare Zedek Medical Center, Jerusalem 9103102, Israel
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21
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Sherriff B, Clark C, Killingback C, Newell D. Musculoskeletal practitioners' perceptions of contextual factors that may influence chronic low back pain outcomes: a modified Delphi study. Chiropr Man Therap 2023; 31:12. [PMID: 37020314 PMCID: PMC10075502 DOI: 10.1186/s12998-023-00482-4] [Citation(s) in RCA: 5] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/07/2022] [Accepted: 03/03/2023] [Indexed: 04/07/2023] Open
Abstract
BACKGROUND Optimal shaping of contextual factors (CFs) during clinical encounters may be associated with analgesic responses in treatments for musculoskeletal pain. These CFs (i.e., the patient-practitioner relationship, patient's and practitioner's beliefs/characteristics, treatment characteristics, and environment) have not been widely evaluated by musculoskeletal practitioners. Understanding their views has the potential to improve treatment quality and effectiveness. Drawing on a panel of United Kingdom practitioners' expertise, this study aimed to investigate their perceptions of CFs during the management of patients presenting with chronic low back pain (LBP). METHODS A modified two-round online Delphi-consensus survey was conducted to measure the extent of panel agreement regarding the perceived acceptability and influence of five main types of CFs during clinical management of patients with chronic LBP. Qualified musculoskeletal practitioners in the United Kingdom providing regular treatment for patients with chronic LBP were invited to take part. RESULTS The successive Delphi rounds included 39 and 23 panellists with an average of 19.9 and 21.3 years of clinical experience respectively. The panel demonstrated a high degree of consensus regarding approaches to enhance the patient-practitioner relationship (18/19 statements); leverage their own characteristics/beliefs (10/11 statements); modify the patient's beliefs and consider patient's characteristics (21/25 statements) to influence patient outcomes during chronic LBP rehabilitation. There was a lower degree of consensus regarding the influence and use of approaches related to the treatment characteristics (6/12 statements) and treatment environment (3/7 statements), and these CFs were viewed as the least important. The patient-practitioner relationship was rated as the most important CF, although the panel were not entirely confident in managing a range of patients' cognitive and emotional needs. CONCLUSION This Delphi study provides initial insights regarding a panel of musculoskeletal practitioners' attitudes towards CFs during chronic LBP rehabilitation in the United Kingdom. All five CF domains were perceived as capable of influencing patient outcomes, with the patient-practitioner relationship being perceived as the most important CF during routine clinical practice. Musculoskeletal practitioners may require further training to enhance their proficiency and confidence in applying essential psychosocial skills to address the complex needs of patients with chronic LBP.
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Affiliation(s)
- Bronwyn Sherriff
- Department of Rehabilitation and Sport Sciences, Faculty of Health and Social Sciences, Bournemouth University, 504 Bournemouth Gateway Building, 10 St Paul's Lane, Bournemouth, Dorset, BH8 8AJ, England.
- AECC University College, Bournemouth, England.
| | - Carol Clark
- Department of Rehabilitation and Sport Sciences, Faculty of Health and Social Sciences, Bournemouth University, 504 Bournemouth Gateway Building, 10 St Paul's Lane, Bournemouth, Dorset, BH8 8AJ, England
| | - Clare Killingback
- Department of Sport, Health and Exercise Sciences, Faculty of Health Sciences, University of Hull, Hull, England
| | - Dave Newell
- AECC University College, Bournemouth, England
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22
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Measuring Patient Experience and Patient Satisfaction—How Are We Doing It and Why Does It Matter? A Comparison of European and U.S. American Approaches. Healthcare (Basel) 2023; 11:healthcare11060797. [PMID: 36981454 PMCID: PMC10048416 DOI: 10.3390/healthcare11060797] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/22/2022] [Revised: 01/12/2023] [Accepted: 02/28/2023] [Indexed: 03/12/2023] Open
Abstract
(1) Background: Patients’ experiences and satisfaction with their treatment are becoming increasingly important in the context of quality assurance, but the measurement of these parameters is accompanied by several disadvantages such as poor cross-country comparability and methodological problems. The aim of this review is to describe and summarize the process of measuring, publishing, and utilizing patient experience and satisfaction data in countries with highly developed healthcare systems in Europe (Germany, Sweden, Finland, Norway, the United Kingdom) and the USA to identify possible approaches for improvement. (2) Methods: Articles published between 2000 and 2021 that address the topics described were identified. Furthermore, patient feedback in social media and the influence of sociodemographic and hospital characteristics on patient satisfaction and experience were evaluated. (3) Results: The literature reveals that all countries perform well in collecting patient satisfaction and experience data and making them publicly available. However, due to the use of various different questionnaires, comparability of the results is difficult, and consequences drawn from these data remain largely unclear. (4) Conclusions: Surveying patient experience and satisfaction with more unified as well as regularly updated questionnaires would be helpful to eliminate some of the described problems. Additionally, social media platforms must be considered as an increasingly important source to expand the range of patient feedback.
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23
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Bussod L, Nerich V, Girard C, Pudlo M. La composante placebo des traitements de la douleur, vers une optimisation de l’efficacité. ACTUALITES PHARMACEUTIQUES 2023. [DOI: 10.1016/j.actpha.2023.01.012] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/12/2023]
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24
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Widgren Y, Silén M, Wåhlin I, Lindberg M, Fransson P, Efverman A. Chemotherapy-induced Emesis: Experienced Burden in Life, and Significance of Treatment Expectations and Communication in Chemotherapy Care. Integr Cancer Ther 2023; 22:15347354231217296. [PMID: 38098295 PMCID: PMC10725131 DOI: 10.1177/15347354231217296] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/29/2023] [Revised: 10/10/2023] [Accepted: 11/13/2020] [Indexed: 12/18/2023] Open
Abstract
OBJECTIVE Because antiemetics have become more effective and integrative therapies such as acupuncture are used in combination with antiemetics, people receiving chemotherapy for cancer today might expect less emesis than in the past. It is not previously described if and how people receiving modern antiemetics during chemotherapy experience emesis. The objective of this study was to describe experiences regarding emesis among persons undergoing emetogenic chemotherapy, and how it affects their quality of life, daily life and work. A further aim was to describe views on the significance of treatment expectations and communication with healthcare personnel while undergoing chemotherapy for cancer. METHOD Fifteen participants (median age 62 years, n = 1 man and n = 14 women, with breast (n = 13) or colorectal (n = 2) cancer) undergoing adjuvant or neo-adjuvant highly or moderately emetogenic chemotherapy were interviewed individually. The data were then analyzed using inductive thematic analysis. RESULTS Three themes described the participants' experiences: "Your whole life is affected, or continues as usual," covering descriptions of emesis limiting some participants' everyday lives, while others experienced no emesis at all or had found ways to manage it. Overall, participants described satisfaction with their antiemetic treatment. "Experiences and expectations more important than information", that is, the participants reported wanting all the information they could get about possible adverse effects of treatment, although they believed previous experiences were more important than information in creating expectations about treatment outcomes. The participants reported that being seen as a unique person was of utmost importance: "Meet me as I am." This creates trust in healthcare personnel and a feeling of safety and security in the situation. CONCLUSIONS These findings underline the importance of person-centered care and support in creating positive treatment expectations. Future research is called for regarding the potential antiemetic effects of positive communication regarding strengthening positive treatment expectations during emetogenic chemotherapy.
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Affiliation(s)
- Ylva Widgren
- University of Gävle, Gävle, Sweden
- Region Hospital of Sundsvall-Härnösand, County Council of Västernorrland, Sundsvall, Sweden
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25
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Zegarra-Parodi R, Baroni F, Lunghi C, Dupuis D. Historical Osteopathic Principles and Practices in Contemporary Care: An Anthropological Perspective to Foster Evidence-Informed and Culturally Sensitive Patient-Centered Care: A Commentary. Healthcare (Basel) 2022; 11:healthcare11010010. [PMID: 36611470 PMCID: PMC9818574 DOI: 10.3390/healthcare11010010] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/06/2022] [Revised: 12/16/2022] [Accepted: 12/19/2022] [Indexed: 12/24/2022] Open
Abstract
Historical osteopathic principles and practices (OPP)-considering the patient as a dynamic interaction of the body, mind, and spirit and incorporating the body's self-healing ability into care-are inherited from traditional/complementary and alternative (CAM) principles. Both concepts are familiar to contemporary osteopathic practitioners, but their incorporation into healthcare for evidence-informed, patient-centered care (PCC) remains unclear. Further, a polarity exists in the osteopathic profession between a 'traditional-minded' group following historical OPP despite evidence against those models and an 'evidence-minded' group following the current available evidence for common patient complaints. By shifting professional practices towards evidence-based practices for manual therapy in line with the Western dominant biomedical paradigm, the latter group is challenging the osteopathic professional identity. To alleviate this polarity, we would like to refocus on patient values and expectations, highlighting cultural diversity from an anthropological perspective. Increasing an awareness of diverse sociocultural health assumptions may foster culturally sensitive PCC, especially when including non-Western sociocultural belief systems of health into that person-centered care. Therefore, the current medical anthropological perspective on the legacy of traditional/CAM principles in historical OPP is offered to advance the osteopathic profession by promoting ethical, culturally sensitive, and evidence-informed PCC in a Western secular environment. Such inclusive approaches are likely to meet patients' values and expectations, whether informed by Western or non-Western sociocultural beliefs, and improve their satisfaction and clinical outcomes.
