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Ballering AV, Plug I, van Zon SKR, Olde Hartman T, Das E, Rosmalen J. Different patterns of persistent somatic symptoms after COVID-19 reported by the Dutch media and the general population. J Psychosom Res 2024; 186:111886. [PMID: 39167967 DOI: 10.1016/j.jpsychores.2024.111886] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/21/2023] [Revised: 05/08/2024] [Accepted: 08/12/2024] [Indexed: 08/23/2024]
Abstract
OBJECTIVE Post COVID-19 condition is characterized by persistent symptoms after COVID-19 with yet unknown etiology. To explore whether media-related nocebo effects potentially contribute to post COVID-19 condition, we studied in an observational cohort whether frequencies of media coverage of symptoms after COVID-19 corresponded with prevalence rates of these symptoms in participants from a general population cohort diagnosed with COVID-19. METHODS Prevalence rates and typology of symptoms after COVID-19 in the general population (N = 4231), adjusted for prevalence rates in a matched non-infected control population (n = 8462) were calculated by using data on 23 symptoms from the Lifelines COVID-19 Cohort collected between March 2020 and August 2021. Media coverage of post COVID-19 condition was assessed by coding 1266 Dutch post COVID-19-related news articles (inter-rater-κ ≥ 0.75), published during the corresponding timeframe. Herein, we assessed whether the same 23 symptoms were mentioned as being related to post COVID-19 condition. RESULTS Core post COVID-19 condition symptoms were mentioned in 390 (30.8%) articles. Five of the ten core symptoms were mentioned by 10 or fewer articles. Ageusia/anosmia was most often persistently increased in COVID-19-positive participants (7.6%), yet was mentioned in 80 (6.3%) articles. General tiredness and breathing difficulties were frequently mentioned, in 23.9% and 17.1% of the articles respectively, while these were not the most frequently increased symptoms reported by participants (4.9% and 2.4%). CONCLUSION If post COVID-19 condition was predominantly attributable to nocebo effects, its symptom profile would be expected to reflect levels of media coverage for symptoms after COVID-19. However, our findings do not support this.
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Affiliation(s)
- Aranka Vivienne Ballering
- University of Groningen, University Medical Center Groningen, Department of Psychiatry, Hanzeplein 1, P.O. Box 30.001, 9700 RB Groningen, the Netherlands.
| | - Ilona Plug
- VU University Amsterdam, Department of Language, Literature and Communication, De Boelelaan 1105, 1081 HV Amsterdam, the Netherlands.
| | - Sander K R van Zon
- University of Groningen, University Medical Center Groningen, Department of Health Sciences, Community and Occupational Medicine, Hanzeplein 1, P.O. Box 30.001, 9700 RB Groningen, the Netherlands; Netherlands Organisation for Applied Scientific Research, Unit Healthy Living & Work, Sylviusweg 71, 2333 BE Leiden, the Netherlands.
| | - Tim Olde Hartman
- Radboud University Medical Center, Radboud Institute of Medical Innovation, Department of Primary and Community Care, P.O. Box 9101, 6500 HB, Nijmegen, the Netherlands.
| | - Enny Das
- Centre for Language Studies, Radboud University, Erasmusplein 1, 6525 HT Nijmegen, the Netherlands.
| | - Judith Rosmalen
- University of Groningen, University Medical Center Groningen, Department of Psychiatry, Hanzeplein 1, P.O. Box 30.001, 9700 RB Groningen, the Netherlands; University of Groningen, University Medical Center Groningen, Department of Internal Medicine, Hanzeplein 1, P.O. Box 30.001, 9700 RB Groningen, the Netherlands.
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2
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Xue P, Qin H, Qin D, Shi Y, Li H, Luo T, Shi C, Wang Y, Zhao Z, Cao W, Zou Z, Yang Q, Jin R, Li J, Xiao X. The Effect of Placebo on Pruritus in Patients with Chronic Urticaria: A Systematic Review and Meta-Analysis of Randomized Placebo-Controlled Trials. Clin Drug Investig 2024:10.1007/s40261-024-01389-5. [PMID: 39242484 DOI: 10.1007/s40261-024-01389-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 08/19/2024] [Indexed: 09/09/2024]
Abstract
BACKGROUND The anti-pruritic effect of placebo in patients with chronic urticaria has gained increasing attention in clinical research. However, the extent of placebo effect and its influencing factors in the treatment of chronic urticaria are not well understood. OBJECTIVE The objective of this systematic review and meta-analysis was to investigate the effect of placebo on pruritus in patients with chronic urticaria and to explore relevant influencing factors. METHODS PubMed, Embase, Web of Science, Cochrane Library, and PsycINFO were searched from inception to 10 July, 2024. Primary outcome included pruritus scores. The secondary outcomes focused on global symptoms and quality of life. Subgroup analyses and meta-regression analyses were conducted based on drug types, sample size, participants' age, and other variables. The Grading of Recommendations Assessment, Development, and Evaluation (GRADE) system and a trial sequential analysis were employed to establish the reliability of evidence. RESULTS A total of 65 eligible publications (including 67 randomized controlled trials) involving 10,704 patients with chronic urticaria were included. The pruritus scores decreased following placebo treatment (moderate evidence). In addition, favorable results were observed in global symptoms (moderate evidence) and quality of life (low evidence) after placebo treatment. Subgroup analyses indicated that the type of active medication in intervention groups was an influencing factor of placebo effect of pruritus. Meta-regression analyses demonstrated that the anti-pruritic effect of placebo was inversely correlated with sample size and positively correlated with participants' age. A trial sequential analysis provided further support for the anti-pruritic effect of placebo. CONCLUSIONS A substantial improvement of pruritus after placebo treatment was observed in patients with chronic urticaria. The anti-pruritic effect of placebo varied with sample size, participants' age, and type of active medication used. Future research should further investigate the effect size of placebo and clarify the potential mechanism. PROSPERO REGISTRATION The protocol was registered in the International Prospective Register of Systematic Reviews (PROSPERO) as CRD42023482608.
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Affiliation(s)
- Peiwen Xue
- College of Health Preservation and Rehabilitation, Chengdu University of Traditional Chinese Medicine, No. 37 Shierqiao Road, Jinniu District, Chengdu, 610075, Sichuan, China
| | - Haiyan Qin
- College of Acupuncture and Tuina, Chengdu University of Traditional Chinese Medicine, Chengdu, Sichuan, China
| | - Di Qin
- College of Acupuncture and Tuina, Chengdu University of Traditional Chinese Medicine, Chengdu, Sichuan, China
| | - Yunzhou Shi
- College of Acupuncture and Tuina, Chengdu University of Traditional Chinese Medicine, Chengdu, Sichuan, China
| | - Huijing Li
- College of Clinical Medicine, Chengdu University of Traditional Chinese Medicine, Chengdu, Sichuan, China
| | - Tian Luo
- College of Health Preservation and Rehabilitation, Chengdu University of Traditional Chinese Medicine, No. 37 Shierqiao Road, Jinniu District, Chengdu, 610075, Sichuan, China
| | - Caiyun Shi
- College of Health Preservation and Rehabilitation, Chengdu University of Traditional Chinese Medicine, No. 37 Shierqiao Road, Jinniu District, Chengdu, 610075, Sichuan, China
| | - Yeliu Wang
- College of Health Preservation and Rehabilitation, Chengdu University of Traditional Chinese Medicine, No. 37 Shierqiao Road, Jinniu District, Chengdu, 610075, Sichuan, China
| | - Zihao Zhao
- College of Medicine and Life Sciences, Chengdu University of Traditional Chinese Medicine, Chengdu, Sichuan, China
| | - Wei Cao
- College of Acupuncture and Tuina, Chengdu University of Traditional Chinese Medicine, Chengdu, Sichuan, China
| | - Zihao Zou
- College of Acupuncture and Tuina, Chengdu University of Traditional Chinese Medicine, Chengdu, Sichuan, China
| | - Qian Yang
- College of Acupuncture and Tuina, Chengdu University of Traditional Chinese Medicine, Chengdu, Sichuan, China
| | - Rongjiang Jin
- College of Health Preservation and Rehabilitation, Chengdu University of Traditional Chinese Medicine, No. 37 Shierqiao Road, Jinniu District, Chengdu, 610075, Sichuan, China.
| | - Juan Li
- College of Health Preservation and Rehabilitation, Chengdu University of Traditional Chinese Medicine, No. 37 Shierqiao Road, Jinniu District, Chengdu, 610075, Sichuan, China.
- Affiliated Sichuan Provincial Rehabilitation Hospital of Chengdu University of TCM, Chengdu, Sichuan, China.
| | - Xianjun Xiao
- College of Health Preservation and Rehabilitation, Chengdu University of Traditional Chinese Medicine, No. 37 Shierqiao Road, Jinniu District, Chengdu, 610075, Sichuan, China.
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Chen C, Niehaus JK, Dinc F, Huang KL, Barnette AL, Tassou A, Shuster SA, Wang L, Lemire A, Menon V, Ritola K, Hantman AW, Zeng H, Schnitzer MJ, Scherrer G. Neural circuit basis of placebo pain relief. Nature 2024; 632:1092-1100. [PMID: 39048016 PMCID: PMC11358037 DOI: 10.1038/s41586-024-07816-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/07/2022] [Accepted: 07/11/2024] [Indexed: 07/27/2024]
Abstract
Placebo effects are notable demonstrations of mind-body interactions1,2. During pain perception, in the absence of any treatment, an expectation of pain relief can reduce the experience of pain-a phenomenon known as placebo analgesia3-6. However, despite the strength of placebo effects and their impact on everyday human experience and the failure of clinical trials for new therapeutics7, the neural circuit basis of placebo effects has remained unclear. Here we show that analgesia from the expectation of pain relief is mediated by rostral anterior cingulate cortex (rACC) neurons that project to the pontine nucleus (rACC→Pn)-a precerebellar nucleus with no established function in pain. We created a behavioural assay that generates placebo-like anticipatory pain relief in mice. In vivo calcium imaging of neural activity and electrophysiological recordings in brain slices showed that expectations of pain relief boost the activity of rACC→Pn neurons and potentiate neurotransmission in this pathway. Transcriptomic studies of Pn neurons revealed an abundance of opioid receptors, further suggesting a role in pain modulation. Inhibition of the rACC→Pn pathway disrupted placebo analgesia and decreased pain thresholds, whereas activation elicited analgesia in the absence of placebo conditioning. Finally, Purkinje cells exhibited activity patterns resembling those of rACC→Pn neurons during pain-relief expectation, providing cellular-level evidence for a role of the cerebellum in cognitive pain modulation. These findings open the possibility of targeting this prefrontal cortico-ponto-cerebellar pathway with drugs or neurostimulation to treat pain.
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Affiliation(s)
- Chong Chen
- Department of Cell Biology and Physiology, The University of North Carolina at Chapel Hill, Chapel Hill, NC, USA
- UNC Neuroscience Center, The University of North Carolina at Chapel Hill, Chapel Hill, NC, USA
- Department of Pharmacology, The University of North Carolina at Chapel Hill, Chapel Hill, NC, USA
| | - Jesse K Niehaus
- Department of Cell Biology and Physiology, The University of North Carolina at Chapel Hill, Chapel Hill, NC, USA
- UNC Neuroscience Center, The University of North Carolina at Chapel Hill, Chapel Hill, NC, USA
- Department of Pharmacology, The University of North Carolina at Chapel Hill, Chapel Hill, NC, USA
| | - Fatih Dinc
- Department of Applied Physics, Stanford University, Stanford, CA, USA
- CNC Program, Stanford University, Stanford, CA, USA
| | - Karen L Huang
- Department of Cell Biology and Physiology, The University of North Carolina at Chapel Hill, Chapel Hill, NC, USA
- UNC Neuroscience Center, The University of North Carolina at Chapel Hill, Chapel Hill, NC, USA
- Department of Pharmacology, The University of North Carolina at Chapel Hill, Chapel Hill, NC, USA
| | - Alexander L Barnette
- Department of Cell Biology and Physiology, The University of North Carolina at Chapel Hill, Chapel Hill, NC, USA
- UNC Neuroscience Center, The University of North Carolina at Chapel Hill, Chapel Hill, NC, USA
- Department of Pharmacology, The University of North Carolina at Chapel Hill, Chapel Hill, NC, USA
| | - Adrien Tassou
- Department of Cell Biology and Physiology, The University of North Carolina at Chapel Hill, Chapel Hill, NC, USA
- UNC Neuroscience Center, The University of North Carolina at Chapel Hill, Chapel Hill, NC, USA
- Department of Pharmacology, The University of North Carolina at Chapel Hill, Chapel Hill, NC, USA
| | - S Andrew Shuster
- Department of Neurobiology, Harvard Medical School, Boston, MA, USA
| | - Lihua Wang
- Janelia Research Campus, Howard Hughes Medical Institute, Ashburn, VA, USA
| | - Andrew Lemire
- Janelia Research Campus, Howard Hughes Medical Institute, Ashburn, VA, USA
| | - Vilas Menon
- Department of Neurology, Columbia University, New York, NY, USA
| | - Kimberly Ritola
- UNC Neuroscience Center, The University of North Carolina at Chapel Hill, Chapel Hill, NC, USA
- Department of Pharmacology, The University of North Carolina at Chapel Hill, Chapel Hill, NC, USA
| | - Adam W Hantman
- Department of Cell Biology and Physiology, The University of North Carolina at Chapel Hill, Chapel Hill, NC, USA
- UNC Neuroscience Center, The University of North Carolina at Chapel Hill, Chapel Hill, NC, USA
| | - Hongkui Zeng
- Allen Institute for Brain Science, Seattle, WA, USA
| | - Mark J Schnitzer
- Department of Applied Physics, Stanford University, Stanford, CA, USA
- CNC Program, Stanford University, Stanford, CA, USA
- Department of Biology, Stanford University, Stanford, CA, USA
- Department of Neurosurgery, Stanford University, Stanford, CA, USA
- James H. Clark Center for Biomedical Engineering & Sciences, Stanford University, Stanford, CA, USA
- Howard Hughes Medical Institute, Stanford University, Stanford, CA, USA
| | - Grégory Scherrer
- Department of Cell Biology and Physiology, The University of North Carolina at Chapel Hill, Chapel Hill, NC, USA.
- UNC Neuroscience Center, The University of North Carolina at Chapel Hill, Chapel Hill, NC, USA.
- Department of Pharmacology, The University of North Carolina at Chapel Hill, Chapel Hill, NC, USA.
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MacNair L, Eglit GML, Mosesova I, Bonn-Miller MO, Peters EN. Sex Differences in the Safety and Subjective Effects of Two Oral Δ9-Tetrahydrocannabinol-Containing Cannabis Products over Multiple Doses Among Healthy Adults. Cannabis Cannabinoid Res 2024; 9:967-978. [PMID: 37582197 DOI: 10.1089/can.2022.0340] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 08/17/2023] Open
Abstract
Introduction: A growing number of females report consuming cannabis products. There is a paucity of data on sex differences in safety and subjective effects after repeated use of varying oral doses of Δ9-tetrahydrocannabinol (THC; the primary psychoactive constituent of cannabis). Materials and Methods: Data were from two randomized, double-blind, placebo-controlled, multiple-dose, between-subject trials of two THC-containing oral cannabis products. Healthy adults received placebo, low-dose THC (∼2.5 or ∼5 mg per dose), or high-dose THC (∼7.5 or ∼10 mg per dose) twice daily for 7 days. There were 38 males (8 placebo, 17 low-dose THC, 13 high-dose THC) and 46 females (8 placebo, 17 low-dose THC, 21 high-dose THC). Analyses compared adverse events (AEs) and subjective effects between males and females, by THC dose. Results: In the placebo and low-dose THC groups, there were no sex differences in the relative rate of AEs. In the high-dose THC group, females versus males reported 3.08 (95% confidence interval [CI]=1.31-8.33) times as many AEs. There were no significant interactions of sex×low-dose THC group for any subjective effect. In the high-dose THC group, females versus males reported greater "relaxed" ratings (b=15.14, 95% CI=1.44-28.84, p=0.027), whereas in the placebo group, males versus females reported greater ratings of "liking the effect" (b=-30.01, 95% CI=2.77-57.26, p=0.028). Although analyses were underpowered to assess the sex×THC dose×day interaction, the initial sex disparity in AEs and some subjective effects in the high-dose THC group appeared to shrink after the first day. Conclusions: In this exploratory analysis, sex differences in some responses to oral THC were nuanced. Females appeared more sensitive than males to AEs and some subjective effects at higher but not lower doses. Males reported higher ratings than females on some subjective effects in response to placebo. Initial sex differences in response to higher doses of oral THC tended to diminish over 7 days of dosing. If replicated, findings could help inform sex-specific dosing strategies of medical cannabis products and could help educate medical cannabis patients on any temporality of effects.
