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The effects of low-level laser therapy on muscle strength and functional outcomes in individuals with knee osteoarthritis: a double-blinded randomized controlled trial. Sci Rep 2023; 13:165. [PMID: 36599881 PMCID: PMC9812996 DOI: 10.1038/s41598-022-26553-9] [Citation(s) in RCA: 4] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/27/2022] [Accepted: 12/16/2022] [Indexed: 01/05/2023] Open
Abstract
The purpose of this study was to compare the therapeutic effects of low-level laser therapy (LLLT) with 808 and 660 nm wavelength on muscle strength and functional outcomes in individuals with knee osteoarthritis (OA). A total of 47 participants were randomly assigned to the 808 nm, 660 nm, and sham control groups. Two LLLT groups received continuous LLLT with a mean power of 300 mW in different wavelengths at the knee joint 15 min a session three days per week for eight weeks, while the control group received the sham LED treatment. The knee strength and functional performance involving 30-s sit-to-stand, 40 m fast-paced walk, stair climbing, and the TUG test were measured at the baseline and one week after the interventions were completed. The results showed that knee extensor strength was more improved in the 808 nm group as compared to the 660 nm group (p < 0.001, d = 0.57) and the sham control (p < 0.001, d = 0.40), while increased flexor strength was demonstrated in the 808 nm (p = 0.009, d = 0.67) and sham control groups (p < 0.001, d = 0.97). The number of 30-s sit-to-stand was increased only in the 660 nm group (p = 0.006, d = 0.49). All three groups exhibited improvements in the other three functional performance-based tests after the interventions with no statistically significant differences among the groups. In conclusion, both intervention groups improved muscle strength and functional performance as compared to the control group. The 808 nm wavelength group showed better results in knee extensor strength. Therefore, laser therapy is suggested to be integrated into rehabilitation programs to improve muscle strength and functional performance in the population with knee OA.
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Chen IP, Huang CC, Huang HC, Yang FPG, Ko KT, Lee YT, Sun FJ, Liu SI. Adjunctive Bright Light Therapy for Non-Seasonal Major Depressive Disorder: A Randomized Controlled Trial. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2022; 19:12430. [PMID: 36231728 PMCID: PMC9566126 DOI: 10.3390/ijerph191912430] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 08/17/2022] [Revised: 09/25/2022] [Accepted: 09/27/2022] [Indexed: 06/16/2023]
Abstract
This double-blind, randomized controlled trial assessed bright light therapy (BLT) augmentation efficacy compared with placebo light in treating non-seasonal major depressive disorder. The study participants belonged to a subtropical area (24.5°-25.5°N) with extensive daylight and included outpatients who had received stable dosages and various regimens of antidepressive agents for 4 weeks before enrollment. The outcomes were the 17-item Hamilton Depression Rating Scale, Montgomery-Asberg Depression Rating Scale, and Patient Health Questionnaire-9, which were assessed at weeks 1, 2, and 4. A total of 43 participants (mean age 45 years, ranging from 22-81) were randomized into the BLT [n = 22] and placebo light groups [n = 21]. After a 4-week administration of morning light therapy (30 min/day), depressive symptoms did not reduce significantly, which might be due to the small sample size. Nonetheless, this study had some strengths because it was conducted in warmer climates, unlike other studies, and examined diverse Asians with depression. Our findings suggest that several factors, such as poor drug response, different antidepressive regimens, duration of BLT, and daylength variability (i.e., natural daylight in the environment) may influence the utility of add-on BLT. Researchers may consider these important factors for future non-seasonal depression studies in subtropical environments.
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Affiliation(s)
- I-Peng Chen
- Department of Psychiatry, MacKay Memorial Hospital, Taipei 104217, Taiwan
- Department of Medicine, MacKay Medical College, New Taipei City 252005, Taiwan
| | - Chun-Chao Huang
- Department of Medicine, MacKay Medical College, New Taipei City 252005, Taiwan
- Department of Radiology, MacKay Memorial Hospital, Taipei 104217, Taiwan
- MacKay Junior College of Medicine, Nursing and Management, Taipei 112021, Taiwan
| | - Hui-Chun Huang
- MacKay Junior College of Medicine, Nursing and Management, Taipei 112021, Taiwan
- Department of Medical Research, MacKay Memorial Hospital, Taipei 104217, Taiwan
| | - Fan-Pei Gloria Yang
- Department of Foreign Languages and Literature, National Tsing Hua University, Hsinchu 300044, Taiwan
- Center for Cognition and Mind Sciences, National Tsing Hua University, Hsinchu 300044, Taiwan
- Department of Radiology, Graduate School of Dentistry, Osaka University, Osaka 565-0871, Japan
| | - Kai-Ting Ko
- Department of Psychiatry, MacKay Memorial Hospital, Taipei 104217, Taiwan
- Department of Medicine, MacKay Medical College, New Taipei City 252005, Taiwan
| | - Yun-Tse Lee
- Department of Psychiatry, MacKay Memorial Hospital, Taipei 104217, Taiwan
- Department of Medicine, MacKay Medical College, New Taipei City 252005, Taiwan
| | - Fang-Ju Sun
- MacKay Junior College of Medicine, Nursing and Management, Taipei 112021, Taiwan
- Department of Medical Research, MacKay Memorial Hospital, Taipei 104217, Taiwan
- Institute of Biomedical Informatics, National Yang Ming Chiao Tung University, Hsinchu 300093, Taiwan
| | - Shen-Ing Liu
- Department of Psychiatry, MacKay Memorial Hospital, Taipei 104217, Taiwan
- Department of Medicine, MacKay Medical College, New Taipei City 252005, Taiwan
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ROSSI S, SANTAMARIA JUNIOR M, VENEZIAN GC, MENEZES CCD, SOUZA JEPD, VEDOVELLO SAS. A double-blinded randomized clinical trial of pain perception during orthodontic treatment. REVISTA DE ODONTOLOGIA DA UNESP 2022. [DOI: 10.1590/1807-2577.00722] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
Abstract
Abstract Introduction Orthodontic movement can cause painful symptoms, especially in the early stages of treatment. Objective This study aimed to compare the performance of chewing gum and ibuprofen in pain control during the initial period of orthodontic treatment. Material and method A randomized blind clinical trial, with an allocation ratio of 1:1, was developed with patients aged ≥18 years old. The sample size was established considering a significance level of 5% and test power of 80%, resulting in a minimum of 30 volunteers per group (n=90). Participants were paired regarding sex, age, the severity of malocclusion, defined by the Dental Health Component (DHC) of the Index of Orthodontic Treatment Need (IOTN), and crowding, determined by Little’s irregularity index. The sample was randomly allocated to three groups: Group I (control) placebo; Group II chewing gum; and Group III Ibuprofen. Pain perception was evaluated by the Visual Analog Scale (VAS) in the first 24, 36, and 48 hours after activation of the orthodontic appliance. The data were analyzed by generalized linear models for repeated measures in time. Result No statistically significant difference (p>0.05) was observed among the groups for the methods of pain therapy evaluated in 24, 36, and 48 hours post-activation. Conclusion There was no difference among the method used for pain control during the orthodontic treatment.
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Marschall J, Fejer G, Lempe P, Prochazkova L, Kuchar M, Hajkova K, van Elk M. Psilocybin microdosing does not affect emotion-related symptoms and processing: A preregistered field and lab-based study. J Psychopharmacol 2022; 36:97-113. [PMID: 34915762 PMCID: PMC8801668 DOI: 10.1177/02698811211050556] [Citation(s) in RCA: 26] [Impact Index Per Article: 13.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/03/2023]
Abstract
BACKGROUND Microdoses of psychedelics (i.e. a sub-hallucinogenic dose taken every third day) can reduce symptoms of depression, anxiety and stress according to anecdotal reports and observational studies. Research with medium to high doses of psilocybin points towards potential underlying mechanisms, including the modulation of emotion and interoceptive processing. AIMS In this preregistered study, we investigated whether psilocybin microdoses alter self-reported interoceptive awareness and whether repeated microdosing over 3 weeks modulates emotion processing and reduces symptoms of anxiety and depression. METHODS We used a double-blind, placebo-controlled, within-subject crossover design. Participants completed the Multidimensional Assessment of Interoceptive Awareness Questionnaire 1½ h after self-administering their second dose (or placebo), and the emotional go/no-go task and the shortened Depression Anxiety Stress Scale 1½ h after self-administering their seventh dose. RESULTS Our confirmatory analyses revealed that psilocybin microdosing did not affect emotion processing or symptoms of anxiety and depression compared with placebo. Our exploratory analyses revealed that psilocybin microdosing did not affect self-reported interoceptive awareness, that symptoms of depression and stress were significantly reduced in the first block compared with baseline, that participants broke blind in the second block and that there was no effect of expectations. Further research in a substance-naïve population with clinical range anxiety and depressive symptoms is needed to substantiate the potential beneficial effects of microdosing.
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Affiliation(s)
- Josephine Marschall
- Department of Psychology, University of Amsterdam, Amsterdam, The Netherlands
| | - George Fejer
- Department of Psychology, University of Amsterdam, Amsterdam, The Netherlands
| | - Pascal Lempe
- Department of Psychology, University of Amsterdam, Amsterdam, The Netherlands
| | - Luisa Prochazkova
- Department of Psychology, Leiden University, Leiden, The Netherlands
| | - Martin Kuchar
- Forensic Laboratory of Biologically Active Substances, Department of Chemistry of Natural Compounds, University of Chemistry and Technology Prague, Prague, Czech Republic,Department of Experimental Neurobiology, National Institute of Mental Health, Klecany, Czech Republic
| | - Katerina Hajkova
- Forensic Laboratory of Biologically Active Substances, Department of Chemistry of Natural Compounds, University of Chemistry and Technology Prague, Prague, Czech Republic,Department of Experimental Neurobiology, National Institute of Mental Health, Klecany, Czech Republic
| | - Michiel van Elk
- Department of Psychology, University of Amsterdam, Amsterdam, The Netherlands,Michiel van Elk, Institute of Psychology, Leiden University, Wassenaarseweg 52, 2333 AK Leiden, The Netherlands.
