Placebo Responses on Cardiovascular, Gastrointestinal, and Respiratory Organ Functions

Meißner, Karin

doi:10.1007/978-3-662-44519-8_11

Cited by 28 publications

(20 citation statements)

References 96 publications

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“…Nevertheless, the ANS is increasingly appreciated in the context of pain modulation [e.g., (41)], especially in acute and chronic visceral pain as a key component of the brain axis (42–50). Within the placebo field, the ANS has been proposed as a primary mediator of peripheral placebo effects in conditioning models (51, 52). Placebo analgesia evokes complex effects within the cardiovascular system, including changes in heart rate and blood pressure (25, 53).…”

Section: Discussionmentioning

confidence: 99%

Can a Brief Relaxation Exercise Modulate Placebo or Nocebo Effects in a Visceral Pain Model?

Elsenbruch

Roderigo

Enck³

et al. 2019

Front. Psychiatry

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Translational research aiming to elucidate mediators and moderators of placebo and nocebo effects is highly relevant. This experimental study tested effects of a brief progressive muscle relaxation (PMR) exercise, designed to alter psychobiological stress parameters, on the magnitude of placebo and nocebo effects in a standardized psychosocial treatment context. In 120 healthy volunteers (60 men, 60 women), pain expectation, pain intensity, and pain unpleasantness in response to individually-calibrated rectal distensions were measured with visual analog scales during a baseline. Participants were then randomized to exercise PMR (relaxation group: N = 60) or a simple task (control group: N = 60), prior to receiving positive (placebo), negative (nocebo) or neutral suggestions regarding an intravenous administration that was in reality saline in all groups. Identical distensions were repeated (test). State anxiety, salivary cortisol, heart rate, and blood pressure were assessed repeatedly. Data were analyzed using analysis of covariance, planned Bonferroni-corrected group comparisons, as well as exploratory correlational and mediation analyses. Treatment suggestions induced group-specific changes in pain expectation, with significantly reduced expectation in placebo and increased expectation in nocebo groups. PMR had no discernable effect on pain expectation, state anxiety or cortisol, but led to significantly lower heart rate and systolic blood pressure. Relaxation significantly interacted with positive treatment suggestions, which only induced placebo analgesia in relaxed participants. No effects of negative suggestions were found in planned group comparisons, irrespective of relaxation. Exploratory correlation and mediation analyses revealed that pain expectation was a mediator to explain the association between treatment suggestions and pain-related outcomes. Clearly, visceral pain modulation is complex and involves many cognitive, emotional, and possibly neurobiological factors that remain to be fully understood. Our findings suggest that a brief relaxation exercise may facilitate the induction of placebo analgesia by positive when compared to neutral treatment suggestions. They underscore the contribution of relaxation and stress as psychobiological states within the psychosocial treatment context—factors which clearly deserve more attention in translational studies aiming to maximize positive expectancy effects in clinical settings.

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Section: Discussionmentioning

confidence: 99%

Can a Brief Relaxation Exercise Modulate Placebo or Nocebo Effects in a Visceral Pain Model?

Elsenbruch

Roderigo

Enck³

et al. 2019

Front. Psychiatry

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“…Moreover, the studies of Grassi et al [ 5 ] and Rostami et al [ 9 ] were not double-blinded, in contrast to our study and those of Mellor et al [ 6 ], and failed to demonstrate any effect on BP. Thus, an impact on BP due to different expectations of the participants with regard to treatment [ 29 ] can be ruled out in our study due to placebo-controlled study design.…”

Section: Discussionmentioning

confidence: 99%

Regular Intake of a Usual Serving Size of Flavanol-Rich Cocoa Powder Does Not Affect Cardiometabolic Parameters in Stably Treated Patients with Type 2 Diabetes and Hypertension—A Double-Blinded, Randomized, Placebo-Controlled Trial