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Affiliation(s)
- Rafael Zegarra-Parodi
- A.T. Still Research Institute, A.T. Still University, Kirksville, MO 63501, USA
- BMS Formation, 75116 Paris, France
- Centre Européen d’Enseignement Supérieur de l’Ostéopathie (CEESO) Paris, 93200 Saint-Denis, France
- Correspondence:
| | - Francesca Baroni
- BMS Formation, 75116 Paris, France
- Centre Européen d’Enseignement Supérieur de l’Ostéopathie (CEESO) Paris, 93200 Saint-Denis, France
- Osteopatia Lunghi-Baroni Private Practice, 00146 Rome, Italy
| | - Christian Lunghi
- BMS Formation, 75116 Paris, France
- Centre Européen d’Enseignement Supérieur de l’Ostéopathie (CEESO) Paris, 93200 Saint-Denis, France
- Osteopatia Lunghi-Baroni Private Practice, 00146 Rome, Italy
| | - David Dupuis
- Institut National de la Santé et de la Recherche Médicale, Institut de Recherche Interdisciplinaire sur les Enjeux Sociaux (INSERM/IRIS), 93300 Aubervilliers, France
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26
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Vera J, Redondo B, Ocaso E, Martinez‐Guillorme S, Molina R, Jiménez R. Manipulating expectancies in optometry practice: Ocular accommodation and stereoacuity are sensitive to placebo and nocebo effects. Ophthalmic Physiol Opt 2022; 42:1390-1398. [PMID: 35959593 PMCID: PMC9804873 DOI: 10.1111/opo.13036] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/07/2022] [Revised: 07/06/2022] [Accepted: 07/06/2022] [Indexed: 01/09/2023]
Abstract
INTRODUCTION There is scientific evidence that an individual's beliefs and/or expectations play a role in the behavioural and physiological response to a given treatment. This study aimed to assess whether the dynamics of the accommodative response and stereoacuity are sensitive to experimentally induced placebo and nocebo effects. METHODS Nineteen healthy university students performed three experimental sessions (placebo, nocebo and control) in randomised order, with the dynamics of the accommodative response (magnitude and variability), stereoacuity and subjective measures being assessed in all sessions. For the experimental manipulation, participants ingested an inert capsule that was alleged to have positive (white capsule, placebo condition) or negative (yellow capsule, nocebo conditions) effects on the human physiology. In the control condition, participants did not ingest a capsule. RESULTS The data revealed that the variability of accommodation was sensitive to experimentally induced placebo and nocebo effects, showing a more stable accommodative response for the placebo compared with the nocebo condition (corrected p-value = 0.04, Cohen's d = 0.60). In addition, better stereoacuity was found with the placebo, compared with the nocebo (corrected p-value = 0.01, Cohen's d = 0.69) and control (corrected p-value = 0.03, Cohen's d = 0.59) conditions. Successful experimental manipulation was confirmed by the analysis of subjective perceptions. CONCLUSIONS These findings provide evidence that manipulating expectations about the efficacy of an inert treatment affect the dynamics of the accommodative response (variability of accommodation) and stereoacuity. The results have important applications in both clinical and research outcomes, where individuals´ beliefs/expectations could modulate the visual function.
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Affiliation(s)
- Jesús Vera
- CLARO (Clinical and Laboratory Applications of Research in Optometry) Research Group, Department of Optics, Faculty of SciencesUniversity of GranadaGranadaSpain
| | - Beatriz Redondo
- CLARO (Clinical and Laboratory Applications of Research in Optometry) Research Group, Department of Optics, Faculty of SciencesUniversity of GranadaGranadaSpain
| | - Elena Ocaso
- Óptica del Penedes Optometry CenterZaragozaSpain
| | | | - Rubén Molina
- CLARO (Clinical and Laboratory Applications of Research in Optometry) Research Group, Department of Optics, Faculty of SciencesUniversity of GranadaGranadaSpain
| | - Raimundo Jiménez
- CLARO (Clinical and Laboratory Applications of Research in Optometry) Research Group, Department of Optics, Faculty of SciencesUniversity of GranadaGranadaSpain
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Husted RS, Troelsen A, Husted H, Grønfeldt BM, Thorborg K, Kallemose T, Rathleff MS, Bandholm T. Knee-extensor strength, symptoms, and need for surgery after two, four, or six exercise sessions/week using a home-based one-exercise program: a randomized dose-response trial of knee-extensor resistance exercise in patients eligible for knee replacement (the QUADX-1 trial). Osteoarthritis Cartilage 2022; 30:973-986. [PMID: 35413476 DOI: 10.1016/j.joca.2022.04.001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/03/2021] [Revised: 02/28/2022] [Accepted: 04/05/2022] [Indexed: 02/02/2023]
Abstract
OBJECTIVE To investigate firstly the efficacy of three different dosages of one home-based, knee-extensor resistance exercise on knee-extensor strength in patients eligible for knee replacement, and secondly, the influence of exercise on symptoms, physical function and decision on surgery. METHOD One-hundred and forty patients eligible for knee replacement were randomized to three groups: 2, 4 or 6 home-based knee-extensor resistance exercise-sessions per week (group 2, 4 and 6 respectively) for 12 weeks. PRIMARY OUTCOME isometric knee-extensor strength. SECONDARY OUTCOMES Oxford Knee Score, Knee injury and Osteoarthritis Outcome Score, average knee pain last week (0-10 numeric rating scale), 6-min walk test, stair climbing test, exercise adherence and "need for surgery". RESULTS Primary analysis: Intention-to-treat analysis of 140 patients did not find statistically significant differences between the groups from baseline to after 12 weeks of exercise in isometric knee-extensor strength: Group 2 vs 4 (0.003 Nm/kg (0.2%) [95% CI -0.15 to 0.15], P = 0.965) and group 4 vs 6 (-0.04 Nm/kg (-2.7%) [95% CI -0.15 to 0.12], P = 0.628). Secondary analysis: Intention-to-treat analyses showed statistically significant differences between the two and six sessions/week groups in favor of the two sessions/week group for Oxford Knee Score: 4.8 OKS points (15.2%) [1.3 to 8.3], P = 0.008) and avg. knee pain last week (NRS 0-10): -1.3 NRS points (-19.5%) [-2.3 to -0.2], P = 0.018. After the 12-week exercise intervention, data were available for 117 patients (N = 39/group): 38 (32.5%) patients wanted surgery and 79 (67.5%) postponed surgery. This was independent of exercise dosage. CONCLUSION In patients eligible for knee-replacement we found no between-group differences in isometric knee extensor strength after 2, 4 and 6 knee-extensor resistance exercise sessions per week. We saw no indication of an exercise dose-response relationship for isometric knee-extensor strength and only clinically irrelevant within group changes. For some secondary outcome (e.g., KOOS subscales) we found clinically relevant within group changes, which could help explain why only one in three patients decided to have surgery after the simple home-based exercise intervention. TRIAL REGISTRATION ClinicalTrials.gov identifier: NCT02931058. Preprint: https://doi.org/10.1101/2021.04.07.21254965.
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Affiliation(s)
- R S Husted
- Department of Clinical Research, Copenhagen University Hospital Amager-Hvidovre, Hvidovre, Denmark; Physical Medicine & Rehabilitation Research - Copenhagen (PMR-C), Department of Physical and Occupational Therapy, Copenhagen University Hospital Amager-Hvidovre, Hvidovre, Denmark; Clinical Orthopedic Research Hvidovre (CORH), Department of Orthopedic Surgery, Copenhagen University Hospital Amager-Hvidovre, Hvidovre, Denmark.
| | - A Troelsen
- Clinical Orthopedic Research Hvidovre (CORH), Department of Orthopedic Surgery, Copenhagen University Hospital Amager-Hvidovre, Hvidovre, Denmark.
| | - H Husted
- Clinical Orthopedic Research Hvidovre (CORH), Department of Orthopedic Surgery, Copenhagen University Hospital Amager-Hvidovre, Hvidovre, Denmark.
| | - B M Grønfeldt
- Department of Clinical Research, Copenhagen University Hospital Amager-Hvidovre, Hvidovre, Denmark; Physical Medicine & Rehabilitation Research - Copenhagen (PMR-C), Department of Physical and Occupational Therapy, Copenhagen University Hospital Amager-Hvidovre, Hvidovre, Denmark.
| | - K Thorborg
- Physical Medicine & Rehabilitation Research - Copenhagen (PMR-C), Department of Physical and Occupational Therapy, Copenhagen University Hospital Amager-Hvidovre, Hvidovre, Denmark; Sports Orthopaedic Research Center - Copenhagen (SORC-C), Department of Orthopedic Surgery, Copenhagen University Hospital Amager-Hvidovre, Hvidovre, Denmark.
| | - T Kallemose
- Department of Clinical Research, Copenhagen University Hospital Amager-Hvidovre, Hvidovre, Denmark.
| | - M S Rathleff
- Center for General Practice at Aalborg University, Aalborg, Denmark; Department of Occupational Therapy and Physiotherapy, Aalborg University Hospital, Aalborg, Denmark; Department of Health Science and Technology, Aalborg University, Denmark.
| | - T Bandholm
- Department of Clinical Research, Copenhagen University Hospital Amager-Hvidovre, Hvidovre, Denmark; Physical Medicine & Rehabilitation Research - Copenhagen (PMR-C), Department of Physical and Occupational Therapy, Copenhagen University Hospital Amager-Hvidovre, Hvidovre, Denmark; Clinical Orthopedic Research Hvidovre (CORH), Department of Orthopedic Surgery, Copenhagen University Hospital Amager-Hvidovre, Hvidovre, Denmark; Department of Clinical Medicine, University of Copenhagen, Denmark.
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28
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Boussac M, Arbus C, Klinger H, Eusebio A, Hainque E, Corvol JC, Rascol O, Rousseau V, Harroch E, d'Apollonia CS, Croiset A, Ory-Magne F, De Barros A, Fabbri M, Moreau C, Rolland AS, Benatru I, Anheim M, Marques AR, Maltête D, Drapier S, Jarraya B, Hubsch C, Guehl D, Meyer M, Rouaud T, Giordana B, Tir M, Devos D, Brefel-Courbon C. Personality Related to Quality-of-Life Improvement After Deep Brain Stimulation in Parkinson's Disease (PSYCHO-STIM II). JOURNAL OF PARKINSON'S DISEASE 2022; 12:699-711. [PMID: 34897100 DOI: 10.3233/jpd-212883] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
BACKGROUND Deep brain stimulation of the sub-thalamic nucleus (DBS-STN) reduces symptoms in Parkinson's disease (PD) patients with motor fluctuations. However, some patients may not feel ameliorated afterwards, despite an objective motor improvement. It is thus important to find new predictors of patients' quality of life (QoL) amelioration after DBS-STN. We hypothesized that personality dimensions might affect QoL after DBS-STN. OBJECTIVE To evaluate associations between personality dimensions and QoL improvement one year after DBS-STN. METHODS DBS-STN-PD patients (n = 303) having answered the "Temperament and Character Inventory" (TCI) before surgery and the PDQ-39 before and one year after surgery were included, from the cohort study PREDI-STIM. Linear regression models were used to evaluate associations between TCI dimensions and change in PDQ-39 scores after DBS-STN. RESULTS Novelty Seeking and Cooperativeness scores before surgery were positively associated with PDQ-39 scores improvement after DBS-STN (FDR-adjusted p < 0.01). Moreover, paradoxically unimproved patients with deterioration of their PDQ-39 scores after DBS-STN despite improvement of their MDS-UPDRS-IV scores had lower Cooperativeness scores, while paradoxically improved patients with amelioration of their PDQ-39 scores despite deterioration of their MDS-UPDRS-IV scores had higher Reward Dependence scores. CONCLUSION Some presurgical personality dimensions were significantly associated with QoL amelioration and discrepancy between motor state and QoL changes after DBS-STN in PD. Educational programs before DBS-STN should take in account patient personality dimensions to better deal with their expectations.