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Patsalis PC, Malik-Patsalis AB, Rauscher HG, Schaefers C, Useini D, Strauch JT, Zahn PK, Dobos GJ, Mügge A, Cramer H. Efficacy of Auricular Acupuncture and Lavender Oil Aromatherapy in Reducing Preinterventional Anxiety in Cardiovascular Patients: A Randomized Single-Blind Placebo-Controlled Trial. JOURNAL OF INTEGRATIVE AND COMPLEMENTARY MEDICINE 2022; 28:45-50. [PMID: 35085018 DOI: 10.1089/jicm.2021.0171] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/14/2023]
Abstract
Introduction: Auricular acupuncture at the "relaxation point" and lavender oil aromatherapy can reduce preoperative anxiety associated with increased mortality and morbidity. Data on the effect of combined auricular acupuncture and lavender oil aromatherapy in patients undergoing cardiovascular interventions with the use of local anesthesia or under conscious sedation are sparse. The authors sought to evaluate the efficacy of auricular acupuncture and lavender oil aromatherapy in reducing preinterventional anxiety in cardiovascular patients. Materials and Methods: Data of 80 consecutive patients undergoing diagnostic coronary angiography (n = 56) with or without percutaneous coronary intervention (n = 9) and right heart catheterization (n = 6), transcatheter aortic valve replacement (n = 17) and percutaneous mitral valve repair (MitraClip; n = 2) were analyzed. Patients were prospectively randomized to receive either preinterventional auricular acupuncture and lavender oil (Lavandula angustifolia) aromatherapy (verum group, n = 39) or combined sham auricular acupuncture and placebo oil aromatherapy (placebo group, n = 41). For the verum group bilateral auricular acupuncture was performed at the "relaxation point." State anxiety and blood pressure were assessed before and at 30 min after acupuncture and presternal oil application. State anxiety was defined as primary outcome measure and assessed using the Spielberger State Anxiety Inventory (STAI) for Adults form Y6. Intervention-specific anxiety was assessed by a 10-point numerical rating scale, and perceived treatment success by a single dichotomous question. Clinical blood pressure was further assessed. Results: After the intervention, the verum group had significantly decreased anxiety on the STAI compared with the placebo group (Δ = -4.18; 95% confidence interval = -8.31 to -0.05; p = 0.047). Significantly more patients reported subjective treatment success in the verum group (87.2%) than in the placebo group (65.9%, p = 0.035). No significant differences were observed regarding intervention-specific anxiety and blood pressure between the two groups. No serious adverse events occurred in any group. Conclusions: Combined auricular acupuncture and lavender oil aromatherapy can decrease preinterventional anxiety in cardiovascular patients and requires further investigation. German Clinical Trials Register (registration no. DRKS00023686).
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Affiliation(s)
- Polykarpos C Patsalis
- Department of Cardiology and Angiology, University Hospital Bergmannsheil, Ruhr University Bochum, Bochum, Germany
- Division of Cardiology and Emergency Medicine, Department of Medicine, Knappschaft University Hospital, Ruhr University Bochum, Bochum, Germany
| | - Amena B Malik-Patsalis
- Department of Internal and Integrative Medicine, Evang. Kliniken Essen-Mitte, Faculty of Medicine, University of Duisburg-Essen, Essen, Germany
| | - Helen Gwendolin Rauscher
- Department of Cardiology and Angiology, University Hospital Bergmannsheil, Ruhr University Bochum, Bochum, Germany
| | - Christian Schaefers
- Department of Cardiology and Angiology, University Hospital Bergmannsheil, Ruhr University Bochum, Bochum, Germany
| | - Dritan Useini
- Department of Cardiothoracic Surgery, University Hospital Bergmannsheil, Ruhr University Bochum, Bochum, Germany
| | - Justus Thomas Strauch
- Department of Cardiothoracic Surgery, University Hospital Bergmannsheil, Ruhr University Bochum, Bochum, Germany
| | - Peter K Zahn
- Department of Anesthesiology, Intensive Care Medicine, Palliative Care Medicine and Pain Management, University Hospital Bergmannsheil, Ruhr University Bochum, Bochum, Germany
| | - Gustav J Dobos
- Department of Internal and Integrative Medicine, Evang. Kliniken Essen-Mitte, Faculty of Medicine, University of Duisburg-Essen, Essen, Germany
| | - Andreas Mügge
- Department of Cardiology and Angiology, University Hospital Bergmannsheil, Ruhr University Bochum, Bochum, Germany
| | - Holger Cramer
- Department of Internal and Integrative Medicine, Evang. Kliniken Essen-Mitte, Faculty of Medicine, University of Duisburg-Essen, Essen, Germany
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Iolascon G, Moretti A. Myths and Truths about Placebo Effect in Rehabilitation for Musculoskeletal Pain. Adv Ther 2021; 38:4995-5001. [PMID: 34476754 PMCID: PMC8478741 DOI: 10.1007/s12325-021-01894-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/02/2021] [Accepted: 08/12/2021] [Indexed: 02/08/2023]
Abstract
This commentary provides the authors' point of view about the biopsychosocial perspective of placebo effect on musculoskeletal pain in the rehabilitation field.
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Affiliation(s)
- Giovanni Iolascon
- Department of Medical and Surgical Specialties and Dentistry, University of Campania Luigi Vanvitelli, Via de Crecchio, 6, 80138, Naples, Italy.
| | - Antimo Moretti
- Department of Medical and Surgical Specialties and Dentistry, University of Campania Luigi Vanvitelli, Via de Crecchio, 6, 80138, Naples, Italy
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Precision medicine reaching out to the patients in allergology - a German-Japanese workshop report. Allergol Select 2021; 5:162-179. [PMID: 34079922 PMCID: PMC8167740 DOI: 10.5414/alx02234e] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/27/2021] [Accepted: 03/19/2021] [Indexed: 12/12/2022] Open
Abstract
An expert workshop in collaboration of the German Society of Allergy and Clinical Immunology (DGAKI) and the Japanese Society of Allergy (JSA) provided a platform for key opinion leaders of both countries aimed to join expertise and to highlight current developments and achievements in allergy research. Key domains of the meeting included the following seven main sections and related subchapters: 1) basic immunology, 2) bronchial asthma, 3) prevention of allergic diseases, 4) food allergy and anaphylaxis, 5) atopic dermatitis, 6) venom allergy, and 7) upper airway diseases. This report provides a summary of panel discussions of all seven domains and highlights unmet needs and project possibilities of enhanced collaborations of scientific projects.
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Visser LM, Davies OE. The Becoming of Online Healthcare through Entangled Power and Performativity: A posthumanist agential realist perspective. ORGANIZATION STUDIES 2021. [DOI: 10.1177/0170840621997616] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/22/2022]
Abstract
In this article we adopt Barad’s theory of agential realism to explore how power and performativity are simultaneously processual and ontologically entangled. We use the hyphenated term power-performativity to mobilize an exploration of how power is not an ‘outcome’ or ‘effect’ of, but an inseparable flow within, the processes of performativity through which the world is continuously becoming. This moves us beyond the traditional, anthropocentric take on the relationship between power and performativity which emphasizes human agency and linear cause-effect, toward an alternative understanding of organizational phenomena as always enacted through myriad intra-acting more-than-human actants. To empirically mobilize this approach, we explore power-performativity within online healthcare, enacted through personal online healthcare communities (POHCs). We explore multiple ‘diffraction gratings’ through which particular outcomes of online healthcare come to matter, while others are prevented from mattering. In doing so, we posit the suitability of Barad’s agential realism for further explorations of the dynamics of power and performativity in modes of organizing and organizational life and offer tools for how these may be done.
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Mitsui T, Arii Y, Tsukamoto A, Taniguchi K, Mabuchi M, Shimizu A, Sumitomo N, Maki YK. Sociability-based fitness approach in Parkinson's disease: Comparison with conventional rehabilitation. Eur J Neurol 2021; 28:1893-1900. [PMID: 33657674 DOI: 10.1111/ene.14798] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/03/2020] [Revised: 02/25/2021] [Accepted: 02/25/2021] [Indexed: 12/19/2022]
Abstract
BACKGROUND AND PURPOSE The effect of a sociability-based fitness approach on parkinsonian disability in patients with Parkinson's disease (PD) was assessed. METHODS Eighty patients diagnosed with PD were randomly assigned to either the group-based rehabilitation (GBR) group (n = 40) or the individual-based rehabilitation (IBR) group (n = 40). The primary outcome was the difference between the two groups in the mean change from baseline to post-training in the total score on the Unified Parkinson's Disease Rating Scale (UPDRS). The secondary outcomes included the change in mental status and the difference in the mean change from baseline to month 3 and month 6 in the total score on the UPDRS. RESULTS The mean (±SD) UPDRS scores were 72.0 ± 21.0 in the GBR group and 72.1 ± 18.6 in the IBR group. The UPDRS scores from baseline to post-training were 22.8 ± 13.5 in the GBR group and 10.9 ± 8.8 in the IBR group (difference 11.8 points; 95% confidence interval [CI] 5.0-18.6; p = 0.001). The difference between the groups from baseline to month 3 (difference 10.06 points; 95% CI 3.3-16.8) and the difference between the groups from baseline to month 6 (difference 11.7 points; 95% CI 4.9-18.5) were also significant (p = 0.004 and p = 0.001, respectively). The scores of cognitive function and depression had not changed significantly. CONCLUSIONS Patients receiving GBR demonstrated significant improvements in parkinsonian symptoms, suggesting that the sociability-based fitness can be applied to clinical treatment by sustaining the motivation in PD.