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Affiliation(s)
- Laura MacNair
- Canopy Growth Corporation, Smiths Falls, Ontario, Canada
| | | | - Irina Mosesova
- Canopy Growth Corporation, Smiths Falls, Ontario, Canada
| | | | - Erica N Peters
- Canopy Growth Corporation, Smiths Falls, Ontario, Canada
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5
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Botvinik-Nezer R, Petre B, Ceko M, Lindquist MA, Friedman NP, Wager TD. Placebo treatment affects brain systems related to affective and cognitive processes, but not nociceptive pain. Nat Commun 2024; 15:6017. [PMID: 39019888 PMCID: PMC11255344 DOI: 10.1038/s41467-024-50103-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/29/2024] [Accepted: 06/28/2024] [Indexed: 07/19/2024] Open
Abstract
Drug treatments for pain often do not outperform placebo, and a better understanding of placebo mechanisms is needed to improve treatment development and clinical practice. In a large-scale fMRI study (N = 392) with pre-registered analyses, we tested whether placebo analgesic treatment modulates nociceptive processes, and whether its effects generalize from conditioned to unconditioned pain modalities. Placebo treatment caused robust analgesia in conditioned thermal pain that generalized to unconditioned mechanical pain. However, placebo did not decrease pain-related fMRI activity in brain measures linked to nociceptive pain, including the Neurologic Pain Signature (NPS) and spinothalamic pathway regions, with strong support for null effects in Bayes Factor analyses. In addition, surprisingly, placebo increased activity in some spinothalamic regions for unconditioned mechanical pain. In contrast, placebo reduced activity in a neuromarker associated with higher-level contributions to pain, the Stimulus Intensity Independent Pain Signature (SIIPS), and affected activity in brain regions related to motivation and value, in both pain modalities. Individual differences in behavioral analgesia were correlated with neural changes in both modalities. Our results indicate that cognitive and affective processes primarily drive placebo analgesia, and show the potential of neuromarkers for separating treatment influences on nociception from influences on evaluative processes.
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Affiliation(s)
- Rotem Botvinik-Nezer
- Department of Psychology, The Hebrew University of Jerusalem, Jerusalem, Israel.
- Department of Psychological and Brain Sciences, Dartmouth College, Hanover, NH, USA.
| | - Bogdan Petre
- Department of Psychological and Brain Sciences, Dartmouth College, Hanover, NH, USA
| | - Marta Ceko
- Institute of Cognitive Science, University of Colorado Boulder, Boulder, CO, USA
| | - Martin A Lindquist
- Department of Biostatistics, Johns Hopkins University, Baltimore, MD, USA
| | - Naomi P Friedman
- Institute for Behavioral Genetics, University of Colorado Boulder, Boulder, CO, USA
- Department of Psychology and Neuroscience, University of Colorado Boulder, Boulder, CO, USA
| | - Tor D Wager
- Department of Psychological and Brain Sciences, Dartmouth College, Hanover, NH, USA.
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Schienle A, Kogler W. Reducing Emotional Distress with Open-Label Placebos: Assessing the Role of Motor Engagement in Pill Consumption. Behav Sci (Basel) 2024; 14:455. [PMID: 38920788 PMCID: PMC11200763 DOI: 10.3390/bs14060455] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/05/2024] [Revised: 05/26/2024] [Accepted: 05/27/2024] [Indexed: 06/27/2024] Open
Abstract
It has been posited that ingesting a pill constitutes a pivotal action that facilitates the effects of open-label placebos (OLPs: placebos honestly prescribed). In the present OLP experiment, the motor components of a placebo treatment were systematically varied. The participants (n = 183) were randomly allocated to one of four groups that all viewed aversive pictures. The 'active OLP' group took a placebo pill with specific instructions concerning the sequence of motor actions for the intake. The 'usual OLP' group swallowed the pill (without specific motor instructions), while the third group received an 'imaginary OLP' (no pill intake). The fourth group applied cognitive reappraisal (CR; active control group) to reduce emotional distress. The participants rated their affective state as well as the efficacy and plausibility of the treatment approach. Moreover, blood pressure and pulse were recorded as indicators of bodily arousal. The four groups did not differ in their valence ratings and physiological measures. The 'imaginary OLP' received higher ratings for both effectiveness and plausibility than the 'usual OLP'. CR was rated as superior relative to all OLP conditions. In conclusion, reducing emotional distress with OLPs does not necessitate the consumption of a placebo pill. In terms of acceptability and ease of implementation, CR stands as a well-established alternative.
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Affiliation(s)
- Anne Schienle
- Clinical Psychology, University of Graz, 8010 Graz, Austria
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7
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Klauß H, Kunkel A, Müßgens D, Haaker J, Bingel U. Learning by observing: a systematic exploration of modulatory factors and the impact of observationally induced placebo and nocebo effects on treatment outcomes. Front Psychol 2024; 15:1293975. [PMID: 38699574 PMCID: PMC11064928 DOI: 10.3389/fpsyg.2024.1293975] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/14/2023] [Accepted: 03/26/2024] [Indexed: 05/05/2024] Open
Abstract
Introduction Observational learning (OL) refers to learning through observing other people's behavior. OL has been suggested as an effective and simple tool to evoke treatment expectations and corresponding placebo and nocebo effects. However, the exact mechanisms by which OL shapes treatment outcomes, its moderating factors and possible areas of application remain unclear. We thus reviewed the existing literature with two different literature searches to answer the following questions: Which influencing factors contribute to OL-induced placebo and nocebo effects (in healthy volunteers and patients) and how large are these effects (search 1)? In which medical fields has OL been used so far to modulate treatment expectancy and treatment outcomes in patients, their caregivers, and at-risk groups (search 2)? We also aimed to explore whether and how the assessment of treatment expectations has been incorporated. Methods We conducted two independent and comprehensive systematic literature searches, both carried out on September 20, 2022. Results We identified 21 studies that investigated OL-mediated placebo and nocebo effects for pain and itch, the (placebo) efficacy of sham treatment on anxiety, and the (nocebo) induction of medication side effects (search 1). Studies showed that OL can efficiently induce placebo and nocebo effects across different presentation modes, with medium effect sizes on average: placebo effects, d = 0.79 (range: d = -0.36-1.58), nocebo effects, d = 0.61 (range: d = 0.04-1.5). Although several moderating factors have been investigated, their contribution to OL-induced effects remains unclear because of inconsistent results. Treatment expectation was assessed in only four studies. Regarding medical applications of OL (search 2), we found 12 studies. They showed that OL was effectively applied in preventive, therapeutic and rehabilitative interventions and that it was mainly used in the field of psychosomatics. Discussion OL effects on treatment outcomes can be both positive and negative. Future research should investigate which individuals would benefit most from OL and how OL can be implemented most effectively to induce placebo and avoid nocebo effects in clinical settings. Systematic review registration This work was preregistered at the Center for Open Science as open-ended registration (doi: 10.17605/OSF.IO/FVHKE). The protocol can be found here: https://archive.org/details/osf-registrations-fvhke-v1.
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Affiliation(s)
- Helena Klauß
- Department of Neurology, Center for Translational Neuro-and Behavioral Sciences (C-TNBS), University Medicine Essen, University of Duisburg-Essen, Essen, Germany
| | - Angelika Kunkel
- Department of Neurology, Center for Translational Neuro-and Behavioral Sciences (C-TNBS), University Medicine Essen, University of Duisburg-Essen, Essen, Germany
| | - Diana Müßgens
- Department of Neurology, Center for Translational Neuro-and Behavioral Sciences (C-TNBS), University Medicine Essen, University of Duisburg-Essen, Essen, Germany
| | - Jan Haaker
- Department of Systems Neuroscience, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | - Ulrike Bingel
- Department of Neurology, Center for Translational Neuro-and Behavioral Sciences (C-TNBS), University Medicine Essen, University of Duisburg-Essen, Essen, Germany
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8
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Patel E, Ramaiah P, Mamaril-Davis JC, Bauer IL, Koujah D, Seideman T, Kelbert J, Nosova K, Bina RW. Outcome differences between males and females undergoing deep brain stimulation for treatment-resistant depression: systematic review and individual patient data meta-analysis. J Affect Disord 2024; 351:481-488. [PMID: 38296058 DOI: 10.1016/j.jad.2024.01.251] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/22/2023] [Revised: 01/22/2024] [Accepted: 01/26/2024] [Indexed: 02/06/2024]
Abstract
BACKGROUND Treatment-resistant depression (TRD) occurs more commonly in women. Deep brain stimulation (DBS) is an emerging treatment for TRD, and its efficacy continues to be explored. However, differences in treatment outcomes between males and females have yet to be explored in formal analysis. METHODS A PRISMA-compliant systematic review of DBS for TRD studies was conducted. Patient-level data were independently extracted by two authors. Treatment response was defined as a 50 % or greater reduction in depression score. Percent change in depression scores by gender were evaluated using random-effects analyses. RESULTS Of 737 records, 19 studies (129 patients) met inclusion criteria. The mean reduction in depression score for females was 57.7 % (95 % CI, 64.33 %-51.13 %), whereas for males it was 35.2 % (95 % CI, 45.12 %-25.23 %) (p < 0.0001). Females were more likely to respond to DBS for TRD when compared to males (OR = 2.44, 95 % CI 1.06, 1.95). These differences varied in significance when stratified by DBS anatomical target, age, and timeframe for responder classification. LIMITATIONS Studies included were open-label trials with small sample sizes. CONCLUSIONS Our findings suggest that females with TRD respond at higher rates to DBS treatment than males. Further research is needed to elucidate the implications of these results, which may include connectomic sexual dimorphism, depression phenotype variations, or unrecognized symptom reporting differences. Methodological standardization of outcome scales, granular demographic data, and individual subject outcomes would allow for more robust comparisons between trials.
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Affiliation(s)
- Ekta Patel
- University of Arizona College of Medicine - Phoenix, Phoenix, AZ, USA
| | - Priya Ramaiah
- University of Arizona College of Medicine - Phoenix, Phoenix, AZ, USA
| | | | - Isabel L Bauer
- University of Arizona College of Medicine - Phoenix, Phoenix, AZ, USA
| | - Dalia Koujah
- University of Arizona College of Medicine - Phoenix, Phoenix, AZ, USA
| | - Travis Seideman
- University of Arizona College of Medicine - Phoenix, Phoenix, AZ, USA
| | - James Kelbert
- University of Arizona College of Medicine - Phoenix, Phoenix, AZ, USA
| | - Kristin Nosova
- Department of Neurosurgery, Banner University Medical Center/University of Arizona College of Medicine - Phoenix, Phoenix, AZ, USA
| | - Robert W Bina
- Department of Neurosurgery, Banner University Medical Center/University of Arizona College of Medicine - Phoenix, Phoenix, AZ, USA.
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9
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Daniali H, Ruben MA, Aslaksen PM, Fiskum C, Kaptchuk TJ, Flaten MA. The Effect of Singular Nonverbal Behaviours of Experimenters on Pain Reports. J Pain Res 2024; 17:1345-1360. [PMID: 38584862 PMCID: PMC10999184 DOI: 10.2147/jpr.s449150] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/17/2023] [Accepted: 03/02/2024] [Indexed: 04/09/2024] Open
Abstract
Introduction Studies suggest facial expressions of caregivers may be important in placebo effects; however, this has not been systematically tested. This experiment investigated the effects of caregivers' singular positive nonverbal behaviours (NBs) on pain reports. Methods Fifty-one males and 53 females (total of 104) participants were randomized to four groups that were displayed positive facial expressions, tone of voice, body movement, or neutral NBs of videotaped experimenters. Subjective reports of pain, stress, arousal, and cardiac activity were obtained in a pre-test, a conditioning phase, and at a post-test. Four minutes of heat pain was induced in each test, and a placebo cream was administered before the conditioning and post-test in all groups. Results There were no differences between the NB groups in the reduced pain. Males had larger reduction in pain in the post-test, and females had lower arousal than the opposite sex. During the conditioning, females had larger reduction in pain ie, unconditioned pain response (UPR). In females, the UPR predicted the reinforced expectation ie, increase in expectations from conditioning to post-test, and fear of minor pain negatively predicted both the UPR and reinforced expectation. Discussion Singular NBs of caregiver were weak to enhance placebo effects. Females had lower pain during conditioning, and the UPR amplitude in females was associated with positive expectations. Moreover, for females, fear of minor pain weakened the UPR and expectations of cream. Conclusion No NB of caregivers is more effective in reducing pain. Caregivers' NBs are less effective when displayed individually. Males and females may be different in underlying mechanisms of placebo effects.
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Affiliation(s)
- Hojjat Daniali
- Department of Psychology, Norwegian University of Science and Technology, Trondheim, Norway
| | - Mollie A Ruben
- Department of Psychology, University of Rhode Island, Kingston, RI, USA
| | - Per M Aslaksen
- Department of Psychology, UiT The Arctic University of Norway, Tromsø, Norway
| | - Charlotte Fiskum
- Department of Psychology, Norwegian University of Science and Technology, Trondheim, Norway
| | - Ted J Kaptchuk
- Program in Placebo Studies, Beth Israel Deaconess Medical Center/ Harvard Medical School, Boston, MA, USA
| | - Magne A Flaten
- Department of Psychology, Norwegian University of Science and Technology, Trondheim, Norway
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10
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Schienle A, Kogler W, Seibel A, Wabnegger A. The pill you don't have to take that is still effective: neural correlates of imaginary placebo intake for regulating disgust. Soc Cogn Affect Neurosci 2024; 19:nsae021. [PMID: 38450743 PMCID: PMC11227952 DOI: 10.1093/scan/nsae021] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/06/2023] [Revised: 12/22/2023] [Accepted: 03/06/2024] [Indexed: 03/08/2024] Open
Abstract
A commonly established protocol for the administration of open-label placebos (OLPs)-placebos honestly prescribed-emphasizes the necessity of ingesting the pill for the placebo effect to manifest. The current functional magnetic resonance imaging study used a novel approach to OLP administration: the imaginary intake of an OLP pill for regulating disgust. A total of 99 females were randomly allocated to one of three groups that either swallowed a placebo pill (OLP Pill), imagined the intake of a placebo pill (Imaginary Pill) or passively viewed (PV) repulsive and neutral images. The imaginary pill reduced reported disgust more effectively than the OLP pill and was also perceived as a more plausible method to reduce emotional distress. Relative to the OLP pill, the imaginary pill lowered neural activity in a region of interest involved in disgust processing: the pallidum. No significant differences in brain activation were found when comparing the OLP pill with PV. These findings highlight that imagining the intake of an OLP emerged as a superior method for regulating feelings of disgust compared to the actual ingestion of a placebo pill. The study's innovative approach sheds new light on the potential of placebo interventions in emotion regulation.
