Overt versus covert treatment for pain, anxiety, and Parkinson's disease

Colloca, Luana; Lopiano, Leonardo; Lanotte, Michele; Benedetti, Fabrizio

doi:10.1016/s1474-4422(04)00908-1

Cited by 480 publications

(340 citation statements)

References 29 publications

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“…Experiments involving medications for pain, anxiety, and Parkinson's disease reliably demonstrate approximately twice the symptomatic relief when patients see medication injected intravenously, compared with administration of the same medication by a concealed, pre-programmed infusion pump. 27 The patient's knowledge of and psychological reaction to the medication appear to be as important as its chemical properties in producing the desired outcome. Supportive, empathic communication with the physician further enhances therapeutic results.…”

Section: The Scientific Base For the Expanded Modelmentioning

confidence: 99%

The Placebo Phenomenon: Implications for the Ethics of Shared Decision-Making

2012

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Recent research into the placebo effect has implications for the ethics of shared decision-making (SDM). The older biomedical model views SDM as affecting which therapy is chosen, but not the nature or likelihood of any health outcomes produced by the therapy. Research indicates, however, that both the content and manner in which information is shared with the patient, and the patient's experience of being involved in the decision, can directly alter therapeutic outcomes via placebo responses. An ethical tension is thereby created between SDM aimed strictly and solely at conveying accurate information, and "outcome engineering" in which SDM is adapted toward therapeutic goals. Several practical strategies mitigate this tension and promote respect for autonomous decision-making while still utilizing the therapeutic potential of SDM.

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Section: The Scientific Base For the Expanded Modelmentioning

confidence: 99%

The Placebo Phenomenon: Implications for the Ethics of Shared Decision-Making

2012

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“…A crucial question is how pharmacological effects of a drug can be separated from expectation pathways. One solution results from the open -hidden paradigm where medication is given covertly [66]. Hidden administration of medication has been proved to be less effective than open administration when treatment is combined with a 'healing' procedure.…”

Section: Implications For Clinical Research and Practicementioning

confidence: 99%

Lessons learned from placebo groups in antidepressant trials

Shedden-Mora

Nestoriuc

Rief

2011

Phil. Trans. R. Soc. B

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This comprehensive review provides an overview about placebo and nocebo phenomena in antidepressant trials. Improvements in the placebo groups may partly be explained through methodological issues such as natural course of depression and regression to the mean, but also fundamentally reflect investigators' and participants' expectations. A meta-analysis by our group of 96 randomized placebo-controlled trials showed large placebo responses to antidepressant medication. Moderator analyses revealed substantially larger placebo responses in observer ratings compared with self-report. Effect sizes in observer ratings showed strong increase with publication year while this effect was not found for patients' self-ratings. This reflects the strong influence of investigators' expectations. The analysis of 'nocebo effects', e.g. adverse effects in placebo groups of antidepressant trials also confirms the impact of expectations: nocebo symptoms reflected the typical side-effect patterns expected in the drug group, with higher symptoms rates in the placebo groups of tricyclic antidepressant trials compared with placebo groups of trials testing selective serotonin reuptake inhibitors. While the placebo response seems to be similar for women and men, gender differences were found for nocebo rates. In the conclusion, we discuss potential implications for clinical trial designs and argue for interventions aimed at optimizing positive expectations of treatment benefit while minimizing the impact of adverse effects.

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“…As shown most convincingly in the work by Benedetti et al using the hidden infusion design [6,7], the placebo effect can be a component accounting for varying proportions of the response to active drugs. Other studies have shown that manipulating the 'dose' of placebo factors (e.g.…”

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confidence: 95%

Preface

Kirsch

2011

Phil. Trans. R. Soc. B

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Overt versus covert treatment for pain, anxiety, and Parkinson's disease

Cited by 480 publications

References 29 publications

The Placebo Phenomenon: Implications for the Ethics of Shared Decision-Making

The Placebo Phenomenon: Implications for the Ethics of Shared Decision-Making

Lessons learned from placebo groups in antidepressant trials

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