The Influence of Placebo Analgesia Manipulations on Pain Report, the Nociceptive Flexion Reflex, and Autonomic Responses to Pain

Rhudy, Jamie L.; Güereca, Y.; Kuhn, B.; Palit, Shreela; Flaten, Magne Arve

doi:10.1016/j.jpain.2018.04.012

Cited by 18 publications

(23 citation statements)

References 61 publications

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“…Together, these studies raise the important issue of the role of expectations in placebo analgesia. Several studies have observed that placebos or cues can reduce pain in the absence of expectations ( de Jong et al, 1996 ; Babel et al, 2017 ; Rhudy et al, 2018 ) whereas the present study showed that even if a capsule was rated as effective in reducing pain, a placebo effect was not observed.…”

Section: Discussioncontrasting

confidence: 88%

“…Thus, a conditioning only procedure was used, and no verbal information was provided that could increase the placebo response in the Conditioned group compared to the Capsule control group. Other studies have used a similar procedure and found placebo analgesia ( Voudouris et al, 1990 ; de Jong et al, 1996 ; Klinger et al, 2007 ), whereas a recent study ( Rhudy et al, 2018 ) found no evidence of placebo analgesia in a conditioning only group. However, in Rhudy et al (2018) and Voudouris et al (1990) the participants were explicitly told that they would not receive a pain relieving cream.…”

Section: Discussionmentioning

confidence: 90%

“…Thirdly, the difference in temperatures between the manipulation trials and the post-test in the Conditioned group could have violated the expectations of pain relief. The present study was, however, modeled after previous successful studies on classical conditioning of placebo analgesia ( Voudouris et al, 1990 ; Watson et al, 2006 ; Rhudy et al, 2018 ). In these studies, and in the present one, the stimulus in the post-test was identical to that in the pre-test.…”

Section: Discussionmentioning

confidence: 99%

“…However, in Rhudy et al (2018) and Voudouris et al (1990) the participants were explicitly told that they would not receive a pain relieving cream. This information abolished any expectation of pain relief ( Rhudy et al, 2018 ). Thus, there are inconsistencies in the literature regarding how a conditioning only procedure is performed, and the results from this type of procedure.…”

Section: Discussionmentioning

confidence: 99%

“…Fifthly, the present study used capsules as the placebo intervention, whereas many other studies that have induced pain to the arm have used a cream ( de Jong et al, 1996 ; Rhudy et al, 2018 ). However, placebo effects have been induced by administration of capsules or tablets in previous studies ( Flaten et al, 1999 ), also when pain has been administrated to the arm ( Flaten et al, 2006 ; Chouchou et al, 2015 ).…”

Section: Discussionmentioning

confidence: 99%

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Failure to Find a Conditioned Placebo Analgesic Response

et al. 2018

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Background: Associative learning has, in several studies, been modulated by the sex of the participant. Consistent with this, a recent review found that conditioned nocebo effects are stronger in females than in males.Purpose: It has been suggested that conditioned placebo responses are stronger in females, and this hypothesis was investigated in the present study. Cortisol and measures of negative emotions were taken to investigate if these processes could mediate any conditioned placebo effects.Methods: Cold pain was applied to the volar forearm. The Conditioned group received inert capsules prior to two presentations of less painful stimulations, to associate intake of the capsules with reduced pain. The pain control group received the same painful stimulation as the Conditioned group, but no capsules. The Capsule control group received the capsules in the same way as the Conditioned group, but no decrease in the painful stimulation. Participant sex was crossed across groups. It was hypothesized that in the Conditioned group, an expectation of reduced pain should be induced after administration of the capsules, and this should generate placebo analgesia, and mostly so in females.Results: The Conditioned group reported lower pain during conditioning, and rated the capsules as more effective painkillers than the capsule control group. However, placebo analgesia was not reliably observed in the Conditioned group.Conclusion: The placebo capsules were rated as effective painkillers, but this did not translate into a placebo analgesic effect. This could be due to violation of response expectancies, too few conditioning trials, and differences in pain ratings in the pre-test that could be due to previous experience with painkillers.

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Section: Discussioncontrasting

confidence: 88%

Section: Discussionmentioning

confidence: 90%

Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

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Failure to Find a Conditioned Placebo Analgesic Response

et al. 2018

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‘External timing’ of placebo analgesia in an experimental model of sustained pain

Camerone

Wiech

Carlino

et al. 2021

European Journal of Pain

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Background Research on placebo analgesia commonly focuses on the impact of information about direction (i.e., increase or decrease of pain) and magnitude of the expected analgesic effect, whereas temporal aspects of expectations have received little attention so far. In a recent study, using short‐lasting, low‐intensity stimuli, we demonstrated that placebo analgesia onset is influenced by temporal information. Here, we investigate whether the same effect of temporal suggestions can be found in longer lasting, high‐intensity pain in a Cold Pressor Test (CPT). Methods Fifty‐three healthy volunteers were allocated to one of three groups. Participants were informed that the application of an (inert‐)cream would reduce pain after 5 min (P5) or 30 min (P30). The third group was informed that the cream only had hydrating properties (NE). All participants completed the CPT at baseline and 10 (Test 10) and 35 min (Test 35) following cream application. Percentage change in exposure time (pain tolerance) from baseline to Test 10 (Δ10) and to Test 35 (Δ35) and changes in heart rate (HR) during CPT were compared between the three groups. Results Δ10 was greater in P5 than in NE and P30, indicating that analgesia was only present in the group that was expecting an early onset of analgesia. Δ35 was greater in P5 and P30 compared to NE, reflecting a delayed onset of analgesia in P30 and maintained analgesia in P5. HR differences between groups were not significant. Conclusions Our data suggest that ‘externally timing’ of placebo analgesia may be possible for prolonged types of pain. Significance Research on placebo effects mainly focuses on the influence of information about direction (i.e., increase or decrease of pain) and magnitude (i.e., strong or weak) of the expected effect but ignores temporal aspects of expectations. In our study in healthy volunteers, the reported onset of placebo analgesia followed the temporal information provided. Such ‘external timing’ effects could not only aid the clinical use of placebo treatment (e.g., in open‐label placebos) but also support the efficacy of active drugs.

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Pavlov’s Pain: the Effect of Classical Conditioning on Pain Perception and its Clinical Implications

Zhang

et al. 2019

Curr Pain Headache Rep

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The Influence of Placebo Analgesia Manipulations on Pain Report, the Nociceptive Flexion Reflex, and Autonomic Responses to Pain

Cited by 18 publications

References 61 publications

Failure to Find a Conditioned Placebo Analgesic Response

Failure to Find a Conditioned Placebo Analgesic Response

‘External timing’ of placebo analgesia in an experimental model of sustained pain

Pavlov’s Pain: the Effect of Classical Conditioning on Pain Perception and its Clinical Implications

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