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Affiliation(s)
- Anne Schienle
- Department of Clinical Psychology, University of Graz, Universitaetsplatz 2, Graz 8010, Austria
| | - Wolfgang Kogler
- Department of Clinical Psychology, University of Graz, Universitaetsplatz 2, Graz 8010, Austria
| | - Arved Seibel
- Department of Clinical Psychology, University of Graz, Universitaetsplatz 2, Graz 8010, Austria
| | - Albert Wabnegger
- Department of Clinical Psychology, University of Graz, Universitaetsplatz 2, Graz 8010, Austria
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11
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Schaefer M, Enge S. Open-label placebos enhance test performance and reduce anxiety in learner drivers: a randomized controlled trial. Sci Rep 2024; 14:6684. [PMID: 38509101 PMCID: PMC10954622 DOI: 10.1038/s41598-024-56600-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/24/2023] [Accepted: 03/08/2024] [Indexed: 03/22/2024] Open
Abstract
Passing the driving school test can be very challenging, especially in big cities, where up to 52% of all students fail this test. Consequently, many learner drivers experience stress and anxiety. For some learner drivers these feelings can be extreme and negatively affect the performance in the driving test. Different strategies to face anxiety and stress are known, including, for example, psychological or pharmacological approaches and even placebo pills. Recent intriguing findings have also demonstrated that placebos without deception, so-called open-label placebos, successfully reduce anxiety. Here we aimed to test effects of this novel treatment for learner drivers. We investigated whether open-label placebos affect test performance and feelings of anxiety in learner drivers. Sixty-eight healthy participants (mean age 21.94 years, 26 females) were randomized into two groups. The open-label placebo group received placebo pills two weeks before the driving test (two pills each day). The control group received no treatment. Results revealed that the open-label placebo group experienced significantly less anxiety than the control group before the test (measured with the State-Trait-Anxiety-Inventory, STAI-S, and the German Test Anxiety Inventory, PAF). Moreover, in the open-label placebo group less learner drivers failed the driving test (29.41% vs. 52.95%). The results suggest that open-label placebos may provide an ethical unproblematic way to experience less anxiety and might also enhance the probability to pass the driving test. We discuss possible mechanisms of open-label placebos and limitations of our findings.
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Affiliation(s)
| | - Sören Enge
- Medical School Berlin, 12247, Berlin, Germany
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12
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Boerner KE, Keogh E, Inkster AM, Nahman-Averbuch H, Oberlander TF. A developmental framework for understanding the influence of sex and gender on health: Pediatric pain as an exemplar. Neurosci Biobehav Rev 2024; 158:105546. [PMID: 38272336 DOI: 10.1016/j.neubiorev.2024.105546] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/12/2022] [Revised: 07/07/2023] [Accepted: 11/06/2023] [Indexed: 01/27/2024]
Abstract
Sex differences are a robust finding in many areas of adult health, including cardiovascular disease, psychiatric disorders, and chronic pain. However, many sex differences are not consistently observed until after the onset of puberty. This has led to the hypothesis that hormones are primary contributors to sex differences in health outcomes, largely ignoring the relative contributions of early developmental influences, emerging psychosocial factors, gender, and the interaction between these variables. In this paper, we argue that a comprehensive understanding of sex and gender contributions to health outcomes should start as early as conception and take an iterative biopsychosocial-developmental perspective that considers intersecting social positions. We present a conceptual framework, informed by a review of the literature in basic, clinical, and social science that captures how critical developmental stages for both sex and gender can affect children's health and longer-term outcomes. The literature on pediatric chronic pain is used as a worked example of how the framework can be applied to understanding different chronic conditions.
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Affiliation(s)
- Katelynn E Boerner
- Department of Pediatrics, University of British Columbia, and BC Children's Hospital Research Institute, Vancouver, BC, Canada.
| | - Edmund Keogh
- Department of Psychology & Centre for Pain Research, University of Bath, Bath, United Kingdom
| | - Amy M Inkster
- Department of Medical Genetics, University of British Columbia, and BC Children's Hospital Research Institute, Vancouver, BC, Canada
| | - Hadas Nahman-Averbuch
- Department of Anesthesiology, Washington University in St. Louis, St. Louis, MO, USA
| | - Tim F Oberlander
- Department of Pediatrics, University of British Columbia, and BC Children's Hospital Research Institute, Vancouver, BC, Canada; School of Population and Public Health, University of British Columbia, and BC Children's Hospital Research Institute, Vancouver, BC, Canada
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13
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Abstract
Adverse nocebo responses can cause harm to patients and interfere with treatment adherence and effects in both clinic practice and clinical trials. Nocebo responses refer to negative outcomes to active medical treatments in clinical trials or practice that cannot be explained by the treatment's pharmacologic effects. Negative expectancies and nocebo effects are less known than placebo responses. Nocebo effects can be triggered by verbal suggestions, prior negative experiences, observation of others experiencing negative outcomes, and other contextual and environmental factors. As research advances over the years, mechanistic knowledge is accumulating on the neurobiological mechanisms of nocebo effects. This review summarizes studies on different facets of nocebo effects and responses and discusses clinical implications, ethical considerations, and future directions.
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Affiliation(s)
- Luana Colloca
- Department of Pain and Translational Symptom Science and Placebo Beyond Opinions Center, School of Nursing, University of Maryland, Baltimore, Maryland, USA;
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14
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Valero F, González-Mohíno F, Salinero JJ. Belief That Caffeine Ingestion Improves Performance in a 6-Minute Time Trial Test without Affecting Pacing Strategy. Nutrients 2024; 16:327. [PMID: 38276565 PMCID: PMC10819016 DOI: 10.3390/nu16020327] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/20/2023] [Revised: 01/18/2024] [Accepted: 01/19/2024] [Indexed: 01/27/2024] Open
Abstract
This study aimed to analyze the placebo effect associated with caffeine ingestion on running performance. METHODS Thirteen recreationally trained males in long-distance running (age: 38.5 ± 11.9 years, 11.0 ± 8.8 years of running experience) performed a 6 min time trial test in each experimental condition (caffeine-informed/placebo ingested (placebo) and non-ingested (control)) separated by 7 days. The total distance covered was measured, and partial times of each 400 m were used to analyze the pacing strategy. Heart rate and kinematic variables were recorded for each split. In addition, the rate of perceived exertion and prevalence of caffeine side effects was measured using questionnaires. RESULTS Placebo ingestion improved running performance in the 6 min time trial test (1668 ± 139 m placebo vs. 1642 ± 158 m control, t = 2.49; p = 0.03; moderate ES = 0.69), while pacing, heart rate, RPE, and kinematic variables were similar between conditions (p > 0.05 in all cases). Minor side effects were reported. CONCLUSIONS Beliefs of caffeine ingestion can improve running performance at speeds around maximal aerobic speed in recreationally trained runners without affecting pacing strategy so this "nutritional" strategy could be useful in competition scenarios. As a practical application, recreationally trained runners could improve ≈5 s in 1500 m or mile competitions.
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Affiliation(s)
- Fernando Valero
- Sport Training Lab, Faculty of Sport Sciences, University of Castilla-La Mancha, 45071 Toledo, Spain; (F.V.); (F.G.-M.)
| | - Fernando González-Mohíno
- Sport Training Lab, Faculty of Sport Sciences, University of Castilla-La Mancha, 45071 Toledo, Spain; (F.V.); (F.G.-M.)
- Facultad de Ciencias de la Vida y de la Naturaleza, Universidad Nebrija, 28248 Madrid, Spain
| | - Juan José Salinero
- Sport Training Lab, Faculty of Sport Sciences, University of Castilla-La Mancha, 45071 Toledo, Spain; (F.V.); (F.G.-M.)
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De Simone M, De Feo R, Choucha A, Ciaglia E, Fezeu F. Enhancing Sleep Quality: Assessing the Efficacy of a Fixed Combination of Linden, Hawthorn, Vitamin B1, and Melatonin. Med Sci (Basel) 2023; 12:2. [PMID: 38249078 PMCID: PMC10801487 DOI: 10.3390/medsci12010002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/03/2023] [Revised: 11/24/2023] [Accepted: 12/18/2023] [Indexed: 01/23/2024] Open
Abstract
Sleep is essential for overall health, yet various sleep disorders disrupt normal sleep patterns, affecting duration, quality, and timing. This pilot study investigate the impact of a food supplement (SPINOFF®) on both sleep quality and mental well-being in 41 participants (mean age: 45.3 years). Initial assessments revealed sleep disturbances (Pittsburgh Sleep Quality Index-PSQ-mean score: 8.2) and insomnia symptoms (Insomnia Severity Index-ISI- mean score: 12.7). Mental health assessments showed psychological distress (Dass-21 Depression mean score: 4.2, Anxiety mean score: 6.9, Stress mean score: 11.6, Total mean score: 22.7). This study assessed sleep continuity using Awakenings per Night (ApN) via a smartwatch (HELO HEALTH®) and conducted the study in two phases: baseline (T0) and after 30 days of treatment (T1) (Phase A). No placebo-control was used in this study. After 30 days (Phase B), 21 patients were selected for reassessment. Eleven continued treatment for another 30 days (T2), while ten discontinued. Following the intervention, we observed remarkable improvements in sleep quality and mental distress. The SPINOFF® supplement significantly reduced the PSQI scores (22.4%), indicating enhanced sleep quality. Additionally, there was a 19.6% decrease in ISI scores, demonstrating a reduction in insomnia symptoms. Moreover, overall psychological distress decreased by 19.5% signifying improved psychological well-being. In the second phase, participants who continued treatment experienced more substantial improvements, with a mean decrease of 0.8 points in PSQI scores (±0.9) and a mean decrease of 0.9 points in ISI scores. Our findings suggest that the SPINOFF® supplement has the potential to effectively address both sleep disturbances and psychological distress in our study population.
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Affiliation(s)
- Matteo De Simone
- Department of Medicine, Surgery and Dentistry “Scuola Medica Salernitana”, University of Salerno, Via Salvatore Allende, 84081 Baronissi, Italy; (R.D.F.); (E.C.)
| | - Rosario De Feo
- Department of Medicine, Surgery and Dentistry “Scuola Medica Salernitana”, University of Salerno, Via Salvatore Allende, 84081 Baronissi, Italy; (R.D.F.); (E.C.)
| | - Anis Choucha
- Department of Neurosurgery, Aix Marseille University, APHM, UH Timone, 13005 Marseille, France;
| | - Elena Ciaglia
- Department of Medicine, Surgery and Dentistry “Scuola Medica Salernitana”, University of Salerno, Via Salvatore Allende, 84081 Baronissi, Italy; (R.D.F.); (E.C.)
| | - Francis Fezeu
- Department of Neurology & Neurological Surgery, Brain Global, 27659 Arabian Drive, Salisbury, MD 21801, USA;
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16
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Aulenkamp JL, Icenhour A, Elsenbruch S. Nocebo effects in visceral pain: concept and design of the experimental randomized-controlled pain study 'NoVis'. Front Psychiatry 2023; 14:1270189. [PMID: 37900300 PMCID: PMC10603299 DOI: 10.3389/fpsyt.2023.1270189] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/31/2023] [Accepted: 09/29/2023] [Indexed: 10/31/2023] Open
Abstract
The role of psychological factors in the pathophysiology and treatment of chronic visceral pain in disorders of gut-brain interactions (DGBI) is increasingly appreciated. Placebo research has underscored that expectations arising from the psychosocial treatment context and from prior experiences shape treatment responses. However, effects of negative expectations, i.e., nocebo effects, as they are likely crucial elements of DGBI patients' clinical reality, have thus far only rarely been investigated in the context of visceral pain, with untapped potential for improved prevention and treatment. The experimental randomized-controlled pain study "NoVis," carried out within the Collaborative Research Center (CRC) 289 ("Treatment Expectation"), aims to close gaps regarding the generation and persistence of nocebo effects in healthy volunteers. It is designed to elucidate effects of negative expectations in a multiple-threat paradigm with intensity-matched rectal distensions and cutaneous thermal stimuli, allowing to test nocebo effects in the visceral and somatic pain modalities. Negative expectations are experimentally induced by elements of doctor-patient communication (i.e., instruction) and/or by surreptitious amplification of symptom intensity (i.e., experience/learning) within a treatment context. Accordingly, the repeated measures between-subject design contains the between-group factors "treatment instruction" (negative vs. control) and "treatment experience" (negative vs. control), with volunteers randomized into four experimental groups undergoing several pain stimulation phases (repeated factor). This allows to compare the efficacy of instruction vs. experience, and more importantly, their combined effects on the magnitude of negative expectations and their impact on pain responses, which we expect will be greatest for the visceral modality. After a Baseline, short-term effects are assessed during a test phase accomplished on study day 1 (Test-1 Phase). To explore the persistence of effects, a second test phase is accomplished 1 week later (Test-2 Phase). Effects of negative expectations within and across pain modalities are assessed at the subjective and objective levels, with a focus on psychophysiological and neuroendocrine measures related to stress, fear, and anxiety. Since nocebo effects can play a considerable role in the generation, maintenance, or worsening of chronic visceral pain, and may even constitute risk factors for treatment failure, knowledge from experimental nocebo research has potential to improve treatment outcomes in DGBI and other clinical conditions associated with chronic visceral pain.
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Affiliation(s)
- Jana Luisa Aulenkamp
- Department of Anesthesiology and Intensive Care Medicine, University Hospital Essen, University of Duisburg-Essen, Essen, Germany
- Department of Neurology, Center for Translational Neuro- and Behavioral Sciences (C-TNBS), University Hospital Essen, University of Duisburg-Essen, Essen, Germany
| | - Adriane Icenhour
- Department of Medical Psychology and Medical Sociology, Ruhr University Bochum, Bochum, Germany
| | - Sigrid Elsenbruch
- Department of Neurology, Center for Translational Neuro- and Behavioral Sciences (C-TNBS), University Hospital Essen, University of Duisburg-Essen, Essen, Germany
- Department of Medical Psychology and Medical Sociology, Ruhr University Bochum, Bochum, Germany
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17
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Hartmann H, Banwinkler M, Riva F, Lamm C. To respond or not to respond: exploring empathy-related psychological and structural brain differences between placebo analgesia responders and non-responders. Front Psychol 2023; 14:1257522. [PMID: 37849473 PMCID: PMC10577216 DOI: 10.3389/fpsyg.2023.1257522] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/12/2023] [Accepted: 09/14/2023] [Indexed: 10/19/2023] Open
Abstract
Introduction Placebo responsiveness is highly variable across individuals. In the domain of pain, it may range from pronounced hypoalgesia to no response at all. Which factors predict such variation awaits clarification, as the available literature is characterized by mixed and inconclusive results. Particularly interesting in this case are social factors such as empathy or prosocial behavior, as prior work has stressed the connection between feeling pain yourself and empathizing with pain observed in others. Methods In a mixed confirmatory and exploratory approach, this study investigated potential psychological and structural brain differences between placebo responders and non-responders in the domain of pain. We aggregated data of four behavioral and neuroimaging studies that had been designed to investigate the effects of placebo analgesia on empathy. Results Analyses comparing groups of placebo responders and non-responders showed significant group differences in trait characteristics, with responders reporting increased helping behavior and lower psychopathic traits compared to non-responders. Uncorrected results further showed higher pain-related empathic concern in responders vs. non-responders. These results were accompaniedby tentative group differences in brain structure: placebo analgesia non-responders exhibited increased gray matter volume in left inferior temporal and parietal supramarginal cortical areas, and an increased cortical surface area in bilateral middle temporal cortex. Discussion Together, our findings suggest that modifiability of one's pain perception by means of placebo effects is linked to personality traits characterizing social emotions and behavior. They also hint that these psychological as well as brain structural characteristics might be beneficial for the identification of placebo responders. At the same time, they stress the importance of considering contextual factors such as the study setting or paradigm when investigating the association between individual characteristics and placebo responding.