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Affiliation(s)
- Mathilde Boussac
- Toulouse Neuro Imaging Center, University of Toulouse, Inserm, UPS, France
| | - Christophe Arbus
- Psychiatry Department of the University Hospital of Toulouse, CHU Purpan, Toulouse, France
| | - Helene Klinger
- Hospices Civils de Lyon, Hôpital Neurologique Pierre Wertheimer, Service de Neurologie C, Lyon, France
| | - Alexandre Eusebio
- Aix Marseille Université, AP-HM, Hôpital de La Timone, Service de Neurologie et Pathologie du Mouvement, and UMR CNRS, Institut de Neuroscience de La Timone, NS-PARK/FCRIN Network, Marseille, France
| | - Elodie Hainque
- Département de Neurologie, Hôpital Pitié-Salpêtrière, AP-HP, Paris, France et Faculté de Médecine de Sorbonne Université, Paris, France
| | - Jean Christophe Corvol
- Sorbonne Université, Paris Brain Institute -ICM, Inserm, CNRS, Assistance Publique Hôpitaux de Paris, Pitié-Salpêtrière Hospital, NS-PARK/FCRIN, Department of Neurology, Paris, France
| | - Olivier Rascol
- Toulouse Neuro Imaging Center, University of Toulouse, Inserm, UPS, France.,Department of Clinical Pharmacology and Neurosciences, Parkinson Expert Center, Clinical Investigation Center, University Hospital of Toulouse, NeuroToul COEN (Center of Excellence in Neurodegeneration), Toulouse, NS-PARK/FCRIN Network, France
| | - Vanessa Rousseau
- Department of Clinical Pharmacology and Neurosciences, Parkinson Expert Center, Clinical Investigation Center, University Hospital of Toulouse, NeuroToul COEN (Center of Excellence in Neurodegeneration), Toulouse, NS-PARK/FCRIN Network, France
| | - Estelle Harroch
- Department of Clinical Pharmacology and Neurosciences, Parkinson Expert Center, Clinical Investigation Center, University Hospital of Toulouse, NeuroToul COEN (Center of Excellence in Neurodegeneration), Toulouse, NS-PARK/FCRIN Network, France
| | - Charlotte Scotto d'Apollonia
- Department of Clinical Pharmacology and Neurosciences, Parkinson Expert Center, Clinical Investigation Center, University Hospital of Toulouse, NeuroToul COEN (Center of Excellence in Neurodegeneration), Toulouse, NS-PARK/FCRIN Network, France
| | - Aurélie Croiset
- CERPPS-Study and Research Center in Psychopathology and Health Psychology, University of Toulouse II Jean-Jaurès, Toulouse, France
| | - Fabienne Ory-Magne
- Toulouse Neuro Imaging Center, University of Toulouse, Inserm, UPS, France.,Department of Clinical Pharmacology and Neurosciences, Parkinson Expert Center, Clinical Investigation Center, University Hospital of Toulouse, NeuroToul COEN (Center of Excellence in Neurodegeneration), Toulouse, NS-PARK/FCRIN Network, France
| | - Amaury De Barros
- Toulouse Neuro Imaging Center, University of Toulouse, Inserm, UPS, France.,Department of Neurosurgery, Toulouse University Hospital, Toulouse, France
| | - Margherita Fabbri
- Toulouse Neuro Imaging Center, University of Toulouse, Inserm, UPS, France.,Department of Clinical Pharmacology and Neurosciences, Parkinson Expert Center, Clinical Investigation Center, University Hospital of Toulouse, NeuroToul COEN (Center of Excellence in Neurodegeneration), Toulouse, NS-PARK/FCRIN Network, France
| | - Caroline Moreau
- Department of Medical Pharmacology, Neurology and Movement Disorders Department, Referent center of Parkinson's disease, CHU of Lille, Univ. Lille Neuroscience & Cognition, Inserm, UMR-S1172, Licend, Lille, NS-PARK/FCRIN Network, France
| | - Anne-Sophie Rolland
- Department of Medical Pharmacology, Neurology and Movement Disorders Department, Referent center of Parkinson's disease, CHU of Lille, Univ. Lille Neuroscience & Cognition, Inserm, UMR-S1172, Licend, Lille, NS-PARK/FCRIN Network, France
| | - Isabelle Benatru
- Neurology Department, University Hospital of Poitiers, Poitiers, France; INSERM, CHU de Poitiers, University of Poitiers, Centre d'Investigation Clinique CIC1402, Poitiers, France
| | - Mathieu Anheim
- Service de Neurologie, Hôpitaux Universitaires de Strasbourg; Institut de Génétique et de Biologie Moléculaire et Cellulaire (IGBMC), INSERM-U964/CNRS-UMR7104/Université de Strasbourg, Illkirch; Fédération de Médecine Translationnelle de Strasbourg (FMTS), Université de Strasbourg, Strasbourg, France
| | - Ana-Raquel Marques
- Université Clermont Auvergne, CNRS, Clermont Auvergne INP, Institut Pascal, Clermont-Ferrand University Hospital, Neurology department, France
| | - David Maltête
- Department of Neurology, Rouen University Hospital and University of Rouen, France; INSERM U1239, Laboratory of Neuronal and Neuroendocrine Differentiation and Communication, Mont-Saint-Aignan, France
| | - Sophie Drapier
- CHU Rennes, Service de neurologie, CIC-INSERM 1414, Rennes, France
| | - Béchir Jarraya
- Pôle Neurosciences, Foch Hospital, Suresnes; Université Paris-Saclay, UVSQ, INSERM U992, CEA Paris-Saclay, Neurospin, France
| | - Cécile Hubsch
- Hôpital Fondation A de Rothschild, Service de recherche clinique, Paris, France
| | - Dominique Guehl
- Institut des Maladies Neurodégénératives (IMN, CNRS U5393), Université de Bordeaux, Bordeaux, France.,Service de Neurophysiologie Clinique, Pôle des Neurosciences Cliniques, CHU de Bordeaux, Bordeaux, France
| | - Mylène Meyer
- Service de neurologie, Hôpital Central, CHRU de Nancy, Nancy Cedex, France
| | - Tiphaine Rouaud
- Clinique Neurologique, Hôpital Guillaume et René Laennec, Boulevard Jacques Monod, Nantes Cedex, France
| | - Bruno Giordana
- CHU Nice, Department of Psychiatry and Psychotherapy, Nice, France
| | - Mélissa Tir
- Department of Neurology, Department of Neurosurgery, Expert Centre for Parkinson's disease, Amiens University Hospital, EA 4559 Laboratoire de Neurosciences Fonctionnelles et Pathologie (LNFP) Université de Picardie Jules Verne, University of Picardy Jules Verne (UPJV), NS-PARK/FCRIN Network, Amiens, France
| | - David Devos
- Department of Medical Pharmacology, Neurology and Movement Disorders Department, Referent center of Parkinson's disease, CHU of Lille, Univ. Lille Neuroscience & Cognition, Inserm, UMR-S1172, Licend, Lille, NS-PARK/FCRIN Network, France
| | - Christine Brefel-Courbon
- Toulouse Neuro Imaging Center, University of Toulouse, Inserm, UPS, France.,Department of Clinical Pharmacology and Neurosciences, Parkinson Expert Center, Clinical Investigation Center, University Hospital of Toulouse, NeuroToul COEN (Center of Excellence in Neurodegeneration), Toulouse, NS-PARK/FCRIN Network, France
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Varoquaux G, Cheplygina V. Machine learning for medical imaging: methodological failures and recommendations for the future. NPJ Digit Med 2022; 5:48. [PMID: 35413988 PMCID: PMC9005663 DOI: 10.1038/s41746-022-00592-y] [Citation(s) in RCA: 144] [Impact Index Per Article: 72.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/21/2021] [Accepted: 03/09/2022] [Indexed: 12/23/2022] Open
Abstract
Research in computer analysis of medical images bears many promises to improve patients' health. However, a number of systematic challenges are slowing down the progress of the field, from limitations of the data, such as biases, to research incentives, such as optimizing for publication. In this paper we review roadblocks to developing and assessing methods. Building our analysis on evidence from the literature and data challenges, we show that at every step, potential biases can creep in. On a positive note, we also discuss on-going efforts to counteract these problems. Finally we provide recommendations on how to further address these problems in the future.
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Affiliation(s)
- Gaël Varoquaux
- INRIA, Versailles, France.
- McGill University, Montreal, Canada.
- Mila, Montreal, Canada.