Dicks

Kirch

Gronwald³

et al. 2018

Nutrients

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Regular cocoa consumption has been shown to improve blood pressure (BP), insulin sensitivity, and lipid levels in patients with type 2 diabetes (T2D), using up to 100 g of chocolate or 54 g of cocoa. These effects, attributed to cocoa flavanols, would be beneficial for patients with T2D if they could be achieved by a usual serving size of flavanol-rich cocoa. Forty-two hypertensive patients with T2D (stable pharmacological treatment, with good adjustment for glucose metabolism, lipids, and BP) ingested capsules with 2.5 g/day of a flavanol-rich cocoa or cocoa-free capsules for 12 weeks in a double-blinded, randomized, placebo-controlled study with parallel group design. Participants had to maintain diet, lifestyle, and medication. Before and after intervention, fasting blood samples were collected; BP and nutritional status were investigated. Cocoa treatment did not affect BP, nor glucose metabolism (glucose, HbA1c, insulin, HOMA-IR) and lipids (triglycerides, total cholesterol, low-density lipoprotein cholesterol, high-density lipoprotein cholesterol). Body weight, fat mass, and nutrient supply remained unchanged. Changes in the placebo group did not occur. Regular intake of a usual serving size of flavanol-rich cocoa does not improve cardiometabolic parameters in stably treated patients with T2D and hypertension. As the medication modulates partly the same targets as cocoa flavanols, future studies should focus on the preventive effect of cocoa against diabetes and other cardiometabolic diseases in individuals with preexisting abnormalities that do not require any pharmacological treatment.

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“…The same definition was applied for a nocebo effect, except that instead of the reduction in pain, an increase in pain was assumed (Flaten et al, 2006 ). Either of the following situations was considered as a cardiac placebo response: a change in BP, HR, or HRV metrics following the administration of a placebo/nocebo treatment/condition compared to the control or the comparison group/condition (Meissner, 2014 ). Studies on both healthy subjects and patients experiencing pain were included.…”

Section: Methodsmentioning

confidence: 99%

“…Placebo/nocebo responses impact various physiological processes, especially those controlled by the autonomic nervous system (ANS) (Meissner, 2014 ). The ANS controls visceral organs and tissues through sympathetic and parasympathetic nervous divisions to preserve homeostasis.…”

Section: Introductionmentioning

confidence: 99%

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Placebo Analgesia, Nocebo Hyperalgesia, and the Cardiovascular System: A Qualitative Systematic Review

Daniali

Flaten

2020

Front. Physiol.

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Background: Placebo/nocebo effects involve the autonomic nervous system, including cardiac activity, but studies have reported inconsistent findings on how cardiac activity is modulated following a placebo/nocebo effect. However, no systematic review has been conducted to provide a clear picture of cardiac placebo responses. Objective: The main goal of the present study is to review the effects of placebo analgesia and nocebo hyperalgesia on cardiac activity as measured by blood pressure, heart rate, and heart rate variability. Methods: Using several Boolean keyword combinations, the PubMed, EMBASE, PsycINFO, Cochrane Review Library, and ISI Web of Knowledge databases were searched until January 5, 2020, to find studies that analyzed blood pressure, heart rate, or heart rate variability indexes following a placebo analgesic/nocebo hyperalgesic effect. Results: Nineteen studies were found, with some reporting more than one index of cardiac activity; eight studies were on blood pressure, 14 studies on heart rate, and six on heart rate variability. No reliable association between placebo/nocebo effects and blood pressure or heart rate was found. However, placebo effects reduced, and nocebo effects increased low-frequency heart rate variability, and heart rate variability significantly predicted placebo effects in two studies. Conclusion: Placebo/nocebo effects can have reliable effects on heart rate variability, but not on heart rate and blood pressure.

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Placebo Responses on Cardiovascular, Gastrointestinal, and Respiratory Organ Functions

Cited by 28 publications

References 96 publications

Can a Brief Relaxation Exercise Modulate Placebo or Nocebo Effects in a Visceral Pain Model?

Can a Brief Relaxation Exercise Modulate Placebo or Nocebo Effects in a Visceral Pain Model?

Regular Intake of a Usual Serving Size of Flavanol-Rich Cocoa Powder Does Not Affect Cardiometabolic Parameters in Stably Treated Patients with Type 2 Diabetes and Hypertension—A Double-Blinded, Randomized, Placebo-Controlled Trial

Placebo Analgesia, Nocebo Hyperalgesia, and the Cardiovascular System: A Qualitative Systematic Review

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