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Affiliation(s)
- Helena Hartmann
- Social, Cognitive and Affective Neuroscience Unit, Department of Cognition, Emotion, and Methods in Psychology, Faculty of Psychology, University of Vienna, Vienna, Austria
- Clinical Neurosciences, Department of Neurology, University Hospital Essen, Essen, Germany
| | - Magdalena Banwinkler
- Social, Cognitive and Affective Neuroscience Unit, Department of Cognition, Emotion, and Methods in Psychology, Faculty of Psychology, University of Vienna, Vienna, Austria
- Department of Nuclear Medicine, Faculty of Medicine and University Hospital Cologne, University of Cologne, Cologne, Germany
| | - Federica Riva
- Social, Cognitive and Affective Neuroscience Unit, Department of Cognition, Emotion, and Methods in Psychology, Faculty of Psychology, University of Vienna, Vienna, Austria
| | - Claus Lamm
- Social, Cognitive and Affective Neuroscience Unit, Department of Cognition, Emotion, and Methods in Psychology, Faculty of Psychology, University of Vienna, Vienna, Austria
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18
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Krecké J, Dierolf AM, Rischer KM, Anton F, van der Meulen M. Baseline heart rate variability predicts placebo hypoalgesia in men, but not women. FRONTIERS IN PAIN RESEARCH 2023; 4:1213848. [PMID: 37799824 PMCID: PMC10547887 DOI: 10.3389/fpain.2023.1213848] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/28/2023] [Accepted: 08/31/2023] [Indexed: 10/07/2023] Open
Abstract
Introduction Placebo hypoalgesic effects vary greatly across individuals, making them challenging to control for in clinical trials and difficult to use in treatment. We investigated the potential of resting vagally-mediated heart rate variability (vmHRV) to help predict the magnitude of placebo responsiveness. Methods In two independent studies (total N = 77), we administered a placebo paradigm after measuring baseline HRV. In Study I, we delivered heat pain to the forearm, on skin patches treated with "real" and "control" cream (identical inactive creams). In Study II, electrical pulses to the forearm were modulated by sham transcutaneous electrical nerve stimulation. We combined data from both studies to evaluate the relationship between vagally-mediated HRV (vmHRV) parameters and the placebo response size, while also assessing sex differences in this relationship. Results and Discussion This revealed a positive association between vmHRV and the degree of pain relief, and this effect was driven by men. These results not only reveal new insights into the (sex-specific) mechanisms of placebo hypoalgesia, but also suggest that measuring vmHRV may be helpful in predicting placebo responsiveness. Given that placebo hypoalgesic effects contribute substantially to treatment outcomes, such a non-invasive and easily obtained predictor would be valuable in the context of personalized medicine.
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Affiliation(s)
- Joy Krecké
- Department of Behavioural and Cognitive Sciences, University of Luxembourg, Esch-sur-Alzette, Luxembourg
| | | | | | | | - Marian van der Meulen
- Department of Behavioural and Cognitive Sciences, University of Luxembourg, Esch-sur-Alzette, Luxembourg
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19
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Schienle A, Kogler W, Wabnegger A. A randomized trial that compared brain activity, efficacy and plausibility of open-label placebo treatment and cognitive repappraisal for reducing emotional distress. Sci Rep 2023; 13:13998. [PMID: 37634020 PMCID: PMC10460441 DOI: 10.1038/s41598-023-39806-y] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/03/2023] [Accepted: 07/31/2023] [Indexed: 08/28/2023] Open
Abstract
Placebo pills can reduce emotional distress even when recipients have been informed about the inert nature of the treatment. However, before such open-label placebos (OLPs) can be recommended for general clinical use, their efficacy and acceptability need to be further investigated and compared with established methods for emotion regulation, such as cognitive reappraisal (CR). The current study with functional magnetic resonance imaging compared the effects of an OLP pill with CR for reducing a specific form of emotional distress: disgust. Participants (150 healthy females) were randomly allocated to one of three groups, all of which were exposed to disgusting and neutral images (OLP, CR, PV: passive viewing). It was tested whether the three groups would differ in brain activity and reported disgust. Ratings for the perceived efficacy and plausibility of treatment were also compared between OLP and CR. Both OLP and CR increased the activity in a cognitive control region, the ventrolateral prefrontal cortex. Relative to PV and OLP, CR reduced activity in the putamen and pallidum. These regions play an important role in decoding disgust signals from different modalities. Self-reports indicated that CR was perceived as a more effective and plausible intervention strategy than OLP. In conclusion, CR was a superior method for disgust regulation compared to OLP, both on the subjective as well as the neurobiological level. Future OLP studies are needed to test whether the observed effects generalize to other forms of emotional distress.
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Affiliation(s)
- Anne Schienle
- Department of Clinical Psychology, University of Graz, BioTechMed, Universitätsplatz 2/DG, 8010, Graz, Austria.
| | - Wolfgang Kogler
- Department of Clinical Psychology, University of Graz, BioTechMed, Universitätsplatz 2/DG, 8010, Graz, Austria
| | - Albert Wabnegger
- Department of Clinical Psychology, University of Graz, BioTechMed, Universitätsplatz 2/DG, 8010, Graz, Austria
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20
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Blythe JS, Thomaidou MA, Peerdeman KJ, van Laarhoven AI, van Schothorst MM, Veldhuijzen DS, Evers AW. Placebo effects on cutaneous pain and itch: a systematic review and meta-analysis of experimental results and methodology. Pain 2023; 164:1181-1199. [PMID: 36718994 PMCID: PMC10184563 DOI: 10.1097/j.pain.0000000000002820] [Citation(s) in RCA: 12] [Impact Index Per Article: 12.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/07/2022] [Revised: 09/14/2022] [Accepted: 10/20/2022] [Indexed: 02/01/2023]
Abstract
ABSTRACT Placebo effects, positive treatment outcomes that go beyond treatment processes, can alter sensations through learning mechanisms. Understanding how methodological factors contribute to the magnitude of placebo effects will help define the mechanisms by which these effects occur. We conducted a systematic review and meta-analysis of experimental placebo studies in cutaneous pain and itch in healthy samples, focused on how differences in methodology contribute to the resulting placebo effect magnitude. We conducted meta-analyses by learning mechanism and sensation, namely, for classical conditioning with verbal suggestion, verbal suggestion alone, and observational learning, separately for pain and itch. We conducted subgroup analyses and meta-regression on the type of sensory stimuli, placebo treatment, number of acquisition and evocation trials, differences in calibrated intensities for placebo and control stimuli during acquisition, age, and sex. We replicated findings showing that a combination of classical conditioning with verbal suggestion induced larger placebo effects on pain ( k = 68, g = 0 . 59) than verbal suggestion alone ( k = 39, g = 0.38) and found a smaller effect for itch with verbal suggestion alone ( k = 7, g = 0.14). Using sham electrodes as placebo treatments corresponded with larger placebo effects on pain than when topical gels were used. Other methodological and demographic factors did not significantly affect placebo magnitudes. Placebo effects on pain and itch reliably occur in experimental settings with varied methods, and conditioning with verbal suggestion produced the strongest effects. Although methods may shape the placebo effect to some extent, these effects appear robust overall, and their underlying learning mechanisms may be harnessed for applications outside the laboratory.
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Affiliation(s)
- Joseph S. Blythe
- Health, Medical and Neuropsychology Unit, Leiden University, Leiden, the Netherlands
- Leiden Institute for Brain and Cognition, Leiden, the Netherlands
| | - Mia A. Thomaidou
- Health, Medical and Neuropsychology Unit, Leiden University, Leiden, the Netherlands
- Leiden Institute for Brain and Cognition, Leiden, the Netherlands
| | - Kaya J. Peerdeman
- Health, Medical and Neuropsychology Unit, Leiden University, Leiden, the Netherlands
- Leiden Institute for Brain and Cognition, Leiden, the Netherlands
| | - Antoinette I.M. van Laarhoven
- Health, Medical and Neuropsychology Unit, Leiden University, Leiden, the Netherlands
- Leiden Institute for Brain and Cognition, Leiden, the Netherlands
- Department of Psychiatry, Leiden University Medical Centre, Leiden, the Netherlands
| | | | - Dieuwke S. Veldhuijzen
- Health, Medical and Neuropsychology Unit, Leiden University, Leiden, the Netherlands
- Leiden Institute for Brain and Cognition, Leiden, the Netherlands
| | - Andrea W.M. Evers
- Health, Medical and Neuropsychology Unit, Leiden University, Leiden, the Netherlands
- Leiden Institute for Brain and Cognition, Leiden, the Netherlands
- Medical Delta Healthy Society, Leiden University, Technical University Delft, and Erasmus University Rotterdam, Rotterdam, the Netherlands
- Department of Psychiatry, Leiden University Medical Centre, Leiden, the Netherlands
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Follow-Up of Side Effects throughout the Entire Course of Coronavirus Vaccination. Vaccines (Basel) 2023; 11:vaccines11030704. [PMID: 36992288 DOI: 10.3390/vaccines11030704] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/30/2023] [Revised: 03/10/2023] [Accepted: 03/12/2023] [Indexed: 03/22/2023] Open
Abstract
Vaccines are considered the best protective means against coronavirus infection. There is increasing interest in reporting the side effects of vaccines, especially for individuals younger than 18 years old. Accordingly, this analytical cohort study aims to report on the side effects of adult and young individuals who received vaccination within 24 h, 72 h, 5 days, and 1 week through the entire course of vaccination (ECoV). A validated online survey was used to collect information. In total, 1069 individuals were completely followed. Most individuals received the Pfizer vaccine (59.6%). Most individuals had received two doses (69.4%). Very strong and statistically significant associations with side effects (p < 0.05, Phi (Φ) > 0.25) throughout the ECoV were reported for the type of vaccine and female gender. Non-smokers reported weak statistically significant associations. Fatigue and localized pain were the most commonly reported side effect, with onset within 24 h and duration of less than 72 h. The prevalence of reported side effects was statistically significantly higher among young individuals (<18 years old) than among adults (X2 (1) =7.6, p = 0.006. Phi φ = 0.11).
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Is cognitive-behavioral coaching an empirically supported approach to coaching? a meta-analysis to investigate its outcomes and moderators. JOURNAL OF RATIONAL-EMOTIVE AND COGNITIVE-BEHAVIOR THERAPY 2023. [DOI: 10.1007/s10942-023-00498-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 03/06/2023]
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23
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Bavbek S, Ozyigit LP, Baiardini I, Braido F, Roizen G, Jerschow E. Placebo, Nocebo, and Patient-Reported Outcome Measures in Drug Allergy. THE JOURNAL OF ALLERGY AND CLINICAL IMMUNOLOGY. IN PRACTICE 2023; 11:371-379. [PMID: 36521832 DOI: 10.1016/j.jaip.2022.11.033] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/31/2022] [Revised: 11/24/2022] [Accepted: 11/30/2022] [Indexed: 12/14/2022]
Affiliation(s)
- Sevim Bavbek
- Division of Allergy and Clinical of Immunology, Department of Chest Diseases, Ankara University, School of Medicine, Ankara, Turkey.
| | - Leyla Pur Ozyigit
- Adult Allergy Service, Glenfield Hospital, University Hospitals of Leicester NHS Trust, Leicester, United Kingdom
| | - Ilaria Baiardini
- Istituti di Ricovero e Cura a Carattere Scientifico, Ospedale Policlinico San Martino, Genova, Italy; Università di Genova, (DIMI), Genova, Italy
| | - Fulvio Braido
- Istituti di Ricovero e Cura a Carattere Scientifico, Ospedale Policlinico San Martino, Genova, Italy; Università di Genova, (DIMI), Genova, Italy
| | - Gigia Roizen
- Department of Immunology, Clinica Alemana De Santiago, Santiago, Chile
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24
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Vaccine hesitancy prospectively predicts nocebo side-effects following COVID-19 vaccination. Sci Rep 2022; 12:20018. [PMID: 36470896 PMCID: PMC9722845 DOI: 10.1038/s41598-022-21434-7] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/29/2022] [Accepted: 09/27/2022] [Indexed: 12/09/2022] Open
Abstract
The directionality between vaccine hesitancy and COVID-19 vaccine side-effects has not been hitherto examined. We hypothesized a nocebo effect, whereby vaccine hesitancy towards the second Pfizer vaccination dose predicts subsequent side-effects for a booster dose, beyond other effects. We expected these nocebo effects to be driven by (mis)information in males and prior experience in females. A representative sample of older adults (n = 756, mean age = 68.9 ± 3.43) were questioned in a typical cross-lagged design (wave 1 following a second Pfizer dose, wave 2 after their booster). As hypothesized, earlier vaccine hesitancy predicted subsequent booster side-effects for females (β = 0.10 p = 0.025, f 2 = 0.02) and males (β = 0.34, p < 0.001, f 2 = 0.16); effects were stronger in males (χ2Δ (1) = 4.34, p = 0.03). The (W1-to-W2) side-effect autoregression was stronger in females (β = .34, p < 0.001; males β = 0.18, p < 0.001), χ2Δ (1) = 26.86, p < 0.001. Results show that a quantifiable and meaningful portion of COVID-19 vaccine side-effects is predicted by vaccine hesitancy, demonstrating that side-effects comprise a psychosomatic nocebo component in vaccinated individuals. The data reveal distinct risk levels for future side-effects, suggesting the need to tailor public health messaging.
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25
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Iwama Y, Takamoto K, Hibi D, Nishimaru H, Matsumoto J, Setogawa T, Nishijo H. Young female participants show blunted placebo effects associated with blunted responses to a cue predicting a safe stimulus in the right dorsolateral prefrontal cortex. Front Neurosci 2022; 16:1001177. [PMID: 36263366 PMCID: PMC9574021 DOI: 10.3389/fnins.2022.1001177] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/22/2022] [Accepted: 09/20/2022] [Indexed: 11/17/2022] Open
Abstract
Discrimination of cues predicting non-nociceptive/nociceptive stimuli is essential for predicting whether a non-painful or painful stimulus will be administered and for eliciting placebo/nocebo (pain reduction/pain enhancement) effects. Dysfunction of the neural system involved in placebo effects has been implicated in the pathology of chronic pain, while female sex is one of the important risk factors for development of chronic pain in young adults. The dorsolateral prefrontal cortex (dl-PFC) is suggested to be involved in placebo effects and is sensitive to sex and age. In this study, to examine the neural mechanisms by which sex and age alter placebo and nocebo effects, we analyzed cerebral hemodynamic activities in the dl-PFC in different sex and age groups during a differential conditioning task. During the training session, two different sounds were followed by low- and high-intensity electrical shocks. In the following recording session, electrical shocks, the intensity of which was mismatched to the sounds, were occasionally administered to elicit placebo and nocebo effects. In young female participants, both placebo effects and hemodynamic responses to the conditioned sounds in the right dl-PFC were significantly lower than those in elderly female participants, while there were no age differences in male participants. The hemodynamic responses to the sound paired with the safe stimulus in the right dl-PFC were significantly correlated with placebo effects, except in the young female group. These results suggest that blunted placebo effects in the young female participants are ascribed to blunted responses to the sound associated with the safe stimulus in the right dl-PFC, and that sex- and age-related factors may alter the responsiveness of the right dl-PFC to associative cues predicting a safe stimulus.
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Affiliation(s)
- Yudai Iwama
- System Emotional Science, Faculty of Medicine, University of Toyama, Toyama, Japan
| | - Kouichi Takamoto
- Department of Sport and Health Sciences, Faculty of Human Sciences, University of East Asia, Shimonoseki, Japan
| | - Daisuke Hibi
- Department of Anesthesiology, Faculty of Medicine, University of Toyama, Toyama, Japan
| | - Hiroshi Nishimaru
- System Emotional Science, Faculty of Medicine, University of Toyama, Toyama, Japan
- Research Center for Idling Brain Science (RCIBS), University of Toyama, Toyama, Japan
| | - Jumpei Matsumoto
- System Emotional Science, Faculty of Medicine, University of Toyama, Toyama, Japan
- Research Center for Idling Brain Science (RCIBS), University of Toyama, Toyama, Japan
| | - Tsuyoshi Setogawa
- System Emotional Science, Faculty of Medicine, University of Toyama, Toyama, Japan
- Research Center for Idling Brain Science (RCIBS), University of Toyama, Toyama, Japan
| | - Hisao Nishijo
- System Emotional Science, Faculty of Medicine, University of Toyama, Toyama, Japan
- Research Center for Idling Brain Science (RCIBS), University of Toyama, Toyama, Japan
- *Correspondence: Hisao Nishijo,
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26
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Feldman HA, Feldman JA, Miller CC, Walsh G, Tyson JE. Informed Consent for Placebo-Controlled Trials: Do Ethics and Science Conflict? Ethics Hum Res 2022; 44:42-48. [PMID: 36047276 PMCID: PMC9841466 DOI: 10.1002/eahr.500142] [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: 01/19/2023]
Abstract
The use of a placebo has been considered the best method for controlling bias in a prospective randomized clinical trial and provides the most rigorous test of treatment efficacy for evaluating a medical therapy. Placebos commonly produce clinically important effects particularly in studies where the primary outcomes are subjective. Yet the potential beneficial or harmful effects of placebos are often not addressed in designing a clinical trial, calculating the sample size, seeking consent, or interpreting clinical trial results. In this manuscript, we use an actual study to indicate three approaches that might be considered in seeking informed consent for placebo-controlled trials, and we explore the fundamental ethical and scientific complexities involved with each.