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Benson S, Theysohn N, Kleine-Borgmann J, Rebernik L, Icenhour A, Elsenbruch S. Positive Treatment Expectations Shape Perceived Medication Efficacy in a Translational Placebo Paradigm for the Gut-Brain Axis. Front Psychiatry 2022; 13:824468. [PMID: 35401247 PMCID: PMC8987023 DOI: 10.3389/fpsyt.2022.824468] [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: 11/29/2021] [Accepted: 03/01/2022] [Indexed: 11/13/2022] Open
Abstract
Placebo research has established the pivotal role of treatment expectations in shaping symptom experience and patient-reported treatment outcomes. Perceived treatment efficacy constitutes a relevant yet understudied aspect, especially in the context of the gut-brain axis with visceral pain as key symptom. Using a clinically relevant experimental model of visceral pain, we elucidated effects of pre-treatment expectations on post-treatment perceived treatment efficacy as an indicator of treatment satisfaction in a translational placebo intervention. We implemented positive suggestions regarding intravenous treatment with a spasmolytic drug (in reality saline), herein applied in combination with two series of individually calibrated rectal distensions in healthy volunteers. The first series used distension pressures inducing pain (pain phase). In the second series, pressures were surreptitiously reduced, modeling pain relief (pain relief phase). Using visual analog scales (VAS), expected and perceived treatment efficacy were assessed, along with perceived pain intensity. Manipulation checks supported that the induction of positive pre-treatment expectations and the modeling of pain relief were successful. Generalized Linear Models (GLM) were implemented to assess the role of inter-individual variability in positive pre-treatment expectations in perceived treatment efficacy and pain perception. GLM indicated no association between pre-treatment expectations and perceived treatment efficacy or perceived pain for the pain phase. For the relief phase, pre-treatment expectations (p = 0.024) as well as efficacy ratings assessed after the preceding pain phase (p < 0.001) were significantly associated with treatment efficacy assessed after the relief phase, together explaining 54% of the variance in perceived treatment efficacy. The association between pre-treatment expectations and perceived pain approached significance (p = 0.057) in the relief phase. Our data from an experimental translational placebo intervention in visceral pain support that reported post-treatment medication efficacy is shaped by pre-treatment expectations. The observation that individuals with higher positive expectations reported less pain and higher treatment satisfaction after pain relief may provide first evidence that perceived symptom improvement may facilitate treatment satisfaction. The immediate experience of symptoms within a given psychosocial treatment context may dynamically change perceptions about treatment, with implications for treatment satisfaction, compliance and adherence of patients with conditions of the gut-brain axis.
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Affiliation(s)
- Sven Benson
- Institute for Medical Education, Center for Translational Neuro- and Behavioral Sciences, University Hospital Essen, University of Duisburg-Essen, Essen, Germany.,Institute of Medical Psychology and Behavioral Immunobiology, Center for Translational Neuro- and Behavioral Sciences, University Hospital Essen, University of Duisburg-Essen, Essen, Germany
| | - Nina Theysohn
- Institute of Diagnostic and Interventional Radiology and Neuroradiology, University Hospital Essen, University of Duisburg-Essen, Essen, Germany
| | - Julian Kleine-Borgmann
- Department of Neurology, Center for Translational Neuro- and Behavioral Sciences, University Hospital Essen, University of Duisburg-Essen, Essen, Germany
| | - Laura Rebernik
- Institute of Medical Psychology and Behavioral Immunobiology, Center for Translational Neuro- and Behavioral Sciences, University Hospital Essen, University of Duisburg-Essen, Essen, Germany
| | - Adriane Icenhour
- Department of Medical Psychology and Medical Sociology, Ruhr University Bochum, Bochum, Germany
| | - Sigrid Elsenbruch
- Department of Neurology, Center for Translational Neuro- and Behavioral Sciences, University Hospital Essen, University of Duisburg-Essen, Essen, Germany.,Department of Medical Psychology and Medical Sociology, Ruhr University Bochum, Bochum, Germany
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31
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Evers AWM, Colloca L, Blease C, Gaab J, Jensen KB, Atlas LY, Beedie CJ, Benedetti F, Bingel U, Büchel C, Bussemaker J, Colagiuri B, Crum AJ, Finniss DG, Geers AL, Howick J, Klinger R, Meeuwis SH, Meissner K, Napadow V, Petrie KJ, Rief W, Smeets I, Wager TD, Wanigasekera V, Vase L, Kelley JM, Kirsch I. What Should Clinicians Tell Patients about Placebo and Nocebo Effects? Practical Considerations Based on Expert Consensus. PSYCHOTHERAPY AND PSYCHOSOMATICS 2021; 90:49-56. [PMID: 33075796 DOI: 10.1159/000510738] [Citation(s) in RCA: 34] [Impact Index Per Article: 11.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/08/2020] [Accepted: 07/23/2020] [Indexed: 11/19/2022]
Abstract
INTRODUCTION Clinical and laboratory studies demonstrate that placebo and nocebo effects influence various symptoms and conditions after the administration of both inert and active treatments. OBJECTIVE There is an increasing need for up-to-date recommendations on how to inform patients about placebo and nocebo effects in clinical practice and train clinicians how to disclose this information. METHODS Based on previous clinical recommendations concerning placebo and nocebo effects, a 3-step, invitation-only Delphi study was conducted among an interdisciplinary group of internationally recognized experts. The study consisted of open- and closed-ended survey questions followed by a final expert meeting. The surveys were subdivided into 3 parts: (1) informing patients about placebo effects, (2) informing patients about nocebo effects, and (3) training clinicians how to communicate this information to the patients. RESULTS There was consensus that communicating general information about placebo and nocebo effects to patients (e.g., explaining their role in treatment) could be beneficial, but that such information needs to be adjusted to match the specific clinical context (e.g., condition and treatment). Experts also agreed that training clinicians to communicate about placebo and nocebo effects should be a regular and integrated part of medical education that makes use of multiple formats, including face-to-face and online modalities. CONCLUSIONS The current 3-step Delphi study provides consensus-based recommendations and practical considerations for disclosures about placebo and nocebo effects in clinical practice. Future research is needed on how to optimally tailor information to specific clinical conditions and patients' needs, and on developing standardized disclosure training modules for clinicians.
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Affiliation(s)
- Andrea W M Evers
- Health, Medical and Neuropsychology Unit, Institute of Psychology, Leiden University, Leiden, The Netherlands, .,Erasmus University Rotterdam & Delft University of Technology, Rotterdam/Delft, The Netherlands,
| | - Luana Colloca
- Departments of Pain Translational Symptoms Science and Anesthesiology, School of Nursing and Medicine, University of Maryland Baltimore, Baltimore, Maryland, USA
| | - Charlotte Blease
- General Medicine and Primary Care, Beth Israel Deaconess Medical Center, Boston, Massachusetts, USA
| | - Jens Gaab
- Faculty of Psychology, University of Basel, Basel, Switzerland
| | - Karin B Jensen
- Department of Clinical Neuroscience, Karolinska Institute, Stockholm, Sweden
| | - Lauren Y Atlas
- National Center for Complementary and Integrative Health, National Institute of Mental Health, and National Institute on Drug Abuse, National Institutes of Health, Bethesda, Maryland, USA
| | - Chris J Beedie
- School of Psychology, University of Kent, Canterbury, United Kingdom
| | - Fabrizio Benedetti
- Physiology and Neuroscience, University of Turin Medical School, Turin, Italy
| | - Ulrike Bingel
- Department of Neurology, University Hospital Essen, Essen, Germany
| | - Christian Büchel
- Department of Systems Neuroscience, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | - Jet Bussemaker
- Public Health and Primary Care, Leiden University Medical Center, Leiden, The Netherlands
| | - Ben Colagiuri
- School of Psychology, University of Sydney, Sydney, New South Wales, Australia
| | - Alia J Crum
- Department of Psychology, Stanford University, Stanford, California, USA
| | | | - Andrew L Geers
- Department of Psychology, University of Toledo, Toledo, Ohio, USA
| | - Jeremy Howick
- Nuffield Department of Primary Care Health Sciences, University of Oxford, Oxford, United Kingdom
| | - Regine Klinger
- Center for Anesthesiology and Intensive Care Medicine, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | - Stefanie H Meeuwis
- Health, Medical and Neuropsychology Unit, Institute of Psychology, Leiden University, Leiden, The Netherlands
| | - Karin Meissner
- Division of Health Promotion, University of Applied Sciences, Coburg, Germany
| | - Vitaly Napadow
- Athinoula A. Martinos Center for Biomedical Imaging, Charlestown, Massachusetts, USA
| | - Keith J Petrie
- Department of Psychological Medicine, University of Auckland, Auckland, New Zealand
| | - Winfried Rief
- Department of Clinical Psychology and Psychotherapy, Philipps University of Marburg, Marburg, Germany
| | - Ionica Smeets
- Science Communication and Society, Institute of Biology, Leiden University, Leiden, The Netherlands
| | - Tor D Wager
- Department of Psychological and Brain Sciences, Dartmouth College, Hanover, New Hampshire, USA
| | | | - Lene Vase
- Department of Psychology and Behavioural Sciences, Aarhus University, Aarhus, Denmark
| | - John M Kelley
- Beth Israel Deaconess Medical Center, Harvard Medical School, Program in Placebo Studies, Boston, Massachusetts, USA
| | - Irving Kirsch
- Beth Israel Deaconess Medical Center, Harvard Medical School, Program in Placebo Studies, Boston, Massachusetts, USA
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van Lennep J(HPA, Trossèl F, Perez RSGM, Otten RHJ, van Middendorp H, Evers AWM, Szadek KM. Placebo effects in low back pain: A systematic review and meta-analysis of the literature. Eur J Pain 2021; 25:1876-1897. [PMID: 34051018 PMCID: PMC8518410 DOI: 10.1002/ejp.1811] [Citation(s) in RCA: 14] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/24/2022]
Abstract
BACKGROUND AND OBJECTIVE The current treatments of primary musculoskeletal low back pain (LBP) have a low to moderate efficacy, which might be improved by looking at the contribution of placebo effects. However, the size of true placebo effects in LBP is unknown. Therefore, a systematic review and meta-analysis were executed of randomized controlled trials investigating placebo effects in LBP. DATABASES AND DATA TREATMENT The study protocol was registered in the international prospective register of systematic reviews Prospero (CRD42019148745). A literature search (in PubMed, Embase, The Cochrane Library, CINAHL and PsycINFO) up to 2021 February 16th yielded 2,423 studies. Two independent reviewers assessed eligibility and risk of bias. RESULTS Eighteen studies were eligible for the systematic review and 5 for the meta-analysis. Fourteen of the 18 studies were clinical treatment studies, and 4 were experimental studies specifically assessing placebo effects. The clinical treatment studies provided varying evidence for placebo effects in chronic LBP but insufficient evidence for acute and subacute LBP. Most experimental studies investigating chronic LBP revealed significant placebo effects. The meta-analysis of 5 treatment studies investigating chronic LBP depicted a significant moderate effect size of placebo for pain intensity (SMD = 0.57) and disability (SMD = 0.52). CONCLUSIONS This review shows a significant contribution of placebo effects to chronic LBP symptom relief in clinical and experimental conditions. The meta-analysis revealed that placebo effects can influence chronic LBP intensity and disability. However, additional studies are required for more supporting evidence and evidence for placebo effects in acute or subacute LBP. SIGNIFICANCE This systematic review and meta-analysis provides evidence of true placebo effects in low back pain (LBP). It shows a significant contribution of placebo effects to chronic LBP symptom relief. The results highlight the importance of patient- and context-related factors in fostering treatment effects in this patient group. New studies could provide insight into the potential value of actively making use of placebo effects in clinical practice.