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Affiliation(s)
- Takao Mitsui
- Department of Neurology, Tokushima National Hospital National Hospital Organization, Tokushima, Japan.,Department of Clinical Research, Tokushima National Hospital National Hospital Organization, Tokushima, Japan
| | - Yoshiharu Arii
- Department of Neurology, Tokushima National Hospital National Hospital Organization, Tokushima, Japan
| | - Ai Tsukamoto
- Department of Neurology, Tokushima National Hospital National Hospital Organization, Tokushima, Japan
| | - Koichiro Taniguchi
- Department of Neurology, Tokushima National Hospital National Hospital Organization, Tokushima, Japan
| | - Masaru Mabuchi
- Department of Rehabilitation, Tokushima National Hospital, National Hospital Organization, Tokushima, Japan
| | - Arisa Shimizu
- Department of Clinical Research, Tokushima National Hospital National Hospital Organization, Tokushima, Japan
| | - Nichika Sumitomo
- Department of Clinical Research, Tokushima National Hospital National Hospital Organization, Tokushima, Japan
| | - Yukiko Kuroda Maki
- Department of Clinical Research, Tokushima National Hospital National Hospital Organization, Tokushima, Japan
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Pfaar O, Agache I, Bergmann K, Bindslev‐Jensen C, Bousquet J, Creticos PS, Devillier P, Durham SR, Hellings P, Kaul S, Kleine‐Tebbe J, Klimek L, Jacobsen L, Jutel M, Muraro A, Papadopoulos NG, Rief W, Scadding GK, Schedlowski M, Shamji MH, Sturm G, Ree R, Vidal C, Vieths S, Wedi B, Gerth van Wijk R, Frew AJ. Placebo effects in allergen immunotherapy-An EAACI Task Force Position Paper. Allergy 2021; 76:629-647. [PMID: 32324902 DOI: 10.1111/all.14331] [Citation(s) in RCA: 27] [Impact Index Per Article: 9.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/11/2020] [Accepted: 03/18/2020] [Indexed: 12/12/2022]
Abstract
The placebo (Latin "I will please") effect commonly occurs in clinical trials. The psychological and physiological factors associated with patients' expectations about a treatment's positive and negative effects have yet to be well characterized, although a functional prefrontal cortex and intense bidirectional communication between the central nervous system and the immune system appear to be prerequisites for a placebo effect. The use of placebo raises certain ethical issues, especially if patients in a placebo group are denied an effective treatment for a long period of time. The placebo effect appears to be relatively large (up to 77%, relative to pretreatment scores) in controlled clinical trials of allergen immunotherapy (AIT), such as the pivotal, double-blind, placebo-controlled (DBPC) randomized clinical trials currently required by regulatory authorities worldwide. The European Academy of Allergy and Clinical Immunology (EAACI) therefore initiated a Task Force, in order to better understand the placebo effect in AIT and its specific role in comorbidities, blinding issues, adherence, measurement time points, variability and the natural course of the disease. In this Position Paper, the EAACI Task Force highlights several important topics regarding the placebo effect in AIT such as a) regulatory aspects, b) neuroimmunological and psychological mechanisms, c) placebo effect sizes in AIT trials, d) methodological limitations in AIT trial design and e) potential solutions in future AIT trial design. In conclusion, this Position Paper aims to examine the methodological problem of placebo in AIT from different aspects and also to highlight unmet needs and possible solutions for future trials.
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Affiliation(s)
- Oliver Pfaar
- Department of Otorhinolaryngology, Head and Neck Surgery Section of Rhinology and Allergy University Hospital Marburg Philipps‐Universität Marburg Marburg Germany
| | | | - Karl‐Christian Bergmann
- Charité – Universitätsmedizin Berlin, corporate member of Freie Universität Berlin Humboldt‐Universität zu Berlin Berlin Germany
- Berlin Institute of Health Allergy‐Centre‐Charité Berlin Germany
| | - Carsten Bindslev‐Jensen
- Department of Dermatology and Allergy Centre Odense University Hospital Odense Research Center for Anaphylaxis (ORCA) Odense Denmark
| | - Jean Bousquet
- MACVIA‐France Montpellier France
- University Hospital Montpellier Montpellier France
| | - Peter S. Creticos
- Division of Allergy & Clinical Immunology Johns Hopkins University School of Medicine Baltimore MD USA
- Creticos Research Group Crownsville MD USA
| | - Philippe Devillier
- Department of Airway Diseases, Exhalomics, Hôpital Foch Université Paris‐Saclay Suresnes France
| | - Stephen R. Durham
- Allergy and Clinical Immunology National Heart and Lung Institute Imperial College London London UK
| | - Peter Hellings
- Department of Otorhinolaryngology University Hospitals of Leuven Leuven Belgium
- Department of Otorhinolaryngology Academic Medical Center University of Amsterdam Amsterdam The Netherlands
- Department of Neuroscience University of Ghent Ghent Belgium
| | - Susanne Kaul
- Paul‐Ehrlich‐Institut Federal Institute for Vaccines and Biomedicines Langen Germany
| | - Jörg Kleine‐Tebbe
- Allergy & Asthma Center Westend Outpatient Clinic and Clinical Research Center Berlin Germany
| | - Ludger Klimek
- Center for Rhinology and Allergology Wiesbaden Germany
| | - Lars Jacobsen
- ALC, Allergy Learning and Consulting Copenhagen Denmark
| | - Marek Jutel
- Department of Clinical Immunology Wroclaw Medical University Wroclaw Poland
- All‐Med Medical Research Institute Wroclaw Poland
| | - Antonella Muraro
- Food Allergy Referral Centre Padua University Hospital Padua Padua Italy
| | - Nikolaos G. Papadopoulos
- Division of Infection Immunity & Respiratory Medicine University of Manchester Manchester UK
- Allergy Department 2nd Pediatric Clinic University of Athens Athens Greece
| | - Winfried Rief
- Department of Clinical Psychology and Psychotherapy Philipps‐University of Marburg Marburg Germany
| | | | - Manfred Schedlowski
- Institute of Medical Psychology and Behavioral Immunobiology University Clinic Essen Essen Germany
| | - Mohamed H. Shamji
- National Heart and Lung Institute Imperial College London London UK
- NIHR Biomedical Research Centre Imperial College London London UK
| | - Gunter Sturm
- Department of Dermatology and Venereology Medical University of Graz Graz Austria
- Allergy Outpatient Clinic Reumannplatz Vienna Austria
| | - Ronald Ree
- Departments of Experimental Immunology and of Otorhinolaryngology Amsterdam University Medical Centers Amsterdam The Netherlands
| | - Carmen Vidal
- Department of Allergy and Faculty of Medicine University of Santiago de Compostela Santiago Spain
| | - Stefan Vieths
- Paul‐Ehrlich‐Institut Federal Institute for Vaccines and Biomedicines Langen Germany
| | - Bettina Wedi
- Department of Dermatology and Allergy Hannover Medical School Comprehensive Allergy Center Hannover Germany
| | - Roy Gerth van Wijk
- Section of Allergology Department of Internal Medicine Erasmus MC Rotterdam the Netherlands
| | - Anthony J. Frew
- Department of Respiratory Medicine Royal Sussex County Hospital University of Sussex and University of Brighton Brighton UK
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Zareba R, Rysiak E, Przylipiak A, Oscilowska I. Ethical-legal evaluation of the use of placebo in clinical trials. J Cosmet Dermatol 2021; 20:1348-1349. [PMID: 33533184 DOI: 10.1111/jocd.13967] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/07/2020] [Revised: 01/14/2021] [Accepted: 01/26/2021] [Indexed: 11/27/2022]
Affiliation(s)
- Renata Zareba
- Laboratory of Private International Law, University of Bialystok, Bialystok, Poland
| | - Edyta Rysiak
- Department of Medicinal Chemistry, Medical University of Bialystok, Bialystok, Poland
| | - Andrzej Przylipiak
- Department of Aesthetic Medicine, Medical University of Bialystok, Bialystok, Poland
| | - Ilona Oscilowska
- Department of Medicinal Chemistry, Medical University of Bialystok, Bialystok, Poland
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Laursen DRT, Hansen C, Paludan-Müller AS, Hróbjartsson A. Active placebo versus standard placebo control interventions in pharmacological randomised trials. Hippokratia 2020. [DOI: 10.1002/14651858.mr000055] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Affiliation(s)
- David RT Laursen
- Centre for Evidence-Based Medicine Odense (CEBMO); Odense University Hospital; Odense Denmark
- Nordic Cochrane Centre; Rigshospitalet; Copenhagen Denmark
- Department of Clinical Research; University of Southern Denmark; Odense Denmark
- Open Patient data Explorative Network (OPEN); Odense University Hospital; Odense Denmark
| | - Camilla Hansen
- Centre for Evidence-Based Medicine Odense (CEBMO); Odense University Hospital; Odense Denmark
- Nordic Cochrane Centre; Rigshospitalet; Copenhagen Denmark
- Department of Clinical Research; University of Southern Denmark; Odense Denmark
- Open Patient data Explorative Network (OPEN); Odense University Hospital; Odense Denmark
| | | | - Asbjørn Hróbjartsson
- Centre for Evidence-Based Medicine Odense (CEBMO); Odense University Hospital; Odense Denmark
- Department of Clinical Research; University of Southern Denmark; Odense Denmark
- Open Patient data Explorative Network (OPEN); Odense University Hospital; Odense Denmark
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Tallyne de Aguiar Silva A, Lima Cavalcanti ID, Ayanny de Lima Fernandes M, Gisele de Oliveira Coimbra C, Manoella de Souza Lima G. Effect of zymomonas mobilis probiotic on cholesterol and its lipoprotein fractions and the intestinal regulation. Clin Nutr 2020; 39:3750-3755. [PMID: 32471645 DOI: 10.1016/j.clnu.2020.04.002] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/22/2019] [Revised: 03/09/2020] [Accepted: 04/02/2020] [Indexed: 11/28/2022]
Abstract
Zymomonas mobilis have characteristics that classify it as probiotic. Thus, this study aimed to evaluate the effect of regular consumption of fermented broth of this strain on the intestinal function of individuals with changes in intestinal transit. This is a randomized, descriptive and quantitative clinical trial, a sample composed of undergraduate students from a university center in Caruaru. After screening for individuals with constipation according to the inclusion and exclusion criteria, only 13 agreed to participate in the study. They were divided into groups: group 1 received Zymomonas mobilis fermented broth once a day; group 2 also received the fermented broth in the same concentration cells being twice a day; group 3 received cell-free fermented broth once daily; and group 4, placebo, received saline once daily, all groups drank for fifteen days, and laboratory tests were performed to check lipid profile before and after that period. Observed an increase in evacuation days in all groups averaged in media 7.0-10.5 days. Groups 1 and 2 showed an increase in total cholesterol (0.5% and 5.0%, respectively), HDL cholesterol (4.1% and 24.1%), LDL cholesterol (4.9% and 8.4%), VLDL cholesterol (17.9% and 11.2%) and triglycerides (19.1% and 27.9%). In group 3, there was a reduction of total cholesterol (-2.4%), LDL cholesterol (-11.2%), VLDL cholesterol (-15.9%), triglycerides (-27.7%) and increase in HDL cholesterol (25.7%). Thus, the broth fermented with Zymomonas mobilis regulated the intestinal transit, but did not improve the lipid profile, while the without cells broth showed a better lipid profile.