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Affiliation(s)
- Hope A. Feldman
- Department of Thoracic and Cardiovascular Surgery at the University of Texas MD Anderson Cancer Center
| | - James A. Feldman
- Department of Emergency Medicine at the Boston Medical Center at the Boston University School of Medicine
| | - Charles C. Miller
- University of Texas Health Science Center at Houston in the McGovern Medical School
| | - Garrett Walsh
- Department of Thoracic and Cardiovascular Surgery at the University of Texas MD Anderson Cancer Center
| | - Jon E. Tyson
- University of Texas Health Science Center at Houston in the McGovern Medical School
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27
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Brietzke C, Cesario JCS, Hettinga FJ, Pires FO. The reward for placebos: mechanisms underpinning placebo-induced effects on motor performance. Eur J Appl Physiol 2022; 122:2321-2329. [PMID: 36006479 DOI: 10.1007/s00421-022-05029-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/27/2022] [Accepted: 08/16/2022] [Indexed: 11/29/2022]
Abstract
Different from the most popular thinking, the placebo effect is not a purely psychological phenomenon. A body of knowledge from multidisciplinary fields has shown that the expectation of a potential benefit when receiving a treatment induces a cascade of neurochemical-electrophysiological alterations in brain reward areas, including motor-related ones. Alterations in the dopamine, opioid, and glutamate metabolism are the neural representation converting reward-derived declarative forms into an attractive and wanted behavior, thereby changing the activation in reward subcortical and cortical structures involved in motor planning, motor execution, and emotional-cognitive attributes of decision-making. We propose that the expectation of receiving a treatment that is beneficial to motor performance triggers a cascade of activations in brain reward areas that travels from motor planning and motor command areas, passing through corticospinal pathways until driving the skeletal muscles, therefore facilitating the motor performance. Although alternative explanations cannot be totally ruled out, this mechanistic route is robust in explaining the results of placebo-induced effects on motor performance and could lead to novel insights and applications in the exercise sciences. Factors such as sex differences in reward-related mechanisms and aversion-induced nocebo effects should also be addressed.
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Affiliation(s)
- Cayque Brietzke
- Exercise Psychophysiology Research Group, School of Arts, Sciences and Humanities, University of São Paulo, São Paulo, Brazil.,Human Movement Science and Rehabilitation Program, Federal University of São Paulo, Santos, Brazil
| | - Julio Cesar Silva Cesario
- Exercise Psychophysiology Research Group, School of Arts, Sciences and Humanities, University of São Paulo, São Paulo, Brazil
| | | | - Flavio Oliveira Pires
- Exercise Psychophysiology Research Group, School of Arts, Sciences and Humanities, University of São Paulo, São Paulo, Brazil. .,Human Movement Science and Rehabilitation Program, Federal University of São Paulo, Santos, Brazil. .,Rehabilitation Sciences Program, Faculty of Medicine, University of São Paulo, São Paulo, Brazil.
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28
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Itskovich E, Bowling DL, Garner JP, Parker KJ. Oxytocin and the social facilitation of placebo effects. Mol Psychiatry 2022; 27:2640-2649. [PMID: 35338314 PMCID: PMC9167259 DOI: 10.1038/s41380-022-01515-9] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/04/2021] [Revised: 02/16/2022] [Accepted: 02/25/2022] [Indexed: 01/30/2023]
Abstract
Significant clinical improvement is often observed in patients who receive placebo treatment in randomized double-blind placebo-controlled trials. While a proportion of this "improvement" reflects experimental design limitations (e.g., reliance on subjective outcomes, unbalanced groups, reporting biases), some of it reflects genuine improvement corroborated by physiological change. Converging evidence across diverse medical conditions suggests that clinically-relevant benefits from placebo treatment are associated with the activation of brain reward circuits. In parallel, evidence has accumulated showing that such benefits are facilitated by clinicians that demonstrate warmth and proficiency during interactions with patients. Here, we integrate research on these neural and social aspects of placebo effects with evidence linking oxytocin and social reward to advance a neurobiological account for the social facilitation of placebo effects. This account frames oxytocin as a key mediator of treatment success across a wide-spectrum of interventions that increase social connectedness, thereby providing a biological basis for assessing this fundamental non-specific element of medical care.
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Affiliation(s)
- Elena Itskovich
- Department of Psychiatry & Behavioral Sciences, Stanford University School of Medicine, Stanford, CA 94305
| | - Daniel L. Bowling
- Department of Psychiatry & Behavioral Sciences, Stanford University School of Medicine, Stanford, CA 94305
| | - Joseph P. Garner
- Department of Psychiatry & Behavioral Sciences, Stanford University School of Medicine, Stanford, CA 94305.,Department of Comparative Medicine, Stanford University School of Medicine, Stanford, CA 94305
| | - Karen J. Parker
- Department of Psychiatry & Behavioral Sciences, Stanford University School of Medicine, Stanford, CA 94305.,Department of Comparative Medicine, Stanford University School of Medicine, Stanford, CA 94305
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29
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Shafir R, Olson E, Colloca L. The neglect of sex: A call to action for including sex as a biological variable in placebo and nocebo research. Contemp Clin Trials 2022; 116:106734. [PMID: 35306216 PMCID: PMC9332926 DOI: 10.1016/j.cct.2022.106734] [Citation(s) in RCA: 7] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/28/2021] [Revised: 03/08/2022] [Accepted: 03/14/2022] [Indexed: 11/22/2022]
Abstract
Sex differences exist in the prevalence, progression and treatment efficacy of a wide array of medical conditions. While the placebo and nocebo effects have become increasingly relevant in the clinical arena, little is known about the influence of biological sex on placebo and nocebo effects. This paper discusses the existing, relatively limited and sometimes conflicting evidence about how sex impacts the occurrence and magnitude of the placebo and nocebo effects, mainly focusing on pain studies. We present recent evidence that when compared to men, women suffering from chronic orofacial pain may derive greater benefit from the placebo effect for analgesia. Nonetheless, we broadly argue that the field is not currently positioned to draw definitive conclusions and propose several important factors that may explain the inconsistency in the literature and that should be taken into account in future research. These include the specific target symptom of the placebo or nocebo manipulation and whether or not the target is related to the medical condition, the placebo or nocebo induction method, the sex of the experimenter or physician, and so forth. Future research should intentionally include sex a biological variable to favor translation of placebo and nocebo mechanisms into clinical applications.
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Affiliation(s)
- Roni Shafir
- Department of Pain and Translational Symptom Science, School of Nursing, University of Maryland, Baltimore, USA.
| | - Elizabeth Olson
- School of Medicine, University of Maryland, Baltimore, MD, United States
| | - Luana Colloca
- Department of Pain and Translational Symptom Science, School of Nursing, University of Maryland, Baltimore, USA; Departments of Anesthesiology and Psychiatry, School of Medicine, University of Maryland, Baltimore, USA; Center to Advance Chronic Pain Research, University of Maryland, Baltimore, USA.
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30
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Changes in neural processing and evaluation of negative facial expressions after administration of an open-label placebo. Sci Rep 2022; 12:6577. [PMID: 35449194 PMCID: PMC9023441 DOI: 10.1038/s41598-022-10567-4] [Citation(s) in RCA: 7] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/20/2022] [Accepted: 04/01/2022] [Indexed: 12/21/2022] Open
Abstract
A recent event-related potential (ERP) study found that an open-label placebo (OLP) reduced emotional distress during the viewing of unpleasant scenes and the amplitude of the late positive potential (LPP). The present ERP experiment aimed at a conceptual replication of this finding and investigated OLP effects during affective face processing. The participants (109 females) were presented with images depicting angry and neutral facial expressions after the administration of a saline nasal spray. The spray was either introduced as a placebo that could help reduce the emotional reactions to viewing angry faces (OLP group) or to improve the electrophysiological recordings (Control group). The OLP was associated with reduced LPP amplitudes (1000-6000 ms) to anger expressions across a frontal cluster. Additionally, the OLP reduced LPP amplitudes (400-1000 ms) to both anger and neutral faces across a centroparietal cluster. Compared to the Control group, the OLP group reported less arousal when confronted with angry faces, and rated the anger expressions as less intense. This study demonstrates that an OLP can alter both subjective and neural responses to anger cues. Future research should directly compare OLP treatment with other strategies for emotion regulation (e.g., cognitive reappraisal) to demonstrate the specificity of this approach.
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31
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Temporal expectancy induced by the mere possession of a placebo analgesic affects placebo analgesia: preliminary findings from a randomized controlled trial. Sci Rep 2022; 12:1395. [PMID: 35082351 PMCID: PMC8792021 DOI: 10.1038/s41598-022-05537-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/29/2021] [Accepted: 01/10/2022] [Indexed: 11/21/2022] Open
Abstract
Research on placebo analgesia usually shows that people experienced a reduction in pain after using a placebo analgesic. An emerging line of research argues that, under some circumstances, merely possessing (but not using) a placebo analgesic could induce placebo analgesia. The current study investigates how temporary expectation of pain reduction associated with different forms of possessing a placebo analgesic affects pain outcomes. Healthy participants (n = 90) were presented with a vial of olive oil (placebo), described as a blended essential oil that blocks pain sensations upon nasal inhalation, and were asked to anticipate the benefits of such analgesic oil to the self (such as anticipating the analgesic oil to reduce their pain). Participants were randomized into one of three different possession conditions: physical-possession condition (participants possessed a tangible placebo analgesic oil, inducing an expectation to acquire analgesic benefit early upon the experience of pain), psychological-possession condition (participants possessed a coupon, which can be redeemed for a placebo analgesic oil, inducing an expectation to acquire analgesic benefit later upon the experience of pain), or no-possession condition. Participants did a cold pressor test (CPT) to experience experimentally-induced pain on their non-dominant hand. Their objective physical pain responses (pain-threshold and pain-tolerance), and subjective psychological pain perception (pain intensity, severity, quality, and unpleasantness) were measured. Results revealed that participants in the physical-possession condition reported greater pain-threshold, F(2, 85) = 6.65, p = 0.002, and longer pain-tolerance, F(2, 85) = 7.19, p = 0.001 than participants in the psychological-possession and no-possession conditions. No significant group difference was found in subjective pain perception. The results of this study can advance knowledge about pain mechanisms and novel pain management.
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32
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Weng L, van Laarhoven AIM, Peerdeman KJ, Evers AWM. Do individual psychological characteristics predict induction and generalization of nocebo and placebo effects on pain and itch? Front Psychiatry 2022; 13:838578. [PMID: 35990075 PMCID: PMC9386339 DOI: 10.3389/fpsyt.2022.838578] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/18/2021] [Accepted: 07/05/2022] [Indexed: 11/16/2022] Open
Abstract
BACKGROUND Nocebo and placebo effects, i.e., adverse or beneficial treatment effects, respectively, putatively due to expectancies can modulate pain and itch. These effects can generalize within the pain or itch modality. Predicting the induction and generalization of these effects can be helpful in clinical practice. This study aims to investigate whether psychological characteristics related to the fear-avoidance model predict the induction and generalization of nocebo and placebo effects on pain and itch in young healthy participants. METHODS Data from two previous experiments were analyzed. In Experiment 1, we induced nocebo and placebo effects on heat pain and tested generalization to pressure pain and to cowhage-evoked itch (n = 33 in a nocebo group, n = 32 in a placebo group). In Experiment 2, we induced nocebo effects on cowhage-evoked itch and tested generalization to mechanical itch and to mechanical touch (n = 44). Potential predictors were anxiety- and stress symptoms, attention to pain/itch, and pain/itch catastrophizing. Multiple regression analyses were performed. RESULTS For nocebo effects, none of the individual psychological characteristics significantly predicted induction of nocebo effects nor their generalization. For placebo effects, only less stress symptoms, lower attention to pain, and higher pain catastrophizing weakly predicted a stronger generalization of placebo effects from heat pain to pressure pain. CONCLUSION The tested psychological characteristics may not play an important role in the induction and generalization of nocebo and placebo effects in healthy individuals. However, firm conclusions cannot be drawn with the current sample. Future studies should validate findings in larger and more diverse samples.
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Affiliation(s)
- Lingling Weng
- Health, Medical and Neuropsychology Unit, Faculty of Social and Behavioral Sciences, Leiden University, Leiden, Netherlands.,Leiden Institute for Brain and Cognition, Leiden University, Leiden, Netherlands
| | - Antoinette I M van Laarhoven
- Health, Medical and Neuropsychology Unit, Faculty of Social and Behavioral Sciences, Leiden University, Leiden, Netherlands.,Leiden Institute for Brain and Cognition, Leiden University, Leiden, Netherlands
| | - Kaya J Peerdeman
- Health, Medical and Neuropsychology Unit, Faculty of Social and Behavioral Sciences, Leiden University, Leiden, Netherlands.,Leiden Institute for Brain and Cognition, Leiden University, Leiden, Netherlands
| | - Andrea W M Evers
- Health, Medical and Neuropsychology Unit, Faculty of Social and Behavioral Sciences, Leiden University, Leiden, Netherlands.,Leiden Institute for Brain and Cognition, Leiden University, Leiden, Netherlands.,Department of Psychiatry, Leiden University Medical Center, Leiden, Netherlands.,Medical Delta, Leiden University, Technical University Delft, Rotterdam University, Rotterdam, Netherlands
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33
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Abstract
A placebo is an inert substance normally used in clinical trials for comparison with an active substance. However, a placebo has been shown to have an effect on its own; commonly known as the placebo effect. A placebo is an essential component in the design of conclusive clinical trials but has itself become the focus of intense research. The placebo effect is partly the result of positive expectations of the recipient on the state of health. Conversely, a nocebo effect is when negative expectations from a substance lead to poor treatment outcomes and/or adverse events. Randomized controlled trials in functional urology have demonstrated the importance of the placebo and nocebo effects across different diseases such as overactive bladder, urinary incontinence, lower urinary tract symptoms and interstitial cystitis/painful bladder syndrome, as well as male and female sexual dysfunction. Understanding the true nature of the placebo-nocebo complex and the scope of its effect in functional urology could help urologists to maximize the positive effects of this phenomenon while minimizing its potentially negative effects.
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34
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Leigh S, Thomas AG, Davies J. The effects of sex and outcome expectancies on perceptions of sexual harassment. PLoS One 2021; 16:e0261409. [PMID: 34910767 PMCID: PMC8673621 DOI: 10.1371/journal.pone.0261409] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/22/2021] [Accepted: 12/01/2021] [Indexed: 11/18/2022] Open
Abstract
Using an outcome expectancy framework, this research sought to understand sex differences in the underlying beliefs that influence harassment perception. One hundred and ninety-six participants (52% women) read a series of vignettes depicting common examples of digital male-on-female sexual harassment. They were asked to what extent they thought each scenario constituted sexual harassment, and how likely the perpetrator would experience positive and negative outcomes. Consistent with predictions, women were more likely to consider the behaviours as harassment than men were. Both sexes harassment perceptions had significant relationships with their outcome expectancies, but we also found evidence of a sex specific moderation; the link between men's negative outcome expectancies was moderated by their positive ones. The results suggest that perceptions of harassment may have sexually asymmetrical underpinnings. Measuring the interplay between positive and negative outcome expectancies in relation to sexual harassment perception is a novel approach, that may have implications for the development of anti-sexual harassment interventions. Implications for theory and future research directions are discussed.