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Affiliation(s)
- Johan (Hans) Peter Alexander van Lennep
- Department of AnesthesiologyAmsterdam University Medical CenterAmsterdamThe Netherlands
- Health, Medical and Neuropsychology UnitFaculty of Social SciencesLeiden UniversityLeidenThe Netherlands
| | - Faye Trossèl
- Department of AnesthesiologyAmsterdam University Medical CenterAmsterdamThe Netherlands
| | | | | | - Henriët van Middendorp
- Department of AnesthesiologyAmsterdam University Medical CenterAmsterdamThe Netherlands
- Health, Medical and Neuropsychology UnitFaculty of Social SciencesLeiden UniversityLeidenThe Netherlands
| | - Andrea Walburga Maria Evers
- Health, Medical and Neuropsychology UnitFaculty of Social SciencesLeiden UniversityLeidenThe Netherlands
- Leiden Institute for Brain and CognitionLeidenThe Netherlands
- Department of PsychiatryLeiden University Medical CenterLeidenThe Netherlands
- Medical DeltaLeiden University, Technical University Delft, and Erasmus UniversityLeidenThe Netherlands
| | - Karolina Maria Szadek
- Department of AnesthesiologyAmsterdam University Medical CenterAmsterdamThe Netherlands
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Svahn Ekdahl A, Fagevik Olsén M, Jendman T, Gutke A. Maintenance of physical activity level, functioning and health after non-pharmacological treatment of pelvic girdle pain with either transcutaneous electrical nerve stimulation or acupuncture: a randomised controlled trial. BMJ Open 2021; 11:e046314. [PMID: 34598980 PMCID: PMC8488730 DOI: 10.1136/bmjopen-2020-046314] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/26/2022] Open
Abstract
OBJECTIVE To investigate if there are differences between acupuncture and transcutaneous electrical nerve stimulation (TENS) as treatment for pelvic girdle pain (PGP) in pregnancy in order to manage pain and thus maintain health and functioning in daily activities and physical activity (PA). DESIGN Randomised controlled trial. SETTING AND PARTICIPANTS Pregnant women (n=113) with clinically verified PGP in gestational weeks 12-28, recruited from maternity healthcare centres, randomised (1:1) into two groups. EXCLUSION CRITERIA any obstetrical complication, systemic disease or previous disorder that could contradict tests or treatment. INTERVENTIONS The intervention consisted of either 10 acupuncture sessions (two sessions per week) provided by a physiotherapist or daily home-based TENS during 5 weeks. PRIMARY OUTCOME VARIABLES Disability (Oswestry Disability Index), functioning (Patient Specific Functional Scale), work ability (Work Ability Index) and PA-level according to general recommendations. SECONDARY OUTCOME VARIABLES Functioning related to PGP (Pelvic Girdle Questionnaire), evening pain intensity (Numeric Rating Scale, NRS), concern about pain (NRS), health (EuroQoL 5-dimension), symptoms of depression/catastrophising (Edinburgh Postnatal Depression Scale/Coping Strategies Questionnaire). RESULTS No mean differences were detected between the groups. Both groups managed to preserve their functioning and PA level at follow-up. This may be due to significantly (p<0.05) reduced within groups evening pain intensity; acupuncture -0.96 (95% CI -1.91 to -0.01; p=0.049), TENS -1.29 (95% CI -2.13 to -0.44; p=0.003) and concern about pain; acupuncture -1.44 (95% CI -2.31 to -0.57; p=0.0012), TENS -1.99 (95% CI -2.81 to -1.17; p<0.0001). The acupuncture group showed an improvement in functioning at follow-up; 0.82 (95% CI 0.01 to 1.63; p=0.048) CONCLUSION: Treating PGP with acupuncture or TENS resulted in maintenance of functioning and physical activity and also less pain and concern about pain. Either intervention could be recommended as a non-pharmacological alternative for pain relief and may enable pregnant women to stay active. TRIAL REGISTRATION NUMBER 12726. https://www.researchweb.org/is/sverige/project/127261.
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Affiliation(s)
- Annika Svahn Ekdahl
- Department of Health and Rehabilitation; Physiotherapy, Sahlgrenska Academy, Gothenburg, Sweden
| | - Monika Fagevik Olsén
- Department of Health and Rehabilitation; Physiotherapy, Sahlgrenska Academy, Gothenburg, Sweden
- Department of Physiotherapy, Sahlgrenska University Hospital, Gothenburg, Sweden
| | - Tove Jendman
- Physiotherapy Clinic 'I Rorelse', Gothenburg, Sweden
| | - Annelie Gutke
- Department of Health and Rehabilitation; Physiotherapy, Sahlgrenska Academy, Gothenburg, Sweden
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Hu H, Li Z, Zhang Y, Gao H. Comment on: Transcutaneous electrical acupoint stimulation before surgery reduces chronic pain after mastectomy: A randomized clinical trial. J Clin Anesth 2021; 75:110501. [PMID: 34481364 DOI: 10.1016/j.jclinane.2021.110501] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/22/2021] [Revised: 08/23/2021] [Accepted: 08/29/2021] [Indexed: 11/19/2022]
Affiliation(s)
- Hantong Hu
- Department of Acupuncture and Moxibustion, The Third Affiliated Hospital of Zhejiang Chinese Medical University, Hangzhou, Zhejiang Province, China
| | - Zengtu Li
- Department of Massage, The Third Affiliated Hospital of Zhejiang Chinese Medical University, Hangzhou, Zhejiang Province, China
| | - Yajun Zhang
- The Third Clinical Medical College, Zhejiang Chinese Medical University, Hangzhou, Zhejiang Province, China.
| | - Hong Gao
- Department of Acupuncture and Moxibustion, The Third Affiliated Hospital of Zhejiang Chinese Medical University, Hangzhou, Zhejiang Province, China.
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Xiao M, Ying J, Zhao Y, Li Q, Zhao Y, Gao R, Lu F. Developing Placebos for Clinical Research in Traditional Chinese Medicine: Assessing Organoleptic Properties of Three Dosage Forms (Oral Liquid, Capsule and Granule). Front Pharmacol 2021; 12:673729. [PMID: 34220509 PMCID: PMC8245784 DOI: 10.3389/fphar.2021.673729] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/28/2021] [Accepted: 06/07/2021] [Indexed: 11/13/2022] Open
Abstract
Background: The successful application of randomized, double-blind placebo-controlled studies requires maximum blinding. Organoleptic properties of the placebo should be similar to the drug, making it difficult to distinguish between the two. The uniqueness of traditional Chinese medicine (TCM) preparations makes it challenging to prepare placebo. Evaluation of the TCM placebo simulation effect can determine whether the preparation of placebo can be genuinely blind in clinical trials. There is still a lack of well-established methods to evaluate TCM placebos. Hence, this study aimed to explore the evaluation methodology of TCM placebo simulation. Methods: An independent evaluation method and three comparative evaluation methods were proposed, and three dosage forms (oral liquid, capsule, and granule) were tested. The independent evaluation, in which each person was given an experimental drug or a placebo, gave an overall assessment of organoleptic properties in a blind state. We comparatively evaluated the similarity in organoleptic properties between the experimental drug and placebo. According to different distribution methods, we divided comparative evaluation methods into three. In method 1, the evaluator was given the experimental drug and placebo and was told that there must be a placebo among them. In method 2, each evaluator was randomly assigned to the combination group or two investigational drugs group. In method 3, the evaluator was assigned to a set of three coded samples, numbered by random three-digit numbers, each different, two of which were identical, and the two samples were equally frequent. Results: In the independent evaluation, there was no difference between TCM placebo and experimental drugs in a blind state at the level of p = 0.05. Even though the comparative evaluation methods enabled identification of potential differences between the two samples, methods 2 and 3 were better than method 1 in eliminating psychological factors. Also, in method 3, the completely random method combined with the blind method eliminated the subjectivity and objectivity bias and improved the experiment's credibility compared with the previous two methods. Conclusion: Regardless of the methods that could evaluate the placebo's simulated effect in actual clinical trials, we suggest that independent evaluation and comparative evaluation (method 3) should be combined to reflect better whether the placebo is truly blind.