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Affiliation(s)
- Andreza Tallyne de Aguiar Silva
- Lato Sensu Multiprofessional Residence Program in Cancer Attention and Palliative Care, University Center Tabosa of Almeida (ASCES-UNITA), Caruaru, Pernambuco, Brazil.
| | - Iago Dillion Lima Cavalcanti
- Lato Sensu Multiprofessional Residence Program in Cancer Attention and Palliative Care, University Center Tabosa of Almeida (ASCES-UNITA), Caruaru, Pernambuco, Brazil
| | - Maria Ayanny de Lima Fernandes
- Lato Sensu Multiprofessional Residence Program in Cancer Attention and Palliative Care, University Center Tabosa of Almeida (ASCES-UNITA), Caruaru, Pernambuco, Brazil
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Ito E, Shima R, Yoshioka T. A novel role of oxytocin: Oxytocin-induced well-being in humans. Biophys Physicobiol 2019; 16:132-139. [PMID: 31608203 PMCID: PMC6784812 DOI: 10.2142/biophysico.16.0_132] [Citation(s) in RCA: 22] [Impact Index Per Article: 4.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/02/2019] [Accepted: 07/27/2019] [Indexed: 12/19/2022] Open
Abstract
We review the involvement of a small molecule, oxytocin, in various effects of physical stimulation of somatosensory organs, mindfulness meditation, emotion and fragrance on humans, and then propose a hypothesis that complex human states and behaviors, such as well-being, social bonding, and emotional behavior, are explained by oxytocin. We previously reported that oxytocin can induce pain relief and described the possibility how oxytocin in the dorsal horn and/or the dorsal root ganglion relieves joint and muscle pain. In the present article, we expand our research target from the physical analgesic effects of oxytocin to its psychologic effects to upregulate well-being and downregulate stress and anxiety. For this purpose, we propose a “hypothalamic-pituitary-adrenal (HPA) axis-oxytocin model” to explain why mindfulness meditation, placebo, and fragrance can reduce stress and anxiety, resulting in contentment. This new proposed model of HPA axis-oxytocin in the brain also provides a target to address other questions regarding emotional behaviors, learning and memory, and excess food intake leading to obesity, aimed at promoting a healthy life.
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Affiliation(s)
- Etsuro Ito
- Department of Biology, Waseda University, Shinjuku-ku, Tokyo 162-8480, Japan.,Graduate Institute of Medicine, School of Medicine, Kaohsiung Medical University, Kaohsiung 80756, Taiwan
| | - Rei Shima
- Department of Biology, Waseda University, Shinjuku-ku, Tokyo 162-8480, Japan
| | - Tohru Yoshioka
- Graduate Institute of Medicine, School of Medicine, Kaohsiung Medical University, Kaohsiung 80756, Taiwan
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Faltinsen E, Todorovac A, Hróbjartsson A, Gluud C, Kongerslev MT, Simonsen E, Storebø OJ. Placebo, usual care and wait-list interventions for all mental health disorders. THE COCHRANE DATABASE OF SYSTEMATIC REVIEWS 2019. [DOI: 10.1002/14651858.mr000050] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/17/2022]
Affiliation(s)
- Erlend Faltinsen
- Region Zealand Psychiatry; Psychiatric Research Unit; Faelledvej 6 Slagelse Denmark 4200
| | - Adnan Todorovac
- Region Zealand Psychiatry; Psychiatric Research Unit; Faelledvej 6 Slagelse Denmark 4200
| | - Asbjørn Hróbjartsson
- Odense University Hospital; Centre for Evidence-Based Medicine Odense (CEBMO); Kløvervaenget 10, 13. Floor Odense C SYDDANMARK Denmark 5000
| | - Christian Gluud
- Copenhagen University Hospital; Copenhagen Trial Unit, Centre for Clinical Intervention Research; Copenhagen Denmark
| | - Mickey T Kongerslev
- Region Zealand Psychiatry; Psychiatric Research Unit; Faelledvej 6 Slagelse Denmark 4200
| | - Erik Simonsen
- Region Zealand Psychiatry; Psychiatric Research Unit; Faelledvej 6 Slagelse Denmark 4200
- Copenhagen University; Institute of Clinical Medicine, Faculty of Health and Medical Sciences; Copenhagen Denmark
| | - Ole Jakob Storebø
- Region Zealand Psychiatry; Psychiatric Research Unit; Faelledvej 6 Slagelse Denmark 4200
- University of Southern Denmark; Department of Psychology, Faculty of Health Science; Campusvej 55 Odense Denmark 5230
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McQueen D, Cohen S, St John-Smith P, Rampes H. Rethinking placebo in psychiatry: the range of placebo effects. ACTA ACUST UNITED AC 2018. [DOI: 10.1192/apt.bp.112.010397] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/31/2022]
Abstract
SummaryThis article, the first of two on placebo effects, provides a broad overview of placebo in the field of medicine. A brief conceptual history is followed by some basic facts about placebos. Problems of definition are identified. Additive and non-additive models of treatment effects, and problems of measurement of placebo effects are described. The role of placebo in the pharmacotherapy of depression and complementary and alternative medicine is discussed. The ‘efficacy paradox’ (that placebo treatments can have larger effects than ‘evidence-based treatments’) is introduced. Finally, ethical issues are discussed.
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Hanssen TA, Iqbal A, Forsdahl SH, Trovik T, Schirmer H. Changes in symptoms of anxiety and depression following diagnostic angiography: a prospective cohort study. EUROPEAN HEART JOURNAL. QUALITY OF CARE & CLINICAL OUTCOMES 2017; 4:106-112. [DOI: 10.1093/ehjqcco/qcx039] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/16/2017] [Accepted: 10/24/2017] [Indexed: 12/13/2022]
Affiliation(s)
- Tove Aminda Hanssen
- Department of Heart Disease, University Hospital of North Norway, Sykehusvegen 38, Tromsø 9013, Norway
- Cardiovascular Research Group, Institute of Clinical Medicine, University of Tromsø-The Arctic University of Norway, Hansine Hansens veg 18, Tromsø 9019, Norway
| | - Amjid Iqbal
- Department of Heart Disease, University Hospital of North Norway, Sykehusvegen 38, Tromsø 9013, Norway
- Cardiovascular Research Group, Institute of Clinical Medicine, University of Tromsø-The Arctic University of Norway, Hansine Hansens veg 18, Tromsø 9019, Norway
| | - Signe Helene Forsdahl
- Department of Radiology, University Hospital of North Norway, Sykehusvegen 38, Tromsø 9013, Norway
| | - Thor Trovik
- Department of Heart Disease, University Hospital of North Norway, Sykehusvegen 38, Tromsø 9013, Norway
| | - Henrik Schirmer
- Department of Heart Disease, University Hospital of North Norway, Sykehusvegen 38, Tromsø 9013, Norway
- Cardiovascular Research Group, Institute of Clinical Medicine, University of Tromsø-The Arctic University of Norway, Hansine Hansens veg 18, Tromsø 9019, Norway
- Department of Cardiology, Akerhus University Hospital, Sykehusveien 25, Lørenskog 1478, Norway
- Institute of Clinical Medicine, Faculty of Medicine, University of Oslo, Sykehusveien 25, Lørenskog 1478, Norway
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Green J, Wright H. From Bench to Bedside: Converting Placebo Research into Belief Activation. J Altern Complement Med 2017; 23:575-580. [PMID: 28719223 DOI: 10.1089/acm.2016.0375] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
Research on the placebo effect contains important elements that can be harnessed to improve clinical care. This paper proposes a new term, "Belief Activation," to describe the deliberate use of placebo effect tools by both patients and clinicians to catalyze healing. Belief Activation includes, but is not limited to, maximizing patient and practitioner expectations, classical and social conditioning, spirituality and prayer/intention, therapeutic relationship, healing environments, and minimizing the nocebo effect. This paper demonstrates ways in which Belief Activation is a form of evidence-based medicine and seeks to translate knowledge from placebo research into medical practice.