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Affiliation(s)
- Shonagh Leigh
- Department of Psychology, Swansea University, Swansea, United Kingdom
| | - Andrew G. Thomas
- Department of Psychology, Swansea University, Swansea, United Kingdom
| | - Jason Davies
- Department of Psychology, Swansea University, Swansea, United Kingdom
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35
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Wahba G, Neshkova E, Jutras G, Liu Chen Kiow J, Clément M, Willems P, Eouani BD, Courbette O, Ayuso É, Bouin M. Lidocaine before esophageal manometry and ambulatory pH monitoring: A randomized controlled trial. Neurogastroenterol Motil 2021; 33:e14167. [PMID: 33969923 DOI: 10.1111/nmo.14167] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/28/2020] [Revised: 04/03/2021] [Accepted: 04/15/2021] [Indexed: 02/08/2023]
Abstract
BACKGROUND Lidocaine is commonly applied to improve the tolerance of esophageal manometry (EM) and ambulatory pH monitoring (PM). We recently published data suggesting a benefit to this practice and we aimed to confirm these findings in a randomized trial. METHODS We conducted a double-blind, randomized trial of lidocaine nasal spray versus placebo (saline) before EM and PM. Patients referred to our center who met inclusion criteria were enrolled. Patients were asked to fill a questionnaire after their test and patient-reported adverse effects were compared. KEY RESULTS Three hundred and four patients were enrolled in our trial. Lidocaine and placebo groups were demographically similar. The primary outcome, pain during catheter insertion, occurred in 60/148 (40.5%) patients in the lidocaine group versus in 72/152 (47.4%) patients in the placebo group (OR: 0.76 [95% CI: 0.48-1.20]; p = 0.23). Patients receiving lidocaine were less likely to report nausea during test recording (OR: 0.48 [95% CI: 0.24-0.91]; p = 0.02) and reported slightly lower intensity of pain during both catheter insertion and test recording (4.68 ± 2.06 versus 5.41 ± 2.24 on 10; p = 0.048 and 3.71 ± 2.00 versus 4.93 ± 2.55 on 10; p = 0.03, respectively). Furthermore, patients receiving lidocaine were less likely to report their test as globally uncomfortable and painful (57% vs. 75%; p = 0.003 and 14% vs. 21%; p = 0.02, respectively). No events of systemic lidocaine toxicity occurred during the study period. CONCLUSIONS Routine use of lidocaine before esophageal function tests does not reduce pain during catheter insertion but may provide other modest benefits with limited toxicity.
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Affiliation(s)
- George Wahba
- Centre hospitalier de l'Université de Montréal (CHUM), Montréal, Québec, Canada
| | - Elissaveta Neshkova
- Centre hospitalier de l'Université de Montréal (CHUM), Montréal, Québec, Canada
| | - Gabrielle Jutras
- Centre hospitalier de l'Université de Montréal (CHUM), Montréal, Québec, Canada
| | | | - Marianne Clément
- Centre hospitalier de l'Université de Montréal (CHUM), Montréal, Québec, Canada
| | - Philippe Willems
- Centre hospitalier de l'Université de Montréal (CHUM), Montréal, Québec, Canada
| | - Benny-Darold Eouani
- Centre hospitalier de l'Université de Montréal (CHUM), Montréal, Québec, Canada
| | - Olivier Courbette
- Centre hospitalier de l'Université de Montréal (CHUM), Montréal, Québec, Canada
| | - Éloïse Ayuso
- Centre hospitalier de l'Université de Montréal (CHUM), Montréal, Québec, Canada
| | - Mickael Bouin
- Centre hospitalier de l'Université de Montréal (CHUM), Montréal, Québec, Canada
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36
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Bagarić B, Jokić-Begić N, Sangster Jokić C. The Nocebo Effect: A Review of Contemporary Experimental Research. Int J Behav Med 2021; 29:255-265. [PMID: 34405336 DOI: 10.1007/s12529-021-10016-y] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 08/06/2021] [Indexed: 12/17/2022]
Abstract
BACKGROUND Nocebo effect, the occurrence of adverse symptoms fallowing an inactive treatment, is much less understood than its opposite, placebo effect. This systematic review of contemporary studies exploring the nocebo effect focuses on (1) the mechanisms underlying the nocebo effect, (2) the characteristics of participants exhibiting a more intensive nocebo response, and (3) the circumstances that might reduce or prevent the nocebo effect. METHOD We included experimental nocebo studies published in English that examined the occurrence of nocebo in various domains (i.e., types of sensations and symptoms) and different levels of nocebo response (e.g., performance, self-assessment) and in different populations of participants (healthy and clinical). Using Web of Science, PsycInfo and PubMed, we identified 25 papers (35 studies) that met our criteria with a total of N = 2614 participants, mostly healthy volunteers. RESULTS Nocebo was invoked by manipulating expectations, conditioning or both. A narrative content synthesis was conducted. Nocebo was successfully invoked in a range of domains (e.g., pain, nausea, itch, skin dryness) and levels (sensory, affective, psychological, and behavioral). Various characteristics of the conditioning procedure and participants' emotions, expectations, and dispositions are found to be related to the nocebo response, which sheds insight into the possible mechanisms of the nocebo effect. Strategies successful and unsuccessful in diminishing the nocebo response are identified. Limitations of this review include a small sample of studies. CONCLUSION These findings point to the universality of nocebo as well as to the importance of participant characteristics and experimental circumstances in invoking the nocebo effect. Further research should examine the nocebo effect in clinical populations.
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Affiliation(s)
- Branka Bagarić
- Croatian Association for Behavioral-Cognitive Therapies (CABCT), Šenoina 25, 10 000, Zagreb, Croatia.
| | - Nataša Jokić-Begić
- Department of Psychology, Faculty of Humanities and Social Sciences, University of Zagreb, Ivana Lučića 3, 10 000, Zagreb, Croatia
| | - Claire Sangster Jokić
- Department of Occupational Therapy, University of Applied Health Sciences, Mlinarska 38, 10 000, Zagreb, Croatia
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Vambheim SM, Daniali H, Flaten MA. Placebo Effects on Stress, but Not on Pain Reports. A Multi-Experiment Study. Front Psychol 2021; 12:639236. [PMID: 34163396 PMCID: PMC8215114 DOI: 10.3389/fpsyg.2021.639236] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/08/2020] [Accepted: 05/10/2021] [Indexed: 11/13/2022] Open
Abstract
Background Contextual factors, such as participant/experimenter sex may moderate the placebo effects. We tested whether the participant and experimenter sex modulated placebo effects on experimentally induced pain and associated stress. Objective To investigate if (i) participant sex and (ii) experimenter sex influence placebo analgesia and subjective and physiological stress in two experiments employing a within-subjects and a mixed design, respectively. Placebo effects were investigated in pain reports, stress, and blood pressure. Methods Participants received painful stimulations and a placebo cream. In Experiment One (N = 59) participants underwent a placebo condition (PC) and a natural history condition (NHC) in random order. A placebo cream was applied in the PC and then the heat stimulation temperature was surreptitiously lowered. Identical stimulations were administered in the NHC, but with no cream, no information, and no lowered temperature. In Experiment Two, participants (N = 93) were randomly assigned to three groups receiving either a placebo cream with surreptitiously lowered intensity of electric stimuli (Placebo, PG), a placebo cream (Cream-Control, CCG) without changing the stimuli, or lowered intensity, but with no cream (Pain-Control, PCG) in a mixed design. All participants in both experiments received the same stimuli in the post-test as in the pre-test. Four experimenters (two females) in Experiment One, and five experimenters (two females) in Experiment Two conducted the studies. Results No placebo effect was seen on pain. However, there were placebo effects on stress, moderated by participant and experimenter sex: in Experiment One males in the PC had lower diastolic blood pressure (DBP) compared to males in the NHC. Participants in the PC had lower DBP compared to the NHC when tested by a female. In Experiment Two, participants expected more cream effectiveness when a female experimenter administered it, and reported lower stress in the PG compared to the PCG when tested by females. Conclusion Our findings highlight a distinction between placebo effects on pain and on associated stress. Secondly, female experimenters recorded lower physiological and subjective stress, higher effectiveness expectations, and lower pain from both sexes compared to male experimenters. Possible reasons for the failure to find a pain placebo effect are discussed.
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Affiliation(s)
| | - Hojjat Daniali
- Department of Psychology, Norwegian University of Science and Technology, Trondheim, Norway
| | - Magne Arve Flaten
- Department of Psychology, Norwegian University of Science and Technology, Trondheim, Norway
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Do Children With Functional Abdominal Pain Benefit More From a Pain-Specific Cognitive-Behavioral Intervention Than From an Unspecific Attention Control Intervention? Results of a Randomized Controlled Trial. Am J Gastroenterol 2021; 116:1322-1335. [PMID: 33767111 DOI: 10.14309/ajg.0000000000001191] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/01/2020] [Accepted: 01/22/2021] [Indexed: 12/11/2022]
Abstract
INTRODUCTION We aimed to compare the efficacy of cognitive-behavioral therapy (CBT) among children with functional abdominal pain with an attention control (AC), hypothesizing the superiority of CBT group intervention regarding pain intensity (primary outcome), pain duration and frequency (further primary outcomes), functional disability, and quality of life and coping strategies (key secondary outcomes). METHODS We conducted a prospective, multicenter, randomized controlled efficacy trial (RCT) with 4 time points (before intervention, after intervention, 3-month follow-up, and 12-month follow-up). One hundred twenty-seven children aged 7-12 years were randomized to either the CBT (n = 63; 55.6% girls) or the AC (n = 64; 57.8% girls). RESULTS Primary endpoint analysis of the logarithmized area under the pain intensity curve showed no significant difference between groups (mean reduction = 49.04%, 95% confidence interval [CI] -19.98%-78.36%). Treatment success rates were comparable (adjusted odds ratio = 0.53, 95% CI 0.21-1.34, number needed to treat = 16). However, time trend analyses over the course of 1 year revealed a significantly greater reduction in pain intensity (40.9%, 95% CI 2.7%-64.1%) and pain duration (43.6%, 95% CI 6.2%-66.1%) in the CBT compared with the AC, but not in pain frequency per day (1.2, 95% CI -2.7 to 5.2). In the long term, children in the CBT benefitted slightly more than those in the AC with respect to functional disability, quality of life, and coping strategies. DISCUSSION Both interventions were effective, which underlines the role of time and attention for treatment efficacy. However, in the longer term, CBT yielded more favorable results.
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Neff PKA, Schoisswohl S, Simoes J, Staudinger S, Langguth B, Schecklmann M, Schlee W. Prolonged tinnitus suppression after short-term acoustic stimulation. PROGRESS IN BRAIN RESEARCH 2021; 262:159-174. [PMID: 33931177 DOI: 10.1016/bs.pbr.2021.02.004] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/12/2022]
Abstract
BACKGROUND Tinnitus suppression following acoustic stimulation is a well-known phenomenon also termed residual inhibition (RI). Some individuals may experience prolonged RI (PRI), which can last for several hours or even days, after a single short-term acoustic stimulation. Exact mechanisms of this phenomenon are unknown and current evidence anecdotal. OBJECTIVES The aim of our report is to collect, present, and discuss cases of PRI from our studies on acoustic stimulation in tinnitus with the aim to better understand this phenomenon as well as its implications for individualized treatments. METHODS We pooled cases of PRI from four of our studies with a total sample size of n = 130. The criterion was set on a PRI duration which is at least sustained twice as long as the acoustic stimulation duration. RESULTS We report a total number of about 5% of all participants experiencing some form of PRI, with rates of 3%-7% across the individual studies. PRI lasted from 20 min up to several days and was induced by the first stimulus in four out of six cases. Four out of six individuals experiencing PRI were female and PRI mostly occurred when acoustic stimuli were matched to the frequency or type of the tinnitus. CONCLUSION PTS seems to be elicitable in a small subset of tinnitus patients which could inform future individualized treatment options. Future studies should investigate if and how identified factors like stimulus type, position, sex, and chronification grade uphold experimental scrutiny. We propose that the set of methods is furthermore extended with neurophysiology in particular.
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Affiliation(s)
- Patrick K A Neff
- Department of Psychiatry and Psychotherapy, University of Regensburg, Regensburg, Germany; University Research Priority Program "Dynamics of Healthy Aging", University of Zurich, Zurich, Switzerland.
| | - Stefan Schoisswohl
- Department of Psychiatry and Psychotherapy, University of Regensburg, Regensburg, Germany
| | - Jorge Simoes
- Department of Psychiatry and Psychotherapy, University of Regensburg, Regensburg, Germany
| | - Susanne Staudinger
- Department of Psychiatry and Psychotherapy, University of Regensburg, Regensburg, Germany
| | - Berthold Langguth
- Department of Psychiatry and Psychotherapy, University of Regensburg, Regensburg, Germany
| | - Martin Schecklmann
- Department of Psychiatry and Psychotherapy, University of Regensburg, Regensburg, Germany
| | - Winfried Schlee
- Department of Psychiatry and Psychotherapy, University of Regensburg, Regensburg, Germany
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Smits RM, Veldhuijzen DS, Olde Hartman T, Peerdeman KJ, Van Vliet LM, Van Middendorp H, Rippe RCA, Wulffraat NM, Evers AWM. Explaining placebo effects in an online survey study: Does 'Pavlov' ring a bell? PLoS One 2021; 16:e0247103. [PMID: 33705397 PMCID: PMC7951811 DOI: 10.1371/journal.pone.0247103] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/03/2020] [Accepted: 02/01/2021] [Indexed: 12/12/2022] Open
Abstract
OBJECTIVES Despite the increasing knowledge about placebo effects and their beneficial impact on treatment outcomes, strategies that explicitly employ these mechanisms remain scarce. To benefit from placebo effects, it is important to gain better understanding in how individuals want to be informed about placebo effects (for example about the underlying mechanisms that steer placebo effects). The main aim of this study was to investigate placebo information strategies in a general population sample by assessing current placebo knowledge, preferences for different placebo explanations (built around well-known mechanisms involved in placebo effects), and attitudes and acceptability towards the use of placebo effects in treatment. DESIGN Online survey. SETTING Leiden, The Netherlands. PARTICIPANTS 444 participants (377 completers), aged 16-78 years. MAIN OUTCOME MEASURES Current placebo knowledge, placebo explanation preferences, and placebo attitudes and acceptability. RESULTS Participants scored high on current placebo knowledge (correct answers: M = 81.15%, SD = 12.75). Comparisons of 8 different placebo explanations revealed that participants preferred explanations based on brain mechanisms and positive expectations more than all other explanations (F(7, 368) = 3.618, p = .001). Furthermore, attitudes and acceptability for placebos in treatment varied for the type of the condition (i.e. more acceptant for psychological complaints) and participants indicated that physicians do not always have to be honest while making use of placebo effects for therapeutic benefit. CONCLUSION Our results brought forth new evidence in placebo information strategies, and indicated that explanations based on brain mechanisms and positive expectations were most preferred. These results can be insightful to construct placebo information strategies for both clinical context and research practices.