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Affiliation(s)
- Mengli Xiao
- NMPA Key Laboratory for Clinical Research and Evaluation of Traditional Chinese Medicine, Xiyuan Hospital of China Academy of Chinese Medical Sciences, Beijing, China
- National Clinical Research Center for Chinese Medicine Cardiology, Xiyuan Hospital of China Academy of Chinese Medical Sciences, Beijing, China
| | - Jiake Ying
- NMPA Key Laboratory for Clinical Research and Evaluation of Traditional Chinese Medicine, Xiyuan Hospital of China Academy of Chinese Medical Sciences, Beijing, China
- National Clinical Research Center for Chinese Medicine Cardiology, Xiyuan Hospital of China Academy of Chinese Medical Sciences, Beijing, China
| | - Yang Zhao
- NMPA Key Laboratory for Clinical Research and Evaluation of Traditional Chinese Medicine, Xiyuan Hospital of China Academy of Chinese Medical Sciences, Beijing, China
- National Clinical Research Center for Chinese Medicine Cardiology, Xiyuan Hospital of China Academy of Chinese Medical Sciences, Beijing, China
| | - Qingna Li
- NMPA Key Laboratory for Clinical Research and Evaluation of Traditional Chinese Medicine, Xiyuan Hospital of China Academy of Chinese Medical Sciences, Beijing, China
- National Clinical Research Center for Chinese Medicine Cardiology, Xiyuan Hospital of China Academy of Chinese Medical Sciences, Beijing, China
| | - Yingpan Zhao
- Department of Gastroenterology, Xiyuan Hospital of China Academy of Chinese Medical Sciences, Beijing, China
| | - Rui Gao
- NMPA Key Laboratory for Clinical Research and Evaluation of Traditional Chinese Medicine, Xiyuan Hospital of China Academy of Chinese Medical Sciences, Beijing, China
- National Clinical Research Center for Chinese Medicine Cardiology, Xiyuan Hospital of China Academy of Chinese Medical Sciences, Beijing, China
| | - Fang Lu
- NMPA Key Laboratory for Clinical Research and Evaluation of Traditional Chinese Medicine, Xiyuan Hospital of China Academy of Chinese Medical Sciences, Beijing, China
- National Clinical Research Center for Chinese Medicine Cardiology, Xiyuan Hospital of China Academy of Chinese Medical Sciences, Beijing, China
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Effectiveness of Dry Needling versus Placebo on Gait Performance, Spasticity, Electromyographic Activity, Pain, Range-of-Movement and Quality of Life in Patients with Multiple Sclerosis: A Randomized Controlled Trial Protocol. Brain Sci 2020; 10:brainsci10120997. [PMID: 33561042 PMCID: PMC7766461 DOI: 10.3390/brainsci10120997] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/18/2020] [Revised: 12/09/2020] [Accepted: 12/16/2020] [Indexed: 12/27/2022] Open
Abstract
Dry needling (DN) is an emerging technique commonly used in neurological and musculoskeletal pain conditions, but there have been no previous studies in patients with multiple sclerosis (pwMS). This trial aims to assess the efficacy of deep DN, compared with sham placebo DN, on gait performance, spasticity level, pain, electromyographic activity, range-of-movement (ROM) and quality of life in pwMS. Forty adults with MS were randomly assigned to one study group. The DN group will undergo 2 sessions (once per week) using DN over the rectus femoris (RF) and gastrocnemius medialis (GM) muscles at the lower extremity with higher spasticity. The placebo group will receive the same protocol using a sham placebo needle (Dong Bang needle). Outcome measures will include gait performance, using the GaitRite® system, spasticity level with the Modified Ashworth Scale, superficial electromyographic activity of RF and GM, pain (pressure algometer), ROM (goniometer), and quality of life (Musiqol). This study is the first investigating the short-term effect of DN, compared with placebo, in pwMS, and taking into account the possible changes in the electromyographic activity of the lower limb. Therefore, the results may help to understand the suitability of using this technique in the clinical setting for this population. Trial registration: ACTRN12619000880145.
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Placebo effects in musculoskeletal radiology procedures. Skeletal Radiol 2020; 49:1921-1924. [PMID: 32661655 DOI: 10.1007/s00256-020-03542-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/21/2020] [Revised: 06/29/2020] [Accepted: 07/05/2020] [Indexed: 02/02/2023]
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Nocebo Response in the Pharmacological Management of Overactive Bladder: A Systematic Review and Meta-analysis. Eur Urol Focus 2020; 7:1143-1156. [PMID: 33153953 DOI: 10.1016/j.euf.2020.10.010] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/08/2020] [Revised: 09/20/2020] [Accepted: 10/21/2020] [Indexed: 12/18/2022]
Abstract
CONTEXT The role of a nocebo response in managing urology patients is unclear. OBJECTIVE To assess the nocebo response in randomized placebo-controlled overactive bladder (OAB) trials of pharmacological treatment by investigating the adverse events in the placebo arms. EVIDENCE ACQUISITION PubMed, Scopus, Embase, and Cochrane Central Register of Controlled Trials were searched to identify potential randomized controlled trials published from 1998 to November 2019. After evaluating the risk of bias in the selected studies, all selected full-text articles were included due to their overall acceptable quality. We extracted the event rate of the most commonly reported adverse events in the placebo arms of OAB trials, and finally, we performed a meta-analysis to calculate the cumulative rate of certain adverse events. The primary outcomes were the event rate of adverse events in the placebo arms of OAB trials of pharmacological treatment, and differences in adverse events in the placebo groups based on drug type and routes of administration. EVIDENCE SYNTHESIS After a systematic search and risk of bias assessment, 57 trials comprising 15 446 patients were included in this systematic review. We selected 13 commonly reported adverse events for the meta-analysis. Owing to the possible differences in study samples and design, we used a random model for the analysis. The average age of the patients was 59.5 yr and 79.8% were female. Dry mouth was the most commonly evaluated adverse event reported in 57 studies comprising 15 324 patients; the mean event rate was 4.9% (95% confidence interval [CI] 0.042-0.057, p < 0.001). Constipation was the second most commonly reported adverse event in 49 studies comprising 14 556 patients; the mean event rate of constipation was 2.6% (95% CI 0.022-0.031, p < 0.001). The event rate of headache was evaluated in 33 studies comprising 10 202 patients, with a mean event rate of 3.1% (95% CI 0.026-0.037, p < 0.001). CONCLUSIONS Dry mouth, constipation, headache, and nasopharyngitis were the most prevalent events in the included studies. The nocebo response plays a statistically significant role in causing and/or facilitating adverse events. Health care providers should have a better understanding of the positive and negative expectations associated with therapies to achieve the best possible outcomes for each individual patient. Finally, identification of the real effect of nocebo requires studies that also include a no-treatment arm. Research could help us better understand and potentially modify the nocebo response. PATIENT SUMMARY In this meta-analysis of 57 studies comprising 15 446 patients, we reviewed the adverse events extracted from the placebo arms of randomized controlled trials studying therapies for overactive bladder. Dry mouth, constipation, headache, and urinary tract infection were the most common adverse events. Adverse events varied based on the drug type and the route of administration. Negative expectations from the therapy and giving verbal information to the patient can cause/alleviate adverse events.
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Rossettini G, Geri T, Palese A, Marzaro C, Mirandola M, Colloca L, Fiorio M, Turolla A, Manoni M, Testa M. What Physiotherapists Specialized in Orthopedic Manual Therapy Know About Nocebo-Related Effects and Contextual Factors: Findings From a National Survey. Front Psychol 2020; 11:582174. [PMID: 33192904 PMCID: PMC7606996 DOI: 10.3389/fpsyg.2020.582174] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/10/2020] [Accepted: 09/25/2020] [Indexed: 12/11/2022] Open
Abstract
Objective The aim of this study was to investigate the knowledge of orthopedic manual therapists (OMTs) regarding context factors (CFs) capable of triggering nocebo effects during the treatment and how this knowledge is related to their socio-demographic features. Design A cross-sectional online survey. Setting National. Main Outcome Measures A 20 items questionnaire composed by open-ended and closed single-choice questions was administered to explore: (a) socio-demographic variables (10 questions); (b) the relation between different CFs and nocebo-related effects (2 questions); and (c) the knowledge of participants about nocebo-related effects and how they managed them in the clinical practice (8 questions). Participants 1288 OMTs were recruited from the database of the Master in Rehabilitation of Musculoskeletal Disorders (MRDM) of the University of Genova from March to May 2019. Inclusion criteria were: (a) to possess a valid email account; (b) to understand and use as a native language the Italian; (c) to be graduated as OMTs; and (d) to be employed as physiotherapists specialized-OMTs during the survey. Results 791 responses were received (61.4%); 473 of them were male (59.8%), with an average age of 31.0 ± 7.1 years. OMTs defined nocebo-related effects as the psychosocial context effects around therapy and patient with specific biological bases (72.2%). OMTs know that their clinical practice is pervaded by nocebo-related effects (42.5%), triggered by CFs. Participants communicated nocebo-related effects balancing the positive features of the therapy with the negative ones (50.9%), during the decision of the therapeutic plan (42.7%). They reported associative learning as the main mechanism involved in nocebo-related effects (28.8%). OMTs taught and trained patient’s strategies to manage nocebo-related effects (39.6%) through an evaluation and correction of patient’s anxieties, doubts and expectations (37.7%). OMTs most frequently considered themselves to have a “medium” education about nocebo-related effects (48.2%) and that their management should be taught during bachelor (78.6%). Conclusion OMTs believed that nocebo-related effects were present in their clinical practice and that they can be triggered by CFs.