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Affiliation(s)
- Jen Green
- 1 Emcura Integrative Clinic , Bloomfield Township, MI
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Bishop FL, Coghlan B, Geraghty AWA, Everitt H, Little P, Holmes MM, Seretis D, Lewith G. What techniques might be used to harness placebo effects in non-malignant pain? A literature review and survey to develop a taxonomy. BMJ Open 2017; 7:e015516. [PMID: 28667217 PMCID: PMC5734496 DOI: 10.1136/bmjopen-2016-015516] [Citation(s) in RCA: 25] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/20/2022] Open
Abstract
OBJECTIVES Placebo effects can be clinically meaningful but are seldom fully exploited in clinical practice. This review aimed to facilitate translational research by producing a taxonomy of techniques that could augment placebo analgesia in clinical practice. DESIGN Literature review and survey. METHODS We systematically analysed methods which could plausibly be used to elicit placebo effects in 169 clinical and laboratory-based studies involving non-malignant pain, drawn from seven systematic reviews. In a validation exercise, we surveyed 33 leading placebo researchers (mean 12 years’ research experience, SD 9.8), who were asked to comment on and add to the draft taxonomy derived from the literature. RESULTS The final taxonomy defines 30 procedures that may contribute to placebo effects in clinical and experimental research, proposes 60 possible clinical applications and classifies procedures into five domains: the patient’s characteristics and belief (5 procedures and 11 clinical applications), the practitioner’s characteristics and beliefs (2 procedures and 4 clinical applications), the healthcare setting (8 procedures and 13 clinical applications), treatment characteristics (8 procedures and 14 clinical applications) and the patientâ€"practitioner interaction (7 procedures and 18 clinical applications). CONCLUSION The taxonomy provides a preliminary and novel tool with potential to guide translational research aiming to harness placebo effects for patient benefit in practice.
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Affiliation(s)
- Felicity L Bishop
- Department of Psychology, Faculty of Social Human and Mathematical Sciences, University of Southampton, Southampton, UK
| | - Beverly Coghlan
- Primary Care and Population Sciences, Aldermoor Health Centre, University of Southampton, Southampton, UK
| | - Adam WA Geraghty
- Primary Care and Population Sciences, Aldermoor Health Centre, University of Southampton, Southampton, UK
| | - Hazel Everitt
- Primary Care and Population Sciences, Aldermoor Health Centre, University of Southampton, Southampton, UK
| | - Paul Little
- Primary Care and Population Sciences, Aldermoor Health Centre, University of Southampton, Southampton, UK
| | - Michelle M Holmes
- Department of Psychology, Faculty of Social Human and Mathematical Sciences, University of Southampton, Southampton, UK
| | - Dionysis Seretis
- Department of Psychology, Faculty of Social Human and Mathematical Sciences, University of Southampton, Southampton, UK
| | - George Lewith
- Primary Care and Population Sciences, Aldermoor Health Centre, University of Southampton, Southampton, UK
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Beauvais F. Possible contribution of quantum-like correlations to the placebo effect: consequences on blind trials. THEORETICAL BIOLOGY & MEDICAL MODELLING 2017; 14:12. [PMID: 28578662 PMCID: PMC5457621 DOI: 10.1186/s12976-017-0058-5] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 02/15/2017] [Accepted: 05/25/2017] [Indexed: 11/23/2022]
Abstract
Background Factors that participate in the biological changes associated with a placebo are not completely understood. Natural evolution, mean regression, concomitant procedures and other non specific effects are well-known factors that contribute to the “placebo effect”. In this article, we suggest that quantum-like correlations predicted by a probabilistic modeling could also play a role. Results An elementary experiment in biology or medicine comparing the biological changes associated with two placebos is modeled. The originality of this modeling is that experimenters, biological system and their interactions are described together from the standpoint of a participant who is uninvolved in the measurement process. Moreover, the small random probability fluctuations of a “real” experiment are also taken into account. If both placebos are inert (with only different labels), common sense suggests that the biological changes associated with the two placebos should be comparable. However, the consequence of this modeling is the possibility for two placebos to be associated with different outcomes due to the emergence of quantum-like correlations. Conclusion The association of two placebos with different outcomes is counterintuitive and this modeling could give a framework for some unexplained observations where mere placebos are compared (in some alternative medicines for example). This hypothesis can be tested in blind trials by comparing local vs. remote assessment of correlations.
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Predictors of positive opinion about Bach Flower Remedies in adults from three Latin-American countries: An exploratory study. Complement Ther Clin Pract 2017; 27:52-56. [PMID: 28438281 DOI: 10.1016/j.ctcp.2017.04.002] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/08/2016] [Revised: 03/08/2017] [Accepted: 04/04/2017] [Indexed: 11/21/2022]
Abstract
The current study aimed to determine if positive opinions about BFR interacts with spirituality in adults from three Latin-American countries using a CHAID algorithm. Participants were 703 adults from Cuba (n = 319), Costa Rica (n = 252) and Chile (n = 132). PREDICTORS demographic data, received information, received treatment, spirituality, dispositional optimism and willingness to use a placebo intervention were measured and analyzed. A supervised classification which included a training phase (n = 423) and a test phase (n = 280) was employed. Received information about BFR, spirituality and education were selected as significant predictors of the positive opinion about BFR (>90% of correct classifications).
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Boehm K, Berger B, Weger U, Heusser P. Does the model of additive effect in placebo research still hold true? A narrative review. JRSM Open 2017; 8:2054270416681434. [PMID: 28321318 PMCID: PMC5347270 DOI: 10.1177/2054270416681434] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/21/2022] Open
Abstract
Personalised and contextualised care has been turned into a major demand by people involved in healthcare suggesting to move toward person-centred medicine. The assessment of person-centred medicine can be most effectively achieved if treatments are investigated using ‘with versus without’ person-centredness or integrative study designs. However, this assumes that the components of an integrative or person-centred intervention have an additive relationship to produce the total effect. Beecher’s model of additivity assumes an additive relation between placebo and drug effects and is thus presenting an arithmetic summation. So far, no review has been carried out assessing the validity of the additive model, which is to be questioned and more closely investigated in this review. Initial searches for primary studies were undertaken in July 2016 using Pubmed and Google Scholar. In order to find matching publications of similar magnitude for the comparison part of this review, corresponding matches for all included reviews were sought. A total of 22 reviews and 3 clinical and experimental studies fulfilled the inclusion criteria. The results pointed to the following factors actively questioning the additive model: interactions of various effects, trial design, conditioning, context effects and factors, neurobiological factors, mechanism of action, statistical factors, intervention-specific factors (alcohol, caffeine), side-effects and type of intervention. All but one of the closely assessed publications was questioning the additive model. A closer examination of study design is necessary. An attempt in a more systematic approach geared towards solutions could be a suggestion for future research in this field.
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Affiliation(s)
- Katja Boehm
- Faculty of Health, Institute for Integrative Medicine, Witten/Herdecke University, 58448 Witten, Germany; Faculty of Health, Department of Psychology and Psychotherapy, Witten/Herdecke University, 58448 Witten, Germany
| | - Bettina Berger
- Faculty of Health, Institute for Integrative Medicine, Witten/Herdecke University, 58448 Witten, Germany
| | - Ulrich Weger
- Faculty of Health, Department of Psychology and Psychotherapy, Witten/Herdecke University, 58448 Witten, Germany
| | - Peter Heusser
- Faculty of Health, Institute for Integrative Medicine, Witten/Herdecke University, 58448 Witten, Germany
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Chojnacka M, Antosik-Wójcińska AZ, Dominiak M, Bzinkowska D, Borzym A, Sokół-Szawłowska M, Bodzak-Opolska G, Antoniak D, Święcicki Ł. A sham-controlled randomized trial of adjunctive light therapy for non-seasonal depression. J Affect Disord 2016; 203:1-8. [PMID: 27267951 DOI: 10.1016/j.jad.2016.05.062] [Citation(s) in RCA: 19] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/08/2015] [Revised: 05/24/2016] [Accepted: 05/25/2016] [Indexed: 10/21/2022]
Abstract
BACKGROUND The aim of the study was to examine the efficacy and safety of morning bright light therapy (BLT) in the treatment of patients with a current major depressive episode (MDE) in bipolar and unipolar disorder without a seasonal pattern. It was a randomized, sham-controlled trial. METHODS Adults, ages 18-70 years were randomized to treatment either with BLT or a sham negative ion generator (as a placebo control). The subjects were required to be on a stable and therapeutic dose of psychotropic medication for at least 4 weeks prior to enrollment and their treatment had to be insufficiently effective. Their clinical state was monitored at the baseline and at the end of treatment. The Hamilton Depression Rating Scale-21 items (HDRS-21), Montgomery-Asberg Depression Rating Scale (MADRS), Beck Depression Inventory (BDI-II), Clinical Global Impression-Severity (CGI-S) and Patient Global Impression (PGI) were used. The results were analyzed with an intention-to-treat (ITT) analysis. RESULTS Ninety-five patients were enrolled (50 diagnosed with bipolar disorder and 45 with unipolar depression). Fifty-two patients were randomized to treatment with BLT and forty-three were in the placebo group (ITT population). Eighty-three subjects completed the study. There were 12 dropouts (5 in the light group and 7 in the placebo group). After 14 days of treatment, a significant improvement was found in all groups (p<0.001). The subjects treated with BLT did not significantly differ in terms of improvement in HDRS-21 scores at the endpoint when compared to patients treated with placebo (p=0.2). However, further analysis demonstrated significantly higher response (50% v. 27.9%, p=0.02) and remission rates (28.8% v. 11.6%, p=0.04) among patients treated with morning BLT when compared to placebo group. It should be noted that in the population of drug-resistant patients, BLT was more efficacious than placebo. There were no statistically significant differences between unipolar and bipolar disorders (p=0.4). CONCLUSION Although overall improvement in HDRS-21 scores were not superior in the BLT group, both response and remission rates were significantly higher among patients treated with BLT relative to those receiving the sham intervention. BLT was also more efficacious than placebo in the population of patients with drug-resistant depression. Further studies to define the subpopulation of patients with non-seasonal depression who may benefit the most from BLT are needed.