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Affiliation(s)
- Rosanne M. Smits
- Health, Medical and Neuropsychology unit, Leiden University, Leiden, The Netherlands
- Leiden Institute for Brain and Cognition, Leiden, The Netherlands
- Pediatric Immunology and Rheumatology, Wilhelmina Children’s Hospital, Utrecht, The Netherlands
| | - Dieuwke S. Veldhuijzen
- Health, Medical and Neuropsychology unit, Leiden University, Leiden, The Netherlands
- Leiden Institute for Brain and Cognition, Leiden, The Netherlands
- Pediatric Immunology and Rheumatology, Wilhelmina Children’s Hospital, Utrecht, The Netherlands
| | - Tim Olde Hartman
- Department of Primary and Community Care, Radboud Institute for Health Sciences, Radboud University Medical Center, Nijmegen, The Netherlands
| | - Kaya J. Peerdeman
- Health, Medical and Neuropsychology unit, Leiden University, Leiden, The Netherlands
- Leiden Institute for Brain and Cognition, Leiden, The Netherlands
| | - Liesbeth M. Van Vliet
- Health, Medical and Neuropsychology unit, Leiden University, Leiden, The Netherlands
- Leiden Institute for Brain and Cognition, Leiden, The Netherlands
| | - Henriët Van Middendorp
- Health, Medical and Neuropsychology unit, Leiden University, Leiden, The Netherlands
- Leiden Institute for Brain and Cognition, Leiden, The Netherlands
| | - Ralph C. A. Rippe
- Research Methods and Statistics, Institute of Education and Child Studies, Leiden University, Leiden, The Netherlands
| | - Nico M. Wulffraat
- Pediatric Immunology and Rheumatology, Wilhelmina Children’s Hospital, Utrecht, The Netherlands
| | - Andrea W. M. Evers
- Health, Medical and Neuropsychology unit, Leiden University, Leiden, The Netherlands
- Leiden Institute for Brain and Cognition, Leiden, The Netherlands
- Department of Psychiatry, Leiden University Medical Center, Leiden, The Netherlands
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Ancochea J, Izquierdo JL, Soriano JB. Evidence of Gender Differences in the Diagnosis and Management of Coronavirus Disease 2019 Patients: An Analysis of Electronic Health Records Using Natural Language Processing and Machine Learning. J Womens Health (Larchmt) 2021; 30:393-404. [DOI: 10.1089/jwh.2020.8721] [Citation(s) in RCA: 24] [Impact Index Per Article: 8.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/13/2022] Open
Affiliation(s)
- Julio Ancochea
- Department of Respiratory Medicine, Hospital Universitario de La Princesa, Madrid, Spain
- Department of Respiratory Medicine, Universidad Autónoma de Madrid, Madrid, Spain
- Centro de Investigación en Red de Enfermedades Respiratorias (CIBERES), Instituto de Salud Carlos III (ISCIII), Madrid, Spain
| | - Jose L. Izquierdo
- Department of Respiratory Medicine, Universidad de Alcalá, Madrid, Spain
- Department of Respiratory Medicine, Hospital Universitario de Guadalajara, Guadalajara, Spain
| | - Joan B. Soriano
- Department of Respiratory Medicine, Hospital Universitario de La Princesa, Madrid, Spain
- Department of Respiratory Medicine, Universidad Autónoma de Madrid, Madrid, Spain
- Centro de Investigación en Red de Enfermedades Respiratorias (CIBERES), Instituto de Salud Carlos III (ISCIII), Madrid, Spain
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Olson EM, Akintola T, Phillipsc J, Blasini M, Haycock NR, Martinez PE, Greenspan JD, Dorsey SG, Wang Y, Colloca L. Effects of sex on placebo effects in chronic pain participants: a cross-sectional study. Pain 2021; 162:531-542. [PMID: 32826757 PMCID: PMC7854995 DOI: 10.1097/j.pain.0000000000002038] [Citation(s) in RCA: 16] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/19/2020] [Accepted: 08/03/2020] [Indexed: 12/19/2022]
Abstract
ABSTRACT Sex-related differences can influence outcomes of randomized clinical trials and may jeopardize the effectiveness of pain management and other therapeutics. Thus, it is essential to understand the mechanistic and translational aspects of sex differences in placebo outcomes. Recently, studies in healthy participants have shed light on how sex-related placebo effects might influence outcomes, yet no research has been conducted in a patient population. Herein, we used a tripartite approach to evaluate the interaction of prior therapeutic experience (eg, conditioning), expectations, and placebo effects in 280 chronic (orofacial) pain patients (215 women). In this cross-sectional study, we assessed sex differences in placebo effects, conditioning as a proxy of prior therapeutic effects, and expectations evaluated before and after the exposure to positive outcomes, taking into account participant-experimenter sex concordance and hormonal levels (estradiol and progesterone assessed in premenopausal women). We used mediation analysis to determine how conditioning strength and expectations impacted sex differences in placebo outcomes. Independent of gonadal hormone levels, women showed stronger placebo effects than men. We also found significant statistical sex differences in the conditioning strength and reinforced expectations whereby reinforced expectations mediated the sex-related placebo effects. In addition, the participant-experimenter sex concordance influenced conditioning strength, reinforced expectations, and placebo effects in women but not in men. Our findings suggest that women experience larger conditioning effects, expectations, and placebo effects emphasizing the need to consider sex as a biological variable when placebo components of any outcomes are part of drug development trials and in pain management.
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Affiliation(s)
| | - Titilola Akintola
- Department of Pain and Translational Symptom Science, School of Nursing, University of Maryland, Baltimore, MD, USA
| | - Jane Phillipsc
- Department of Neural and Pain Sciences, and Brotman Facial Pain Clinic, School of Dentistry, University of Maryland, Baltimore, MD, USA
| | - Maxie Blasini
- Department of Pain and Translational Symptom Science, School of Nursing, University of Maryland, Baltimore, MD, USA
| | - Nathaniel R. Haycock
- Department of Pain and Translational Symptom Science, School of Nursing, University of Maryland, Baltimore, MD, USA
| | - Pedro E. Martinez
- National Institutes of Health, National Institute of Mental Health, Bethesda, MD, USA
| | - Joel D. Greenspan
- Department of Neural and Pain Sciences, and Brotman Facial Pain Clinic, School of Dentistry, University of Maryland, Baltimore, MD, USA
- University of Maryland Center to Advance Chronic Pain Research, Baltimore, MD, USA
| | - Susan G. Dorsey
- Department of Pain and Translational Symptom Science, School of Nursing, University of Maryland, Baltimore, MD, USA
- University of Maryland Center to Advance Chronic Pain Research, Baltimore, MD, USA
| | - Yang Wang
- Department of Pain and Translational Symptom Science, School of Nursing, University of Maryland, Baltimore, MD, USA
| | - Luana Colloca
- Department of Pain and Translational Symptom Science, School of Nursing, University of Maryland, Baltimore, MD, USA
- University of Maryland Center to Advance Chronic Pain Research, Baltimore, MD, USA
- Department of Anesthesiology, School of Medicine, University of Maryland, Baltimore, MD, USA
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Workman CD, Fietsam AC, Kamholz J, Rudroff T. Women report more severe sensations from 2 mA and 4 mA transcranial direct current stimulation than men. Eur J Neurosci 2020; 53:2696-2702. [PMID: 33259084 DOI: 10.1111/ejn.15070] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/28/2020] [Revised: 11/24/2020] [Accepted: 11/25/2020] [Indexed: 01/29/2023]
Abstract
Interest in transcranial direct current stimulation (tDCS) to alter cortical excitability, facilitate neural plasticity, and improve performance is increasing. Subjects often report temporary stimulation-related sensations, which might distract from the task being performed or compromise blinding. tDCS is also prone to high outcome irregularity and one potential variability source is the biological sex of the subject. The purpose of this study was to re-analyze existing tolerability data to ascertain any sex differences in sensation severity and blinding guesses from tDCS at 2 mA and 4 mA. Each subject underwent tDCS at three randomly ordered intensities (sham, 2 mA, 4 mA), reported the severity sensations experienced, and guessed which tDCS condition they underwent (blinding). Women reported higher sensation severities than men from 2 mA and 4 mA tDCS and higher severities with increasing intensity (sham < 2 mA < 4 mA). Men reported similar severities in all stimulation conditions. Both sexes distinguished sham from 2 mA and 4 mA, and neither were able to discriminate between 2 mA from 4 mA. This study highlights differences in severity reports between women and men and adds to the growing body of literature, indicating that current sham methodologies might be inadequate to maintain blinding.
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Affiliation(s)
- Craig D Workman
- Department of Health and Human Physiology, University of Iowa, Iowa City, IA, USA
| | - Alexandra C Fietsam
- Department of Health and Human Physiology, University of Iowa, Iowa City, IA, USA
| | - John Kamholz
- Department of Neurology, University of Iowa Hospitals and Clinics, Iowa City, IA, USA
| | - Thorsten Rudroff
- Department of Health and Human Physiology, University of Iowa, Iowa City, IA, USA.,Department of Neurology, University of Iowa Hospitals and Clinics, Iowa City, IA, USA
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Lin C, Cai X, Yang W, Lv F, Nie L, Ji L. Age, sex, disease severity, and disease duration difference in placebo response: implications from a meta-analysis of diabetes mellitus. BMC Med 2020; 18:322. [PMID: 33190640 PMCID: PMC7667845 DOI: 10.1186/s12916-020-01787-4] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/14/2020] [Accepted: 09/17/2020] [Indexed: 01/10/2023] Open
Abstract
BACKGROUND The placebo response in patients with diabetes mellitus is very common. A systematic evaluation needs to be updated with the current evidence about the placebo response in diabetes mellitus and the associated factors in clinical trials of anti-diabetic medicine. METHODS Literature research was conducted in Medline, Embase, the Cochrane Central Register of Controlled Trials, and ClinicalTrials.gov for studies published between the date of inception and June 2019. Randomized placebo-controlled trials conducted in type 1and type 2 diabetes mellitus (T1DM/T2DM) were included. Random-effects model and meta-regression analysis were accordingly used. This meta-analysis was registered in PROSPERO as CRD42014009373. RESULTS Significantly weight elevation (effect size (ES) = 0.33 kg, 95% CI, 0.03 to 0.61 kg) was observed in patients with placebo treatments in T1DM subgroup while significantly HbA1c reduction (ES = - 0.12%, 95% CI, - 0.16 to - 0.07%) and weight reduction (ES = - 0.40 kg, 95% CI, - 0.50 to - 0.29 kg) were observed in patients with placebo treatments in T2DM subgroup. Greater HbA1c reduction was observed in patients with injectable placebo treatments (ES = - 0.22%, 95% CI, - 0.32 to - 0.11%) versus oral types (ES = - 0.09%, 95% CI, - 0.14 to - 0.04%) in T2DM (P = 0.03). Older age (β = - 0.01, 95% CI, - 0.02 to - 0.01, P < 0.01) and longer diabetes duration (β = - 0.02, 95% CI, - 0.03 to - 0.21 × 10-2, P = 0.03) was significantly associated with more HbA1c reduction by placebo in T1DM. However, younger age (β = 0.02, 95% CI, 0.01 to 0.03, P = 0.01), lower male percentage (β = 0.01, 95% CI, 0.22 × 10-2, 0.01, P < 0.01), higher baseline BMI (β = - 0.02, 95% CI, - 0.04 to - 0.26 × 10-2, P = 0.02), and higher baseline HbA1c (β = - 0.09, 95% CI, - 0.16 to - 0.01, P = 0.02) were significantly associated with more HbA1c reduction by placebo in T2DM. Shorter diabetes duration (β = 0.06, 95% CI, 0.06 to 0.10, P < 0.01) was significantly associated with more weight reduction by placebo in T2DM. However, the associations between baseline BMI, baseline HbA1c, and placebo response were insignificant after the adjusted analyses. CONCLUSION The placebo response in diabetes mellitus was systematically outlined. Age, sex, disease severity (indirectly reflected by baseline BMI and baseline HbA1c), and disease duration were associated with placebo response in diabetes mellitus. The association between baseline BMI, baseline HbA1c, and placebo response may be the result of regression to the mean.
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Affiliation(s)
- Chu Lin
- Department of Endocrinology and Metabolism, Peking University People's Hospital, No.11 Xizhimen South Street, Xicheng District, Beijing, 100044, China
| | - Xiaoling Cai
- Department of Endocrinology and Metabolism, Peking University People's Hospital, No.11 Xizhimen South Street, Xicheng District, Beijing, 100044, China.
| | - Wenjia Yang
- Department of Endocrinology and Metabolism, Peking University People's Hospital, No.11 Xizhimen South Street, Xicheng District, Beijing, 100044, China
| | - Fang Lv
- Department of Endocrinology and Metabolism, Peking University People's Hospital, No.11 Xizhimen South Street, Xicheng District, Beijing, 100044, China
| | - Lin Nie
- Department of Endocrinology and Metabolism, Beijing Airport Hospital, Beijing, China
| | - Linong Ji
- Department of Endocrinology and Metabolism, Peking University People's Hospital, No.11 Xizhimen South Street, Xicheng District, Beijing, 100044, China.
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Mitsikostas DD, Blease C, Carlino E, Colloca L, Geers AL, Howick J, Evers AWM, Flaten MA, Kelley JM, Kirsch I, Klinger R, MaassenVanDenBrink A, Moerman DE, Sfikakis PP, Vase L, Wager TD, Benedetti F. European Headache Federation recommendations for placebo and nocebo terminology. J Headache Pain 2020; 21:117. [PMID: 32977761 PMCID: PMC7519524 DOI: 10.1186/s10194-020-01178-3] [Citation(s) in RCA: 24] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/28/2020] [Accepted: 08/26/2020] [Indexed: 12/31/2022] Open
Abstract
Background and aim Despite recent publications, practitioners remain unfamiliar with the current terminology related to the placebo and nocebo phenomena observed in clinical trials and practice, nor with the factors that modulate them. To cover the gap, the European Headache Federation appointed a panel of experts to clarify the terms associated with the use of placebo in clinical trials. Methods The working group identified relevant questions and agreed upon recommendations. Because no data were required to answer the questions, the GRADE approach was not applicable, and thus only expert opinion was provided according to an amended Delphi method. The initial 12 topics for discussion were revised in the opinion of the majority of the panelists, and after a total of 6 rounds of negotiations, the final agreement is presented. Results/recommendations Two primary and mechanism-based recommendations are provided for the results of clinical trials: [1] to distinguish the placebo or nocebo response from the placebo or nocebo effect; and [2] for any favorable outcome observed after placebo administration, the term “placebo response” should be used, and for any unfavorable outcome recorded after placebo administration, the term “nocebo response” should be used (12 out of 17 panelists agreed, 70.6% agreement). The placebo or nocebo responses are attributed to a set of factors including those that are related to the medical condition (e.g. natural history, random comorbidities, etc.), along with idiosyncratic ones, in which the placebo or nocebo effects are attributed to idiosyncratic, or nonspecific mechanisms, exclusively (e.g. expectation, conditioning, observational learning etc.). To help investigators and practitioners, the panel summarized a list of environmental factors and idiosyncratic dynamics modulating placebo and nocebo effects. Some of them are modifiable, and investigators or physicians need to know about them in order to modify these factors appropriately to improve treatment. One secondary recommendation addresses the use of the terms “placebo” and “nocebo” (“placebos” and “nocebos” in plural), which refer to the triggers of the placebo/nocebo effects or responses, respectively, and which are inert agents or interventions that should not be confused with the placebo/nocebo responses or effects themselves (all panelists agreed, 100% agreement). Conclusion The working group recommends distinguishing the term response from effect to describe health changes from before to after placebo application and to distinguish the terms placebo(s) or nocebo(s) from the health consequences that they cause (placebo/nocebo responses or effects).