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Affiliation(s)
- Giacomo Rossettini
- Department of Neuroscience, Rehabilitation, Ophthalmology, Genetics, Maternal and Child Health, University of Genova, Genova, Italy.,School of Physiotherapy, University of Verona, Verona, Italy
| | - Tommaso Geri
- Department of Neuroscience, Rehabilitation, Ophthalmology, Genetics, Maternal and Child Health, University of Genova, Genova, Italy
| | - Alvisa Palese
- Department of Medical Sciences, University of Udine, Udine, Italy
| | - Chiara Marzaro
- Department of Neuroscience, Rehabilitation, Ophthalmology, Genetics, Maternal and Child Health, University of Genova, Genova, Italy
| | - Mattia Mirandola
- Department of Neuroscience, Rehabilitation, Ophthalmology, Genetics, Maternal and Child Health, University of Genova, Genova, Italy
| | - Luana Colloca
- Department of Pain and Translational Symptom Science, School of Nursing, University of Maryland, Baltimore, Baltimore, MD, United States.,Department of Anesthesiology and Psychiatry, School of Medicine, Center to Advance Chronic Pain Research, University of Maryland, Baltimore, Baltimore, MD, United States
| | - Mirta Fiorio
- Department of Neurosciences, Biomedicine and Movement Sciences, University of Verona, Verona, Italy
| | - Andrea Turolla
- Department of Neurorehabilitation Technologies, San Camillo IRCCS srl, Venezia, Italy
| | - Mattia Manoni
- Department of Neuroscience, Rehabilitation, Ophthalmology, Genetics, Maternal and Child Health, University of Genova, Genova, Italy
| | - Marco Testa
- Department of Neuroscience, Rehabilitation, Ophthalmology, Genetics, Maternal and Child Health, University of Genova, Genova, Italy
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Mitsikostas DD, Blease C, Carlino E, Colloca L, Geers AL, Howick J, Evers AWM, Flaten MA, Kelley JM, Kirsch I, Klinger R, MaassenVanDenBrink A, Moerman DE, Sfikakis PP, Vase L, Wager TD, Benedetti F. European Headache Federation recommendations for placebo and nocebo terminology. J Headache Pain 2020; 21:117. [PMID: 32977761 PMCID: PMC7519524 DOI: 10.1186/s10194-020-01178-3] [Citation(s) in RCA: 24] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/28/2020] [Accepted: 08/26/2020] [Indexed: 12/31/2022] Open
Abstract
Background and aim Despite recent publications, practitioners remain unfamiliar with the current terminology related to the placebo and nocebo phenomena observed in clinical trials and practice, nor with the factors that modulate them. To cover the gap, the European Headache Federation appointed a panel of experts to clarify the terms associated with the use of placebo in clinical trials. Methods The working group identified relevant questions and agreed upon recommendations. Because no data were required to answer the questions, the GRADE approach was not applicable, and thus only expert opinion was provided according to an amended Delphi method. The initial 12 topics for discussion were revised in the opinion of the majority of the panelists, and after a total of 6 rounds of negotiations, the final agreement is presented. Results/recommendations Two primary and mechanism-based recommendations are provided for the results of clinical trials: [1] to distinguish the placebo or nocebo response from the placebo or nocebo effect; and [2] for any favorable outcome observed after placebo administration, the term “placebo response” should be used, and for any unfavorable outcome recorded after placebo administration, the term “nocebo response” should be used (12 out of 17 panelists agreed, 70.6% agreement). The placebo or nocebo responses are attributed to a set of factors including those that are related to the medical condition (e.g. natural history, random comorbidities, etc.), along with idiosyncratic ones, in which the placebo or nocebo effects are attributed to idiosyncratic, or nonspecific mechanisms, exclusively (e.g. expectation, conditioning, observational learning etc.). To help investigators and practitioners, the panel summarized a list of environmental factors and idiosyncratic dynamics modulating placebo and nocebo effects. Some of them are modifiable, and investigators or physicians need to know about them in order to modify these factors appropriately to improve treatment. One secondary recommendation addresses the use of the terms “placebo” and “nocebo” (“placebos” and “nocebos” in plural), which refer to the triggers of the placebo/nocebo effects or responses, respectively, and which are inert agents or interventions that should not be confused with the placebo/nocebo responses or effects themselves (all panelists agreed, 100% agreement). Conclusion The working group recommends distinguishing the term response from effect to describe health changes from before to after placebo application and to distinguish the terms placebo(s) or nocebo(s) from the health consequences that they cause (placebo/nocebo responses or effects).
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Affiliation(s)
- Dimos D Mitsikostas
- 1st Neurology Department, Aeginiton Hospital, Medical School, National and Kapodistrian University of Athens, 72-72 Vas. Sofia's Avenue, 11528, Athens, Greece.
| | - Charlotte Blease
- General Medicine and Primary Care, Beth Israel Deaconess Medical Center, Boston, MA, USA
| | - Elisa Carlino
- Physiology and Neuroscience, University of Turin Medical School, Turin, Italy
| | - Luana Colloca
- Departments of Pain Translational Symptoms Science and Anaesthesiology, School of Nursing and Medicine, University of Maryland Baltimore, Baltimore, MD, USA
| | - Andrew L Geers
- Department of Psychology, University of Toledo, Toledo, OH, USA
| | - Jeremy Howick
- Faculty of Philosophy, University of Oxford, Oxford, UK
| | - Andrea W M Evers
- Health, Medical and Neuropsychology Unit, Institute of Psychology, Leiden University, Leiden, The Netherlands
| | - Magne A Flaten
- Department of Psychology, Norwegian University of Science and Technology, Trondheim, Norway
| | - John M Kelley
- Beth Israel Deaconess Medical Center, Program in Placebo Studies, Boston, MA, USA
| | - Irving Kirsch
- Beth Israel Deaconess Medical Center, Program in Placebo Studies, Boston, MA, USA
| | - Regine Klinger
- Department of Anesthesiology University Medical Center Hamburg-Eppendorf, Center for Anesthesiology and Intensive Care Medicine, Hamburg, Germany
| | | | | | - Petros P Sfikakis
- 1st Department of Propedeutic and Internal Medicine, National and Kapodistrian University Medical School, Athens, Greece
| | - Lene Vase
- Department of Psychology and Behavioural Sciences, Aarhus University, Aarhus, Denmark
| | - Tor D Wager
- Department of Psychological and Brain Sciences, Dartmouth College, Hanover, NH, USA
| | - Fabrizio Benedetti
- Physiology and Neuroscience, University of Turin Medical School, Turin, Italy
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D'Amico F, Solitano V, Peyrin-Biroulet L, Danese S. Nocebo effect and biosimilars in inflammatory bowel diseases: what's new and what's next? Expert Opin Biol Ther 2020; 21:47-55. [PMID: 32857634 DOI: 10.1080/14712598.2020.1817374] [Citation(s) in RCA: 12] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/12/2022]
Abstract
INTRODUCTION The use of biosimilars for the treatment of patients with chronic inflammatory bowel diseases (IBD) showed to be a valid strategy to reduce the economic burden of biologics on health-care costs and to increase patient access to treatment. However, the nocebo effect constitutes an important limitation to the wide use of biosimilars. AREAS COVERED We conducted a literature overview to summarize information on nocebo effect in IBD population and to provide physicians with practical key strategies to prevent the nocebo effect in daily clinical practice and to improve patients' outcomes. EXPERT OPINION Despite the proven efficacy and safety of biosimilars, further clinical studies are needed to define the effects of reverse and multiple switches in the management of patients with IBD. The development of new subcutaneous formulations, better accepted by patients, could contribute to reduce patients' negative expectations, and limit the nocebo effect.
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Affiliation(s)
- Ferdinando D'Amico
- Department of Biomedical Sciences, Humanitas University, Pieve Emanuele , Milan, Italy.,Department of Gastroenterology and Inserm NGERE U1256, University Hospital of Nancy, University of Lorraine, Vandoeuvre-lès-Nancy , France
| | - Virginia Solitano
- Department of Biomedical Sciences, Humanitas University, Pieve Emanuele , Milan, Italy
| | - Laurent Peyrin-Biroulet
- Department of Gastroenterology and Inserm NGERE U1256, University Hospital of Nancy, University of Lorraine, Vandoeuvre-lès-Nancy , France
| | - Silvio Danese
- Department of Biomedical Sciences, Humanitas University, Pieve Emanuele , Milan, Italy.,Department of Gastroenterology, IBD Center, Humanitas Clinical and Research Center - IRCCS, Rozzano , Milan, Italy
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Okusogu C, Wang Y, Akintola T, Haycock NR, Raghuraman N, Greenspan JD, Phillips J, Dorsey SG, Campbell CM, Colloca L. Placebo hypoalgesia: racial differences. Pain 2020; 161:1872-1883. [PMID: 32701846 PMCID: PMC7502457 DOI: 10.1097/j.pain.0000000000001876] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/19/2022]
Abstract
No large-cohort studies that examine potential racial effects on placebo hypoalgesic effects exist. To fill this void, we studied placebo effects in healthy and chronic pain participants self-identified as either African American/black (AA/black) or white. We enrolled 372 study participants, 186 with a diagnosis of temporomandibular disorder (TMD) and 186 race-, sex-, and age-matched healthy participants to participate in a placebo experiment. Using a well-established paradigm of classical conditioning with verbal suggestions, each individual pain sensitivity was measured to calibrate the temperatures for high- and low-pain stimuli in the conditioning protocol. These 2 temperatures were then paired with a red and green screen, respectively, and participants were told that the analgesic intervention would activate during the green screens to reduce pain. Participants then rated the painfulness of each stimulus on a visual analog scale ranging from 0 to 100. Racial influences were tested on conditioning strength, reinforced expectations, and placebo hypoalgesia. We found that white participants reported greater conditioning effects, reinforced relief expectations, and placebo effects when compared with their AA/black counterparts. Racial effects on placebo were observed in TMD, although negligible, short-lasting, and mediated by conditioning strength. Secondary analyses on the effect of experimenter-participant race and sex concordance indicated that same experimenter-participant race induced greater placebo hypoalgesia in TMDs while different sex induced greater placebo hypoalgesia in healthy participants. This is the first and largest study to analyze racial effects on placebo hypoalgesia and has implications for both clinical research and treatment outcomes.
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Affiliation(s)
- Chika Okusogu
- Department of Pain and Translational Symptom Science, School of Nursing, University of Maryland, Baltimore, USA
| | - Yang Wang
- Department of Pain and Translational Symptom Science, School of Nursing, University of Maryland, Baltimore, USA
- Center to Advance Chronic Pain Research, University of Maryland, Baltimore, USA
| | - Titilola Akintola
- Department of Pain and Translational Symptom Science, School of Nursing, University of Maryland, Baltimore, USA
- Center to Advance Chronic Pain Research, University of Maryland, Baltimore, USA
| | - Nathaniel R. Haycock
- Department of Pain and Translational Symptom Science, School of Nursing, University of Maryland, Baltimore, USA
| | - Nandini Raghuraman
- Department of Pain and Translational Symptom Science, School of Nursing, University of Maryland, Baltimore, USA
| | - Joel D. Greenspan
- Center to Advance Chronic Pain Research, University of Maryland, Baltimore, USA
- Department of Neural and Pain Sciences and Brotman Facial Pain Clinic, School of Dentistry, Baltimore, USA
| | - Jane Phillips
- Department of Neural and Pain Sciences and Brotman Facial Pain Clinic, School of Dentistry, Baltimore, USA
| | - Susan G. Dorsey
- Department of Pain and Translational Symptom Science, School of Nursing, University of Maryland, Baltimore, USA
- Center to Advance Chronic Pain Research, University of Maryland, Baltimore, USA
| | - Claudia M. Campbell
- Department of Psychiatry and Behavioral Science, Johns Hopkins University School of Medicine, Baltimore, MD
| | - Luana Colloca
- Department of Pain and Translational Symptom Science, School of Nursing, University of Maryland, Baltimore, USA
- Center to Advance Chronic Pain Research, University of Maryland, Baltimore, USA
- Departments of Anesthesiology and Psychiatry, School of Medicine, University of Maryland, Baltimore, University of Maryland, Baltimore, USA
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Abstract
Placebo effects influence symptom perceptions and treatment outcomes. Placebo effects can be explored in laboratory settings controlling for natural history and expectations. Such a mechanistic approach to neurological disorders has been implemented in the domain of chronic clinical pain and other neurological disorders. This article therefore focuses on definitions and historical notes related to placebo effects and mechanisms of placebo effects in chronic pain. Knowledge on mechanisms of placebo effects could inform current clinical practice for the treatment of neurological disorders by focusing on patients (and providers) expectations for outcome optimization.