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Affiliation(s)
- Magdalena Chojnacka
- Department of Affective Disorders, Institute of Psychiatry and Neurology, Sobieskiego Street 9, 02-957 Warsaw, Poland.
| | - Anna Z Antosik-Wójcińska
- Department of Affective Disorders, Institute of Psychiatry and Neurology, Sobieskiego Street 9, 02-957 Warsaw, Poland
| | | | - Dorota Bzinkowska
- Department of Affective Disorders, Institute of Psychiatry and Neurology, Sobieskiego Street 9, 02-957 Warsaw, Poland
| | | | | | | | | | - Łukasz Święcicki
- Department of Affective Disorders, Institute of Psychiatry and Neurology, Sobieskiego Street 9, 02-957 Warsaw, Poland
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Davidson J, Jonas W. Individualized Homeopathy: A Consideration of Its Relationship to Psychotherapy. J Altern Complement Med 2016; 22:594-8. [PMID: 27285053 DOI: 10.1089/acm.2015.0365] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
OBJECTIVES The benefit and potential mechanisms of action of homeopathy have long been debated. Almost entirely neglected has been the study of individualized homeopathy (IH) as a form of psychotherapy, which incorporates factors that are common to most therapies while using processes that are specific to IH. METHODS Recent research into the therapeutic components of IH is reviewed; similarities and differences between IH and other forms of psychotherapy are also described. RESULTS IH includes elements found in humanistic therapy and narrative medicine and additionally incorporates idiographic material in treatment selection. It is structured in a manner that takes maximum advantage of the components of the placebo effect, which could further expand its effectiveness beyond those conditions thought usually amenable to psychotherapy. CONCLUSIONS It is possible that IH entails specific psychotherapeutic processes in addition to possible therapeutic action of the homeopathic remedy, but the relative contributions of each remain to be determined. Suggestions are given for future research.
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Affiliation(s)
- Jonathan Davidson
- 1 Department of Psychiatry and Behavioral Sciences, Duke University Medical Center , Durham, NC
| | - Wayne Jonas
- 2 Samueli Institute, Georgetown School of Medicine and Uniformed Services University , Alexandria, VA
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Goli F, Rafieian S, Atarodi S. An Introduction to the Semiotic Approach to the Placebo Responses. BIOSEMIOTIC MEDICINE 2016. [DOI: 10.1007/978-3-319-35092-9_1] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/17/2022]
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Greco CM, Yu L, Johnston KL, Dodds NE, Morone NE, Glick RM, Schneider MJ, Klem ML, McFarland CE, Lawrence S, Colditz J, Maihoefer CC, Jonas WB, Ryan ND, Pilkonis PA. Measuring nonspecific factors in treatment: item banks that assess the healthcare experience and attitudes from the patient's perspective. Qual Life Res 2015; 25:1625-34. [PMID: 26563249 DOI: 10.1007/s11136-015-1178-1] [Citation(s) in RCA: 24] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 11/02/2015] [Indexed: 12/17/2022]
Abstract
PURPOSE Nonspecific factors that accompany healthcare treatments, such as patients' attitudes and expectations, are important parts of the experience of care and can influence outcomes. However, no precise, concise, and generalizable instruments to measure these factors exist. We report on the development and calibration of new item banks, titled the Healing Encounters and Attitudes Lists (HEAL), that assess nonspecific factors across a broad range of treatments and conditions. METHODS The instrument development methodology of the Patient-Reported Outcomes Measurement Information System (PROMIS(®)) was used. Patient focus groups and clinician interviews informed our HEAL conceptual model. Literature searches of eight databases yielded over 500 instruments and resulted in an initial item pool of several thousand items. After qualitative item analysis, including cognitive interviewing, 296 items were included in field testing. The calibration sample included 1657 respondents, 1400 obtained through an Internet panel and 257 from conventional and integrative medicine clinics. Following exploratory and confirmatory factor analyses, the HEAL item banks were calibrated using item response theory. RESULTS The final HEAL item banks were Patient-Provider Connection (57 items), Healthcare Environment (25 items), Treatment Expectancy (27 items), Positive Outlook (27 items), and Spirituality (26 items). Short forms were also developed from each item bank. A six-item short form, Attitudes toward Complementary and Alternative Medicine (CAM), was also created. CONCLUSIONS HEAL item banks provided substantial information across a broad range of each construct. HEAL item banks showed initial evidence of predictive and concurrent validity, suggesting that they are suitable for measuring nonspecific factors in treatment.
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Affiliation(s)
- Carol M Greco
- Department of Psychiatry, University of Pittsburgh School of Medicine, Pittsburgh, PA, USA. .,University of Pittsburgh Center for Integrative Medicine, 580 South Aiken Avenue, Suite 310, Pittsburgh, PA, 15232, USA.
| | - Lan Yu
- Department of Medicine, University of Pittsburgh School of Medicine, Pittsburgh, PA, USA
| | - Kelly L Johnston
- Department of Psychiatry, University of Pittsburgh School of Medicine, Pittsburgh, PA, USA
| | - Nathan E Dodds
- Department of Psychiatry, University of Pittsburgh School of Medicine, Pittsburgh, PA, USA
| | - Natalia E Morone
- Department of Medicine, University of Pittsburgh School of Medicine, Pittsburgh, PA, USA
| | - Ronald M Glick
- Department of Psychiatry, University of Pittsburgh School of Medicine, Pittsburgh, PA, USA.,University of Pittsburgh Center for Integrative Medicine, 580 South Aiken Avenue, Suite 310, Pittsburgh, PA, 15232, USA
| | - Michael J Schneider
- Department of Physical Therapy, University of Pittsburgh School of Health and Rehabilitation Sciences, Pittsburgh, PA, USA
| | - Mary Lou Klem
- Health Sciences Library System, University of Pittsburgh, Pittsburgh, PA, USA
| | - Christine E McFarland
- Department of Psychiatry, University of Pittsburgh School of Medicine, Pittsburgh, PA, USA.,University of Pittsburgh Center for Integrative Medicine, 580 South Aiken Avenue, Suite 310, Pittsburgh, PA, 15232, USA
| | - Suzanne Lawrence
- Department of Psychiatry, University of Pittsburgh School of Medicine, Pittsburgh, PA, USA
| | - Jason Colditz
- Department of Medicine, University of Pittsburgh School of Medicine, Pittsburgh, PA, USA
| | - Catherine C Maihoefer
- Department of Psychiatry, University of Pittsburgh School of Medicine, Pittsburgh, PA, USA
| | | | - Neal D Ryan
- Department of Psychiatry, University of Pittsburgh School of Medicine, Pittsburgh, PA, USA.,University of Pittsburgh Center for Integrative Medicine, 580 South Aiken Avenue, Suite 310, Pittsburgh, PA, 15232, USA
| | - Paul A Pilkonis
- Department of Psychiatry, University of Pittsburgh School of Medicine, Pittsburgh, PA, USA
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Abstract
The placebo effect is a complex phenomenon occurring across a variety of clinical conditions. While much placebo research has been conducted in diseases defined by self-report such as depression, chronic pain, and irritable bowel syndrome (IBS), asthma has been proposed as a useful model because of its easily measured objective outcomes. Studies examining the placebo response in asthma have not only contributed to an understanding of the mechanisms behind the placebo response but also shed an interesting light on the current treatment and diagnosis of asthma. This paper will review current literature on placebos in general and specifically on the placebo response in asthma. It focuses on what we know about the mechanisms behind the placebo effect, whether there is a specific portion of the population who responds to placebos, which patient outcomes are influenced by the placebo effect, and whether the effect can be augmented.
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Affiliation(s)
- Stefanie Dutile
- Brigham and Women’s Hospital and Harvard Medical School, Boston, MA, USA
| | - Ted J. Kaptchuk
- Program in Placebo Studies, Beth Israel Deaconess Medical Center and Harvard Medical School, Boston, MA, USA
| | - Michael E. Wechsler
- Division of Pulmonary, Critical Care and Sleep Medicine, National Jewish Health, 1400 Jackson St, Denver, CO 80206, USA
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28
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Effect of carrageenan food supplement on patients with cardiovascular disease results in normalization of lipid profile and moderate modulation of immunity system markers. PHARMANUTRITION 2014. [DOI: 10.1016/j.phanu.2014.02.001] [Citation(s) in RCA: 26] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/01/2023]
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Lund K, Vase L, Petersen GL, Jensen TS, Finnerup NB. Randomised controlled trials may underestimate drug effects: balanced placebo trial design. PLoS One 2014; 9:e84104. [PMID: 24416197 PMCID: PMC3885519 DOI: 10.1371/journal.pone.0084104] [Citation(s) in RCA: 53] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/20/2013] [Accepted: 11/12/2013] [Indexed: 11/19/2022] Open
Abstract
Background It is an inherent assumption in randomised controlled trials that the drug effect can be estimated by subtracting the response during placebo from the response during active drug treatment. Objective To test the assumption of additivity. The primary hypothesis was that the total treatment effect is smaller than the sum of the drug effect and the placebo effect. The secondary hypothesis was that non-additivity was most pronounced in participants with large placebo effects. Methods We used a within-subject randomised blinded balanced placebo design and included 48 healthy volunteers (50% males), mean (SD) age 23.4 (6.2) years. Experimental pain was induced by injections of hypertonic saline into the masseter muscle. Participants received four injections with hypertonic saline along with lidocaine or matching placebo in randomised order: A: received hypertonic saline/told hypertonic saline; B: received hypertonic saline+lidocaine/told hypertonic saline; C: received hypertonic saline+placebo/told hypertonic saline+pain killer; D: received hypertonic saline+lidocaine/told hypertonic saline+pain killer. The primary outcome measure was the area under the curve (AUC, mm2) of pain intensity during injections. Results There was a significant difference between the sum of the drug effect and the placebo effect (mean AUC 6279 mm2 (95% CI, 4936–7622)) and the total treatment effect (mean AUC 5455 mm2 (95% CI, 4585–6324)) (P = 0.049). This difference was larger for participants with large versus small placebo effects (P = 0.015), and the difference correlated significantly with the size of the placebo effect (r = 0.65, P = 0.006). Conclusion Although this study examined placebo effects and not the whole placebo response as in randomised controlled trials, it does suggest that the additivity assumption may be incorrect, and that the estimated drug effects in randomised controlled trials may be underestimated, particularly in studies reporting large placebo responses. The implications for randomised controlled trials and systematic reviews need to be discussed.