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Affiliation(s)
- Dimos D Mitsikostas
- 1st Neurology Department, Aeginiton Hospital, Medical School, National and Kapodistrian University of Athens, 72-72 Vas. Sofia's Avenue, 11528, Athens, Greece.
| | - Charlotte Blease
- General Medicine and Primary Care, Beth Israel Deaconess Medical Center, Boston, MA, USA
| | - Elisa Carlino
- Physiology and Neuroscience, University of Turin Medical School, Turin, Italy
| | - Luana Colloca
- Departments of Pain Translational Symptoms Science and Anaesthesiology, School of Nursing and Medicine, University of Maryland Baltimore, Baltimore, MD, USA
| | - Andrew L Geers
- Department of Psychology, University of Toledo, Toledo, OH, USA
| | - Jeremy Howick
- Faculty of Philosophy, University of Oxford, Oxford, UK
| | - Andrea W M Evers
- Health, Medical and Neuropsychology Unit, Institute of Psychology, Leiden University, Leiden, The Netherlands
| | - Magne A Flaten
- Department of Psychology, Norwegian University of Science and Technology, Trondheim, Norway
| | - John M Kelley
- Beth Israel Deaconess Medical Center, Program in Placebo Studies, Boston, MA, USA
| | - Irving Kirsch
- Beth Israel Deaconess Medical Center, Program in Placebo Studies, Boston, MA, USA
| | - Regine Klinger
- Department of Anesthesiology University Medical Center Hamburg-Eppendorf, Center for Anesthesiology and Intensive Care Medicine, Hamburg, Germany
| | | | | | - Petros P Sfikakis
- 1st Department of Propedeutic and Internal Medicine, National and Kapodistrian University Medical School, Athens, Greece
| | - Lene Vase
- Department of Psychology and Behavioural Sciences, Aarhus University, Aarhus, Denmark
| | - Tor D Wager
- Department of Psychological and Brain Sciences, Dartmouth College, Hanover, NH, USA
| | - Fabrizio Benedetti
- Physiology and Neuroscience, University of Turin Medical School, Turin, Italy
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MacRae JM, Clarke A, Ahmed SB, Elliott M, Quinn RR, James M, King-Shier K, Hiremath S, Oliver MJ, Hemmelgarn B, Scott-Douglas N, Ravani P. Sex differences in the vascular access of hemodialysis patients: a cohort study. Clin Kidney J 2020; 14:1412-1418. [PMID: 33959269 PMCID: PMC8087139 DOI: 10.1093/ckj/sfaa132] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/03/2019] [Accepted: 05/18/2020] [Indexed: 11/14/2022] Open
Abstract
Background We describe differences for probability of receiving a fistula attempt, achieving fistula use, remaining catheter-free and the rate of access-related procedures as a function of sex. Methods Prospectively collected vascular access data on incident dialysis patients from five Canadian programs using the Dialysis Measurement Analysis and Reporting System to determine differences in fistula-related outcomes between women and men. The probability of receiving a fistula attempt and the probability of fistula use were determined using binary logistic regression. Catheter and fistula procedure rates were described using Poisson regression. We studied time to fistula attempt and time to fistula use, accounting for competing risks. Results We included 1446 (61%) men and 929 (39%) women. Men had a lower body mass index (P < 0.001) and were more likely to have coronary artery disease (P < 0.001) and peripheral vascular disease (p < 0.001). A total of 688 (48%) men and 403 (43%) women received a fistula attempt. Women were less likely to receive a fistula attempt by 6 months {odds ratio [OR] 0.64 [95% confidence interval (CI) 0.52-0.79]} and to achieve catheter-free use of their fistula by 1 year [OR 0.38 (95% CI 0.27-0.53)]. At an average of 2.30 access procedures per person-year, there is no difference between women and men [incidence rate ratio (IRR) 0.97 (95% CI 0.87-1.07)]. Restricting to those with a fistula attempt, women received more procedures [IRR 1.16 (95% CI 1.04-1.30)] attributed to increased catheter procedures [IRR 1.50 (95% CI 1.27-1.78)]. There was no difference in fistula procedures [IRR women versus men 0.96 (95% CI 0.85-1.07)]. Conclusion Compared with men, fewer women undergo a fistula attempt. This disparity increases after adjusting for comorbidities. Women have the same number of fistula procedures as men but are less likely to successfully use their fistula.
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Affiliation(s)
- Jennifer M MacRae
- Division of Nephrology, Cumming School of Medicine, University of Calgary, Calgary, AB, Canada.,Libin Cardiovascular Institute, Department of Cardiac Sciences, University of Calgary, Calgary, AB, Canada
| | - Alix Clarke
- Division of Nephrology, Cumming School of Medicine, University of Calgary, Calgary, AB, Canada
| | - Sofia B Ahmed
- Division of Nephrology, Cumming School of Medicine, University of Calgary, Calgary, AB, Canada.,Libin Cardiovascular Institute, Department of Cardiac Sciences, University of Calgary, Calgary, AB, Canada
| | - Meghan Elliott
- Division of Nephrology, Cumming School of Medicine, University of Calgary, Calgary, AB, Canada
| | - Rob R Quinn
- Division of Nephrology, Cumming School of Medicine, University of Calgary, Calgary, AB, Canada
| | - Matthew James
- Division of Nephrology, Cumming School of Medicine, University of Calgary, Calgary, AB, Canada
| | - Kathryn King-Shier
- Faculty of Nursing and Department of Community Health Sciences, University of Calgary, Calgary, AB, Canada
| | - Swapnil Hiremath
- Division of Nephrology, Department of Medicine, University of Ottawa, Ottawa, ON, Canada.,Kidney Research Centre, Ottawa Hospital Research Institute, Ottawa, ON, Canada
| | - Matthew J Oliver
- Department of Medicine, Sunnybrook Health Sciences Centre, Toronto, ON, Canada
| | - Brenda Hemmelgarn
- Division of Nephrology, Cumming School of Medicine, University of Calgary, Calgary, AB, Canada
| | - Nairne Scott-Douglas
- Division of Nephrology, Cumming School of Medicine, University of Calgary, Calgary, AB, Canada
| | - Pietro Ravani
- Libin Cardiovascular Institute, Department of Cardiac Sciences, University of Calgary, Calgary, AB, Canada
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Hall KT, Vase L, Tobias DK, Dashti HT, Vollert J, Kaptchuk TJ, Cook NR. Historical Controls in Randomized Clinical Trials: Opportunities and Challenges. Clin Pharmacol Ther 2020; 109:343-351. [PMID: 32602555 DOI: 10.1002/cpt.1970] [Citation(s) in RCA: 14] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/10/2020] [Accepted: 06/11/2020] [Indexed: 12/19/2022]
Abstract
Randomized control trials (RCTs) with placebo are the gold standard for determining efficacy of novel pharmaceutical treatments. Since their inception, over 75 years ago, researchers have amassed a large body of underutilized data on outcomes in the placebo control arms of these trials. Although rare disease indications have used these historical placebo data as synthetic controls to reduce burden on patients and accelerate drug discovery, broad use of historical controls is in its infancy. Large-scale historical placebo data could be leveraged to benefit both drug developers and patients if warehoused and made more available to guide trial design and analysis. Here, we examine challenges in utilizing historical controls related to heterogeneity in trial design, outcome ascertainment, patient characteristics, and unmeasured pharmacogenomic effects. We then discuss the advantages and disadvantages of current approaches and propose a path forward to broader use of historical controls in RCTs.
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Affiliation(s)
- Kathryn T Hall
- Division of Preventive Medicine, Department of Medicine, Brigham and Women's Hospital, Boston, Massachusetts, USA.,Harvard Medical School, Boston, Massachusetts, USA
| | - Lene Vase
- Department of Psychology and Behavioral Sciences, School of Business and Social Sciences, Aarhus University, Aarhus, Denmark
| | - Deirdre K Tobias
- Division of Preventive Medicine, Department of Medicine, Brigham and Women's Hospital, Boston, Massachusetts, USA.,Harvard Medical School, Boston, Massachusetts, USA
| | - Hesam T Dashti
- Division of Preventive Medicine, Department of Medicine, Brigham and Women's Hospital, Boston, Massachusetts, USA.,Harvard Medical School, Boston, Massachusetts, USA
| | - Jan Vollert
- Pain Research, Department of Surgery and Cancer, Faculty of Medicine, Imperial College London, London, UK.,Neurophysiology, Centre for Biomedicine and Medical Technology Mannheim, Medical Faculty Mannheim, Ruprecht-Karls-University, Heidelberg, Germany
| | - Ted J Kaptchuk
- Harvard Medical School, Boston, Massachusetts, USA.,Beth Israel Deaconess Medical Center, Boston, Massachusetts, USA
| | - Nancy R Cook
- Division of Preventive Medicine, Department of Medicine, Brigham and Women's Hospital, Boston, Massachusetts, USA.,Harvard Medical School, Boston, Massachusetts, USA
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48
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Enck P, Klosterhalfen S. Placebo Responses and Placebo Effects in Functional Gastrointestinal Disorders. Front Psychiatry 2020; 11:797. [PMID: 33192627 PMCID: PMC7477083 DOI: 10.3389/fpsyt.2020.00797] [Citation(s) in RCA: 28] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/25/2019] [Accepted: 07/24/2020] [Indexed: 12/14/2022] Open
Abstract
Much has been written about the placebo effects in functional gastrointestinal disorders (FGD), especially in irritable bowel syndrome (IBS), driven by the early hypothesis that in randomized controlled trials (RCTs) of IBS, the placebo effect might be specifically high and thus, corrupts the efficacy of novel drugs developed for this condition. This narrative review is based on a specific search method, a database (www.jips.online) developed since 2004 containing more than 4,500 papers (data papers, meta-analyses, systematic reviews, reviews) pertinent to the topic placebo effects/placebo response. Three central questions-deducted from the body of current literature-are addressed to explore the evidence behind this hypothesis: What is the size placebo effect in FGD, especially in IBS, and is it different from the placebo effect seen in other gastrointestinal disorders? Is the placebo effect in FGD different from other functional, non-intestinal disorders, e.g. in other pain syndromes? Is the placebo effect in FGD related to placebo effects seen in psychiatry, e.g. in depression, anxiety disorders, and alike? Following this discussion, a fourth question is raised as the result of the three: What are the consequences of this for future drug trials in FGD? In summary it is concluded that, contrary to common belief and discussion, the placebo effect seen in RCT in FGD is not specifically high and extraordinary as compared to other comparable (i.e. functional) disorders. It shares less than expected commonalities with the placebo effect in psychiatry, and very few predictors have yet been identified that determine its effect size, especially some that are driven by design features of the studies. Current practice of RCT in IBS seems to limit and control the placebo effect quite well, and future trial practice, e.g. head-to-head trial, still offers options to maintain this control, even in the absence of placebos used.
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Affiliation(s)
- Paul Enck
- Department of Internal Medicine VI: Psychosomatic Medicine and Psychotherapy, University Hospital Tübingen, Tübingen, Germany
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49
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Zech N, Schrödinger M, Seemann M, Zeman F, Seyfried TF, Hansen E. Time-Dependent Negative Effects of Verbal and Non-verbal Suggestions in Surgical Patients-A Study on Arm Muscle Strength. Front Psychol 2020; 11:1693. [PMID: 32849024 PMCID: PMC7399336 DOI: 10.3389/fpsyg.2020.01693] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/15/2020] [Accepted: 06/22/2020] [Indexed: 12/14/2022] Open
Abstract
Introduction The medical environment is full of suggestions that affect patients and their healing. Most of them inadvertently are negative, thus evoking nocebo effects. Recently, we have reported on the effect of such verbal and non-verbal suggestions as well as alternative formulations on maximal muscular arm strength in healthy volunteers. In the present study, we tested the same suggestions in patients at two time points to evaluate nocebo effects in a clinical situation and the impact of the approaching surgery date. Methods In 45 patients, maximal muscular strength during arm abduction was measured by dynamometry of the deltoid muscle group. One test was several days before and the second on the evening before surgery. Baseline values were compared to the performance after exposure to 18 verbal and non-verbal suggestions. The sequence of presumably negative and positive suggestions was randomized for each patient in order to avoid cumulation effects of immediate succession of two negatives. State anxiety was evaluated at both time points, and suggestibility was measured after surgery. Results Strong and statistically significant weakening effects were observed with all presumed negative suggestions from daily clinical practice including words of encouragement (91.4% of baseline), evaluation of symptoms (89.0%), announcement of a medical intervention (82.8%), a negative memory (86.5%), expectation of an uncertain future (82.8%), and non-verbal signals (87.7–92.2%). In contrast, alternative formulations did not interfere with muscular performance in most cases. A more pronounced effect was observed in the test repeated closer to the date of surgery, accompanied by a 15% higher anxiety level. The increase in anxiety correlated slightly with stronger weakening effects of suggestions, as did suggestibility. Conclusions Negative suggestions cause a decrease in arm muscle strength, i.e., a “weakening” of the patient. This effect is enhanced by an increase in anxiety as the time of treatment, like surgery, approaches. The reaction can be avoided by alternative formulations. These nocebo effects that are objectively measured and quantified by a decrease in arm muscle strength are more pronounced in patients, i.e., in a clinical situation, than in healthy volunteers.
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Affiliation(s)
- Nina Zech
- Department of Anesthesiology, University Hospital Regensburg, Regensburg, Germany
| | - Matthias Schrödinger
- Department of Internal Medicine, District Hospital Wörth an der Donau, Wörth am Rhein, Germany
| | - Milena Seemann
- Department of Anesthesiology, Agaplesion Diakonieklinikum Hamburg, Hamburg, Germany
| | - Florian Zeman
- Centre for Clinical Studies, University Hospital Regensburg, Regensburg, Germany
| | - Timo F Seyfried
- Department of Anesthesiology, University Hospital Regensburg, Regensburg, Germany
| | - Ernil Hansen
- Department of Anesthesiology, University Hospital Regensburg, Regensburg, Germany
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50
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Schmid Y, Navarini A, Thomas ZRM, Pfleiderer B, Krähenbühl S, Mueller SM. Sex differences in the pharmacology of itch therapies-a narrative review. Curr Opin Pharmacol 2019; 46:122-142. [PMID: 31299512 DOI: 10.1016/j.coph.2019.05.008] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/17/2019] [Accepted: 05/17/2019] [Indexed: 02/08/2023]
Abstract
BACKGROUND Chronic itch is the most common skin-related condition, associated with a high psychosocial and economic burden. In recent years, increasing evidence of sex differences in the perception, clinical presentation and treatment requirements of itch points towards potential benefits when using sex-adapted therapies. It is well-known that body composition, absorption, metabolism, elimination and adverse drug reactions (ADRs) differ between sexes, but only little is known about the impact of sex in the pharmacology of itch treatments, which could help to rationalise sex-adapted treatment strategies. AIM To evaluate and review sex effects in the pharmacokinetics and /-dynamics of drugs used to treat itch. METHODS In this narrative review we performed a PubMed and MEDLINE (Ovid) search using the terms (itch OR pruritus) AND (gender OR sex) AND (drug OR medication OR pharmacokinetics OR pharmacodynamics). Additional searches were performed for the topical and systemic drugs recommended by the European Guideline on Chronic Pruritus. RESULTS We found numerous reports with variable levels of evidence of sex effects with respect to the pharmacokinetics and/or pharmacodynamics of 14 drug classes used for the treatment of itch, including a total of 19 systemic and 3 topical drugs. Women seem to present higher plasma levels of several drugs used in itch treatment, including tri- and tetracyclic antidepressants (e.g. doxepin, amitriptyline, mirtazapine), serotonin reuptake inhibitors (e.g. paroxetine, sertraline, fluoxetine), immunosuppressive drugs (e.g. cyclosporine, mycophenolate mofetil), serotonin receptor antagonists (e.g. ondansetron) and betablockers (e.g. propranolol). Adverse drug reactions (ADRs) were generally more common in women. Being female was reported to be an independent risk factor for QTc-prolongation associated with antihistamines and tetracyclic antidepressants. Additionally, women seem to be more prone to sedative effects of antihistamines, and to suffer from a higher frequency as well as severity of side effects with systemic calcineurin inhibitors, opioid agonists, and opioid antagonists. Women were also sensitised more often to topically applied drugs. Of note, apart from only one experimental study with capsaicin, none of these reports were designed specifically to assess the effect of sex (and gender) in the treatment of itch. DISCUSSION/CONCLUSION Our review supports previous reports that sex is of importance in the pharmacokinetics and /-dynamics of several drugs used to treat itch although those drugs were mostly evaluated for non-itch indications. However, the results are limited by methodological limitations evident in most studies such as underrepresentation of women in clinical trials. This emphasises the need to study the impact of sex (and gender) in future itch trials to yield better outcomes and prevent ADRs in both sexes.
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Affiliation(s)
- Yasmin Schmid
- Clinical Pharmacology & Toxicology, University Hospital Basel, Switzerland
| | | | | | - Bettina Pfleiderer
- Department of Clinical Radiology, University Hospital Münster and Medical Faculty, University of Münster, Germany; Competence Center Chronic Pruritus (KCP), University of Muenster, Germany
| | - Stephan Krähenbühl
- Clinical Pharmacology & Toxicology, University Hospital Basel, Switzerland
| | - Simon M Mueller
- Department of Dermatology, University Hospital Basel, Switzerland.
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