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Affiliation(s)
- Luana Colloca
- Department of Pain Translational Symptoms Science, School of Nursing, University of Maryland, Baltimore, MD, United States; Center to Advance Chronic Pain Research, University of Maryland, Baltimore, MD, United States; Departments of Anesthesiology and Psychiatry, School of Medicine, University of Maryland, Baltimore, MD, United States.
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Sundararajan R, Mwanga-Amumpaire J, King R, Ware NC. Conceptual model for pluralistic healthcare behaviour: results from a qualitative study in southwestern Uganda. BMJ Open 2020; 10:e033410. [PMID: 32317259 PMCID: PMC7204928 DOI: 10.1136/bmjopen-2019-033410] [Citation(s) in RCA: 32] [Impact Index Per Article: 8.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/02/2022] Open
Abstract
INTRODUCTION Medical pluralism, or concurrent utilisation of multiple therapeutic modalities, is common in various international contexts, and has been characterised as a factor contributing to poor health outcomes in low-resource settings. Traditional healers are ubiquitous providers in most regions, including the study site of southwestern Uganda. Where both informal and formal healthcare services are both available, patients do not engage with both options equally. It is not well understood why patients choose to engage with one healthcare modality over the other. The goal of this study was to explain therapeutic itineraries and create a conceptual framework of pluralistic health behaviour. METHODS In-depth interviews were conducted from September 2017 to February 2018 with patients seeking care at traditional healers (n=30) and at an outpatient medicine clinic (n=30) in Mbarara, Uganda; the study is nested within a longitudinal project examining HIV testing engagement among traditional healer-using communities. Inclusion criteria included age ≥18 years, and ability to provide informed consent. Participants were recruited from practices representing the range of healer specialties. Following an inductive approach, interview transcripts were reviewed and coded to identify conceptual categories explaining healthcare utilisation. RESULTS We identified three broad categories relevant to healthcare utilisation: (1) traditional healers treat patients with 'care'; (2) biomedicine uses 'modern' technologies and (3) peer 'testimony' influences healthcare engagement. These categories describe variables at the healthcare provider, healthcare system and peer levels that interrelate to motivate individual engagement in pluralistic health resources. CONCLUSIONS Patients perceive clear advantages and disadvantages to biomedical and traditional care in medically pluralistic settings. We identified factors at the healthcare provider, healthcare system and peer levels which influence patients' therapeutic itineraries. Our findings provide a basis to improve health outcomes in medically pluralistic settings, and underscore the importance of recognising traditional healers as important stakeholders in community health.
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Affiliation(s)
- Radhika Sundararajan
- Center for Global Health, Weill Cornell Medicine, New York, NY, USA
- Emergency Medicine, Weill Cornell Medicine, New York, NY, USA
| | | | - Rachel King
- Global Health Sciences, UCSF Medical Center, San Francisco, California, USA
| | - Norma C Ware
- Global Health and Social Medicine, Harvard Medical School, Boston, Massachusetts, USA
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45
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Jilch S, Sel R, Shariat SF. Medical practice and placebo response: an inseparable bond? Wien Klin Wochenschr 2020; 132:228-231. [PMID: 32211987 PMCID: PMC7253381 DOI: 10.1007/s00508-020-01626-9] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/20/2019] [Accepted: 02/26/2020] [Indexed: 12/17/2022]
Abstract
The history of medicine and the history of placebo are closely intertwined. To understand placebo and its effects this article gives a brief overview about its history, the possible mechanisms of action and its counterpart, nocebo. The Catholic Church used placebo around the sixteenth century for the separation from real and incorrect exorcisms, but it needed Henry Beecher during World War II to quantify the placebo effect as control arm in well-designed studies. Until today the different mechanisms of action of placebo remain poorly researched. Understanding them would allow its effect to be modulated to better serve in research and clinical settings. Expectation, psychosocial context and conditioning play a significant role in the effect size and amplitude. The counterpart, nocebo, is even less investigated, even it is commonly observed as adverse effects during medical treatments. Conclusion: Placebo and nocebo are both underestimated and underresearched in their value. Through further investigation doctors could strengthen the placebo response and prevent adverse effects to help their patients at low cost. These techniques would benefit the patient-doctor relationship, which is the alter of a trust-based successful therapy.
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Affiliation(s)
| | - Ruken Sel
- Medical University of Vienna, Vienna, Austria
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46
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Affiliation(s)
- Luana Colloca
- From the University of Maryland School of Nursing and School of Medicine, Baltimore (L.C.); and the Department of Psychiatry, Brigham and Women's Hospital and Harvard Medical School, Boston (A.J.B.)
| | - Arthur J Barsky
- From the University of Maryland School of Nursing and School of Medicine, Baltimore (L.C.); and the Department of Psychiatry, Brigham and Women's Hospital and Harvard Medical School, Boston (A.J.B.)
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47
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Malhotra S, Chauhan N. The therapeutic alliance between the child, parents, and health professionals. HANDBOOK OF CLINICAL NEUROLOGY 2020; 174:323-332. [PMID: 32977888 DOI: 10.1016/b978-0-444-64148-9.00023-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/11/2023]
Abstract
Therapeutic alliance (TA), a term first used by Zetzel (1956), refers to the collaborative relationship between a patient and a therapist, leading to the development of an affective bond during the process of treatment/therapy and an agreement on treatment/therapy-related tasks and goals. Over time, it became clear that therapeutic alliance has a bidirectional nature, not unique to any one form of therapy but universal in all forms of helping relationships. Engagement of both patient and therapist is essential to its development. Trust, empathy, acceptance, and honesty are among the many constituents of a TA. Alongside this, characteristics of healthcare professionals influence TA, with a warm, empathic, gentle, and accepting therapist enhancing positive TA and a rigid, critical, and less involved therapist posing a hindrance to the development of TA. Literature is sparse for TA in children, and it also essentially involves multiple relationships, namely child alliance, caregiver alliance, and child-parent relationship, which need to be taken into account. Developmental aspects should also be kept in mind while dealing with children and adolescents. It is seen that a strong and positive caregiver alliance influences the development of child alliance. There are ways to foster TA with the child and parent/caregiver to maximize benefits from therapy.
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Affiliation(s)
- Savita Malhotra
- Department of Psychiatry and Child and Adolescent Psychiatry, Post Graduate Institute of Medical Education and Research, Chandigarh, India.
| | - Nidhi Chauhan
- Department of Psychiatry, Government Medical College & Hospital, Chandigarh, India
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48
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Martínez-González M, Martínez-González R, Guerra-Tapia A. Key Communication Skills in Cosmetic Dermatology: A 3-Pillar Model. ACTAS DERMO-SIFILIOGRAFICAS 2019. [DOI: 10.1016/j.adengl.2019.10.003] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/25/2022] Open
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49
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Chen PHA, Cheong JH, Jolly E, Elhence H, Wager TD, Chang LJ. Socially transmitted placebo effects. Nat Hum Behav 2019; 3:1295-1305. [PMID: 31636406 PMCID: PMC7494051 DOI: 10.1038/s41562-019-0749-5] [Citation(s) in RCA: 52] [Impact Index Per Article: 10.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/29/2018] [Accepted: 08/29/2019] [Indexed: 12/30/2022]
Abstract
Medical treatments typically occur in the context of a social interaction between healthcare providers and patients. Although decades of research have demonstrated that patients' expectations can dramatically affect treatment outcomes, less is known about the influence of providers' expectations. Here we systematically manipulated providers' expectations in a simulated clinical interaction involving administration of thermal pain and found that patients' subjective experiences of pain were directly modulated by providers' expectations of treatment success, as reflected in the patients' subjective ratings, skin conductance responses and facial expression behaviours. The belief manipulation also affected patients' perceptions of providers' empathy during the pain procedure and manifested as subtle changes in providers' facial expression behaviours during the clinical interaction. Importantly, these findings were replicated in two more independent samples. Together, our results provide evidence of a socially transmitted placebo effect, highlighting how healthcare providers' behaviour and cognitive mindsets can affect clinical interactions.
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Affiliation(s)
- Pin-Hao A Chen
- Department of Psychological and Brain Sciences, Dartmouth College, Hanover, NH, USA
| | - Jin Hyun Cheong
- Department of Psychological and Brain Sciences, Dartmouth College, Hanover, NH, USA
| | - Eshin Jolly
- Department of Psychological and Brain Sciences, Dartmouth College, Hanover, NH, USA
| | - Hirsh Elhence
- Department of Psychological and Brain Sciences, Dartmouth College, Hanover, NH, USA
| | - Tor D Wager
- Department of Psychological and Brain Sciences, Dartmouth College, Hanover, NH, USA
| | - Luke J Chang
- Department of Psychological and Brain Sciences, Dartmouth College, Hanover, NH, USA.
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50
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Huntsinger ME, Doshi RN. Nurse-directed Preventative Management of Atrial Fibrillation: Is it Feasible? J Innov Card Rhythm Manag 2019; 10:3836-3838. [PMID: 32479571 PMCID: PMC7252798 DOI: 10.19102/icrm.2019.100904] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/04/2022] Open
Affiliation(s)
- Mary E Huntsinger
- Division of Cardiology, Keck School of Medicine, University of Southern California, Los Angeles, CA, USA
| | - Rahul N Doshi
- Division of Cardiology, Keck School of Medicine, University of Southern California, Los Angeles, CA, USA
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