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Affiliation(s)
- Karen Lund
- Danish Pain Research Center, Aarhus University Hospital, Aarhus, Denmark
- * E-mail:
| | - Lene Vase
- Department of Psychology, School of Business and Social Sciences, Aarhus University, Aarhus, Denmark
| | - Gitte L. Petersen
- Department of Psychology, School of Business and Social Sciences, Aarhus University, Aarhus, Denmark
| | - Troels S. Jensen
- Danish Pain Research Center, Aarhus University Hospital, Aarhus, Denmark
| | - Nanna B. Finnerup
- Danish Pain Research Center, Aarhus University Hospital, Aarhus, Denmark
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Meissner K. Placebo responses on cardiovascular, gastrointestinal, and respiratory organ functions. Handb Exp Pharmacol 2014; 225:183-203. [PMID: 25304533 DOI: 10.1007/978-3-662-44519-8_11] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/27/2023]
Abstract
It is widely acknowledged that placebo responses are accompanied by physiological changes in the central nervous system, but little is known about placebo responses on end organ functions. The present chapter aims to fill this gap by reviewing the literature on peripheral placebo responses. Overall, there is a wide range of placebo and nocebo responses on various organ functions of the cardiovascular, the gastrointestinal system, and the respiratory system. Most of these studies used expectation paradigms to elicit placebo and nocebo responses. Expectations can affect heart rate, blood pressure, coronary diameter, gastric motility, bowel motility, and lung function. Classical conditioning can induce placebo respiratory depression after prior exposure to opioid drugs, and habitual coffee drinkers show physiological arousal in response to coffee-associated stimuli. Similar to findings in placebo pain research, peripheral placebo responses can be target specific. The autonomic nervous system is a likely candidate to mediate peripheral placebo responses. Further studies are necessary to identify the brain mechanisms and pathways involved in peripheral placebo responses.
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Affiliation(s)
- Karin Meissner
- Institute of Medical Psychology, Ludwig-Maximilians-University Munich, Goethestrasse 31, 80336, Munich, Germany,
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Narkus A, Lehnigk U, Haefner D, Klinger R, Pfaar O, Worm M. The placebo effect in allergen-specific immunotherapy trials. Clin Transl Allergy 2013; 3:42. [PMID: 24360060 PMCID: PMC3878370 DOI: 10.1186/2045-7022-3-42] [Citation(s) in RCA: 49] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/13/2013] [Accepted: 12/09/2013] [Indexed: 01/24/2023] Open
Abstract
BACKGROUND Double-blind, placebo-controlled (DBPC) trials are the gold standard for demonstrating clinical efficacy and tolerability. The placebo effect, although an important feature in placebo-controlled studies, has never been systematically investigated in allergen-specific immunotherapy (SIT) studies. This study was performed to examine the placebo response in SIT trials that employed a baseline observational period and two treatment years using a symptom-medication-score (SMS) as the primary endpoint. METHODS The placebo effect was evaluated in six DBPC SIT studies (five studies using subcutaneous SIT (SCIT) and one sublingual (SLIT)), two grass, two birch and two house dust mite (HDM) SIT, including a total of 472 adult patients treated with a placebo. The results were reported as changes from baseline of the SMS area under the curve after two years of perennial placebo therapy during the respective evaluation periods. Pollen counts and IgG4 levels were additionally analysed. RESULTS Subcutaneously treated placebo patients displayed a marked decrease in the SMS. The mean placebo effect in the SCIT trials with comparable allergen exposure was up to 41% in the second treatment year and, in contrast, reached only 1% in the SLIT trial. Allergen exposure had an inverse influence on the placebo effect. No changes from baseline in allergen specific IgG4 antibodies were observed in the placebo-treated patients. CONCLUSIONS SIT studies display a significant placebo effect, mainly observed in subcutaneous immunotherapy, with high variability depending on the route of application and allergen exposure. Our findings indicate the differential role of the placebo effect in SIT efficacy depending on the route of administration and pollen exposure.
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Affiliation(s)
- Annemie Narkus
- Medical Department, Allergopharma GmbH & Co KG, Reinbek, Germany
| | - Ulrike Lehnigk
- Medical Department, Allergopharma GmbH & Co KG, Reinbek, Germany
| | - Dietrich Haefner
- Medical Department, Allergopharma GmbH & Co KG, Reinbek, Germany
| | - Regine Klinger
- Department of Clinical Psychology, Behaviour Therapy, University of Hamburg, Hamburg, Germany
| | - Oliver Pfaar
- Department of Otorhinolaryngology, Head and Neck Surgery, University Hospital Mannheim, Mannheim, Germany
| | - Margitta Worm
- Allergy-Center-Charité, Department of Dermatology and Allergy, Charité-Campus Mitte, Universitätsmedizin, Berlin, Germany
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Abhishek A, Doherty M. Mechanisms of the placebo response in pain in osteoarthritis. Osteoarthritis Cartilage 2013; 21:1229-35. [PMID: 23973135 DOI: 10.1016/j.joca.2013.04.018] [Citation(s) in RCA: 53] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/02/2013] [Revised: 04/17/2013] [Accepted: 04/24/2013] [Indexed: 02/02/2023]
Abstract
INTRODUCTION Administration of a placebo associates with symptomatic improvement in many conditions--the so-called placebo response. In this review we explain the concept of placebo response, examine the data that supports existence in osteoarthritis (OA), and discuss its possible mechanisms and determinants. METHODS A Pubmed literature search was carried out. Key articles were identified, and their findings discussed in a narrative review. RESULTS Pain, stiffness, self-reported function and physician-global assessment in OA clearly improve in response to placebo. However, more objective measures such as quadriceps strength and radiographic progression appear less responsive. Although not directly studied in OA, contextual effects, patient expectation and conditioning are believed to be the main mechanisms. Neurotransmitter changes that mediate placebo-induced analgesia include increased endogenous opioid levels, increased dopamine levels, and reduced levels of cholecystokinin. Almost all parts of the brain involved in pain processing are influenced during placebo-induced analgesia. Determinants of the magnitude of placebo response include the patient-practitioner interaction, treatment response expectancy, knowledge of being treated, patient personality traits and placebo specific factors such as the route and frequency of administration, branding, and treatment costs. CONCLUSION Clearer understanding of the neurobiology of placebo response validates its existence as a real phenomenon. Although routine administration of placebo for symptomatic improvement is difficult to justify, contextual factors that enhance treatment response should be employed in the management of chronic painful conditions such as OA where available treatments have only modest efficacy.
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Affiliation(s)
- A Abhishek
- Arthritis Research UK Pain Centre, Academic Rheumatology, University of Nottingham, Nottingham, United Kingdom.
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Samokhvalov AV, Gamaleddin I, Sproule B, Rehm J. Naltrexone may block euphoria-like placebo effect. BMJ Case Rep 2013; 2013:bcr-2013-010098. [PMID: 23925680 DOI: 10.1136/bcr-2013-010098] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
Abstract
Naltrexone is a first-line treatment for alcohol use disorders in North America and Europe. It was prescribed to a 63-year-old patient in order to help control amounts of alcohol consumed per drinking occasion. The patient experienced a paradoxical, but consistent side effect of feeling inebriated each time he took naltrexone. In order to investigate this phenomenon we administered naltrexone and a placebo in a randomised double-blind fashion. The patient exhibited a 'high-like' response to all placebo capsules and a decrease in the subjectively perceived euphoria shortly after ingestion of naltrexone. Given that this placebo effect could be mediated via opioid receptors we suggest that this case illustrates the ability of naltrexone to eliminate the placebo effect. This feature of naltrexone, upon further investigation, might be used in randomised clinical trials in addition to or as an alternative to a placebo.
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Haresnape C. An exploration of the relationship between placebo and homeopathy and the implications for clinical trial design. JRSM SHORT REPORTS 2013; 4:2042533313490927. [PMID: 24040505 PMCID: PMC3767074 DOI: 10.1177/2042533313490927] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
Placebo appears to be a real neurobiological phenomenon that has evolved through the selection pressure to be able to heal ourselves. The complex language and social structures of humans means that we can attribute meaning to therapeutic encounters with culturally sanctioned authority figures and we can use our attachment to such figures to generate hope for recovery. Different mechanisms may be involved in the neurobiological aspect of placebo including anxiety, learning, conditioning as well as individual genetic variation. Examination of the published work shows that while some trials do seem to indicate a specific mode of action for homeopathic remedies other trials do not and this is an issue that needs to be addressed at the trial design stage. A clinical trial that includes both a placebo group and a non-participating control arm is the most powerful design for separating the non-specific and polymorphic placebo effect from the specific effects of trial medication. The control variables in a trial of homeopathic medication should also include the process of consultation as this may assume a meaning for the individual that can also be associated with a placebo effect.
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Affiliation(s)
- Claire Haresnape
- Barts and the London School of Medicine and Dentistry, Queen Mary University of London, William Harvey Research Institute, London, EC1M 6BQ, UK
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Bogen S, Legenbauer T, Bogen T, Gest S, Jensch T, Schneider S, Holtmann M. Morning light therapy for juvenile depression and severe mood dysregulation: study protocol for a randomized controlled trial. Trials 2013; 14:178. [PMID: 23773310 PMCID: PMC3689601 DOI: 10.1186/1745-6215-14-178] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/17/2012] [Accepted: 04/29/2013] [Indexed: 01/09/2023] Open
Abstract
BACKGROUND The prevalence of depression in young people is increasing. The predominant co-morbidities of juvenile depression include sleep disturbances and persistent problems with the sleep-wake rhythm, which have shown to influence treatment outcomes negatively. Severe mood dysregulation is another condition that includes depressive symptoms and problems with the sleep-wake rhythm. Patients with severe mood dysregulation show symptoms of depression, reduced need for sleep, and disturbances in circadian functioning which negatively affect both disorder-specific symptoms and daytime functioning. One approach to treating both depression and problems with the sleep-wake rhythm is the use of light therapy. Light therapy is now a standard therapy for ameliorating symptoms of seasonal affective disorder and depression in adults, but has not yet been investigated in children and adolescents. In this trial, the effects of 2 weeks of morning bright-light therapy on juvenile depression and severe mood dysregulation will be evaluated. METHODS/DESIGN A total of 60 patients with depression, aged between 12 and 18 years, in some cases presenting additional symptoms of affective dysregulation, will be included in this trial. Morning bright-light therapy will be implemented for 2 weeks (10 sessions of 45 minutes each), either with 'active' light (10,000 lux) or 'inactive' light (100 lux). A comprehensive test battery will be conducted before and after treatment and at follow-up 3 weeks later, to assess depression severity, sleep, and attention parameters. Melatonin levels will be measured by assessing the Dim Light Melatonin Onset. DISCUSSION In this pilot study, the use of morning bright-light therapy for juvenile depression and severe mood dysregulation shall be evaluated and discussed. TRIALS REGISTRATION Current Controlled Trials ISRCTN89305231.
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Affiliation(s)
- Sarah Bogen
- Hospital for Child and Adolescent Psychiatry, LWL University Hospital of the Ruhr-University Bochum, Hamm, Germany
| | - Tanja Legenbauer
- Hospital for Child and Adolescent Psychiatry, LWL University Hospital of the Ruhr-University Bochum, Hamm, Germany
| | - Thorsten Bogen
- Hospital for Child and Adolescent Psychiatry, LWL University Hospital of the Ruhr-University Bochum, Hamm, Germany
| | - Stephanie Gest
- Hospital for Child and Adolescent Psychiatry, LWL University Hospital of the Ruhr-University Bochum, Hamm, Germany
| | - Thomas Jensch
- Hospital for Child and Adolescent Psychiatry, LWL University Hospital of the Ruhr-University Bochum, Hamm, Germany
| | - Silvia Schneider
- Department of Psychology, Ruhr-University Bochum, Bochum, Germany
| | - Martin Holtmann
- Hospital for Child and Adolescent Psychiatry, LWL University Hospital of the Ruhr-University Bochum, Hamm, Germany
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Abstract
The province of Papua, Indonesia has one of the fastest growing rates of HIV infection in Asia. Within volatile political conditions, HIV has reached generalized epidemic status for indigenous Papuans. This article explores the merits of using the concept of local biologies as an analytic tool to assess the range of factors which affect a local pattern of untreated HIV and rapid onset of AIDS. A research team conducted 32 in-depth interviews with HIV-positive indigenous persons and 15 interviews with health care workers in urban and peri-urban sites in the central highlands region. The results show fear of gossip and stigmatization, regional political conditions and gaps in care interweave to create local biological conditions of evasion of care and rapid onset of AIDS. The normative emphasis in contemporary scholarship on stigma as shaping subjective responses to HIV needs to be complemented by a full assessment of the physiological impact of health services, and the ways political conditions trickle down and mediate local biological patterns. The concept of local biologies is highly effective for explaining the full scope of possible factors affecting the intersection of social and physical realms for HIV-positive persons.
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Affiliation(s)
- Leslie Butt
- Department of Pacific and Asian Studies, University of Victoria, P.O. Box 1700, Victoria, BC, V8W 2Y2, Canada.
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Knapp van Bogaert D, Ogunbanjo GA. The ethics of placebos. S Afr Fam Pract (2004) 2013. [DOI: 10.1080/20786204.2013.10874316] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/24/2022] Open
Affiliation(s)
- D Knapp van Bogaert
- Centre for Applied Ethics University of Stellenbosch, Independent Consultant in Ethics
| | - GA Ogunbanjo
- Department of Family Medicine and Primary Health Care, University of Limpopo (Medunsa Campus), Pretoria
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Leech J, Mazzone SB, Farrell MJ. The Effect of Placebo Conditioning on Capsaicin-Evoked Urge to Cough. Chest 2012; 142:951-957. [DOI: 10.1378/chest.12-0362] [Citation(s) in RCA: 34] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/01/2022] Open
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Humphrey N, Skoyles J. The evolutionary psychology of healing: A human success story. Curr Biol 2012; 22:R695-8. [DOI: 10.1016/j.cub.2012.06.018] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/27/2022]
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Placebo response in relation to clinical trial design: a systematic review and meta-analysis of randomized controlled trials for determining biologic efficacy in psoriasis treatment. Arch Dermatol Res 2012; 304:707-17. [DOI: 10.1007/s00403-012-1266-9] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/24/2012] [Revised: 07/11/2012] [Accepted: 07/16/2012] [Indexed: 10/28/2022]
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Horowitz S. New Perspectives on the Placebo Effect: Implications for Research and Clinical Practice. ACTA ACUST UNITED AC 2012. [DOI: 10.1089/act.2012.18304] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/29/2023]
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Current World Literature. Curr Opin Support Palliat Care 2012; 6:289-98. [DOI: 10.1097/spc.0b013e328353e091] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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Meissner K, Höfner L, Fässler M, Linde K. Widespread use of pure and impure placebo interventions by GPs in Germany. Fam Pract 2012; 29:79-85. [PMID: 21808072 DOI: 10.1093/fampra/cmr045] [Citation(s) in RCA: 48] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
AIM To collect data on the use of placebo interventions by GPs in Germany. METHODS A questionnaire was mailed to 400 randomly selected GPs in Bavaria. Non-responders were reminded by telephone after 4 weeks and were given a second copy of the questionnaire after a further 3 weeks. RESULTS In all, 208 completed questionnaires were returned. The majority of GPs (88%) have used a placebo at least once in their practice; 45% have used pure placebos, such as saline injections and sugar pills, at least once last year; the median frequency of use was 5 [interquartile range (IQR), 2-10]. The use of impure placebos during the past year was more common: 76% of GPs have used impure placebos, i.e. medical interventions that have pharmacological or physical activity but have no intrinsic effect (e.g. pharmacological or physical action) on the patient's disease or its symptoms, with a median frequency of 20 times per year (IQR, 10-50). The main reason for the use of placebo was a possible psychological effect, followed by the expectation of patients to receive a treatment. For the majority of GPs placebo interventions were ethically justified if they were used for a possible psychological effect. CONCLUSIONS Placebo interventions are a widely accepted part of medical treatment in German general practices and are used primarily for their psychological effects. Impure placebos are used much more frequently than pure placebos.
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Affiliation(s)
- Karin Meissner
- Institute of Medical Psychology, Ludwig-Maximilians-University of Munich, Goethestrasse 31, 80336 Munich, Germany.
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Waschbisch A, Derfuss T. Placebo-controlled trials in relapsing–remitting multiple sclerosis: are they still needed? FUTURE NEUROLOGY 2012. [DOI: 10.2217/fnl.11.68] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022]
Abstract
Placebo-controlled clinical trials are an important tool to verify the efficacy of therapeutic approaches. During recent years, many trials have been conducted into relapsing–remitting multiple sclerosis, resulting in a variety of treatment options considered effective based on prospective, randomized controlled trials with masked outcome assessment in a representative population of patients (class I evidence). Accordingly, treatment is recommended because the benefit of treatment outweighs the potential risks (level A recommendation), whereas no treatment or delay of treatment may potentially harm patients. Placebo-controlled trials seem to be outdated in relapsing–remitting multiple sclerosis because they: cannot predict where a new treatment is placed in relation to the already established therapies, lead to the recruitment of inactive and nonrepresentative patient populations, delay the registration process due to slow recruitment, change the genetic background of study populations due to a shift of clinical trials to Asian countries and are unethical.
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Affiliation(s)
- Anne Waschbisch
- Department of Neurology, University Hospital Erlangen, Germany
| | - Tobias Derfuss
- Department of Neurology, University Hospital, Petersgraben 4, 4031 Basel, Switzerland
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Pollo A, Carlino E, Benedetti F. Placebo mechanisms across different conditions: from the clinical setting to physical performance. Philos Trans R Soc Lond B Biol Sci 2011; 366:1790-8. [PMID: 21576136 DOI: 10.1098/rstb.2010.0381] [Citation(s) in RCA: 65] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/19/2022] Open
Abstract
Although the great increase in interest in the placebo phenomenon was spurred by the clinical implications of its use, the progressive elucidation of the neurobiological and pharmacological mechanisms underlying the placebo effect also helps cast new light on the relationship between mind (and brain) and body, a topic of foremost philosophical importance but also a major medical issue in light of the complex interactions between the brain on the one hand and body functions on the other. While the concept of placebo can be a general one, with a broad definition generally applicable to many different contexts, the description of the cerebral processes called into action in specific situations can vary widely. In this paper, examples will be given where physiological or pathological conditions are altered following the administration of an inert substance or verbal instructions tailored to induce expectation of a change, and explanations will be offered with details on neurotransmitter changes and neural pathways activated. As an instance of how placebo effects can extend beyond the clinical setting, data in the physical performance domain and implications for sport competitions will also be presented and discussed.
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Affiliation(s)
- Antonella Pollo
- Department of Neuroscience, University of Turin, and National Institute of Neuroscience, Turin, Italy
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