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Placebo and Pain

Placebo and Pain
  • Author : Luana Colloca,Magne Arve Flaten,Karin Meissner
  • Publisher :Unknown
  • Release Date :2013-08-28
  • Total pages :312
  • ISBN : 9780123979315
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Summary : The placebo effect continues to fascinate scientists, scholars, and clinicians, resulting in an impressive amount of research, mainly in the field of pain. While recent experimental and clinical studies have unraveled salient aspects of the neurobiological substrates and clinical relevance of pain and placebo analgesia, an authoritative source remained lacking until now. By presenting and integrating a broad range of research, Placebo and Pain enhances readers’ knowledge about placebo and nocebo effects, reexamines the methodology of clinical trials, and improves the therapeutic approaches for patients suffering from pain. Review for Placebo and Pain: “This ambitious book is the first comprehensive and unified presentation of the placebo and nocebo phenomena in the area of pain. Written by the international leading experts in the field, the book provides an accurate up-to-date [work] on placebo and pain dealing with current perspectives and future challenging issues. --Ted Kaptchuk, Associate Professor of Medicine, Harvard Medical School Contains historical aspects of the placebo effect Discusses biological and psychological mechanisms of placebo analgesic responses Reviews implications of the placebo effect for clinical research and pain management Includes methodological and ethical aspects of the placebo effect

Placebo and Pain

Placebo and Pain
  • Author : Harald Walach
  • Publisher :Unknown
  • Release Date :2013-08-28
  • Total pages :312
  • ISBN : 9780128064269
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Summary : Complementary and alternative medicine (CAM) is frequently conceptualized as ‘nothing but’ placebo. I will argue, and provide the evidence in this chapter, that, apart from potential specific effects, CAM is a clever way of inducing generic self-healing effects. Jerome D Frank's model serves to conceptualize this. CAM practitioners normally establish good relationships and take time to listen to their patients. They have very elaborate rituals to enact those effects. They demonstrate their prowess and they provide alternative explanatory models that make sense, at least to those patients that consult with them. Most important of all, perhaps, is the fact that nearly all CAM modalities require patients to become active, thus serving as a catalyst to mobilize resources and stimulate the experience of self-efficacy. The latter is debatedly one of the most important nonspecific effects of therapy. Hence, it is misleading to conceptualize CAM effects as nonspecific effects. Rather, it seems to be a way of activating a self-healing response that is very specific in itself, and indeed, more specific than purportedly specific pharmacologic effects.

Placebo and Pain

Placebo and Pain
  • Author : Regine Klinger,Herta Flor
  • Publisher :Unknown
  • Release Date :2013-08-28
  • Total pages :312
  • ISBN : 9780128064337
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Summary : In this chapter we discuss the various aspects of the clinical applications of placebo effects. In clinical studies, a placebo intervention is often nearly as potent as the effects of the verum that is applied, and placebo effects can have enduring positive consequences. Most research has focused on healthy humans and it is not clear whether the results reported in these people can be transferred to clinical populations. Initial studies on this topic have suggested that patients may profit more from conditioning, which involves a true reduction of the pain experience, than from expectation alone. This current knowledge about the placebo effect, especially about the analgesic placebo effect, suggests that it is time to use it in clinical practice. The concept of the additional placebo effect as part of an active pain treatment enables an ethical application of placebo mechanisms that can enhance the efficacy of pharmacologic—and potentially also psychologic—interventions.

Placebo and Pain

Placebo and Pain
  • Author : Magne Arve Flaten,Karin Meissner,Luana Colloca
  • Publisher :Unknown
  • Release Date :2013-08-28
  • Total pages :312
  • ISBN : 9780128064221
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Summary : Studies of placebo analgesia necessarily involve the induction and reporting of pain. The pain report is the basic dependent variable in many studies of placebo analgesia, and reported pain should ideally reflect the pain experience. However, the pain report is subject to a number of different influences that threaten the internal validity of research on pain and, consequently, placebo analgesia. The study of placebo analgesia introduces several other issues, in terms of the design of studies that researchers must deal with. Many methodologic issues have been solved, but some important issues are still unresolved. The concept of expectation is central to studies of placebo effects, and poses special challenges in terms of its conceptual status and its measurement.

Placebo and Pain

Placebo and Pain
  • Author : Lene Vase,Gitte Laue Petersen
  • Publisher :Unknown
  • Release Date :2013-08-28
  • Total pages :312
  • ISBN : 9780128064276
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Summary : The magnitude of placebo analgesia effects has been shown to vary across meta-analyses. The conceptualization of placebo effects, and the way in which they are induced, influence the magnitude of placebo analgesia effects. This has been indicated by meta-analyses and further confirmed by experimental studies. In general, small placebo analgesia effects are found in clinical trials in which placebo is used as a control condition, whereas large effects are found in placebo mechanism studies investigating how expectations and emotional feelings contribute to placebo analgesia effects. At present, meta-analyses are used to investigate the seemingly increasing analgesic effects following placebo administration in clinical trials. Current knowledge about placebo mechanisms could contribute to the investigation of these analgesic effects and thereby help to develop new ways of testing pain medication, which ultimately may be of benefit for pain patients.

Placebo and Pain

Placebo and Pain
  • Author : Magne Arve Flaten,Per M. Aslaksen,Peter S. Lyby
  • Publisher :Unknown
  • Release Date :2013-08-28
  • Total pages :312
  • ISBN : 9780128064153
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Summary : Pain may be modulated by positive and negative emotions, and this is the basic element in the hypothesis that placebo effects are due to a reduction in negative emotions. Individual differences are discussed, especially as they relate to negative emotions. There is evidence that the placebo effect is partly due to a reduction in negative emotions. The role of positive emotions in placebo analgesia is less studied, and the data are mixed. The nocebo effect, the opposite of the placebo effect, can be explained by increased negative emotions. Taken together, the placebo and nocebo effects may be seen as different consequences of changes in emotional processes.

Placebo and Pain

Placebo and Pain
  • Author : Ben Colagiuri,Peter F. Lovibond
  • Publisher :Unknown
  • Release Date :2013-08-28
  • Total pages :312
  • ISBN : 9780128064245
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Summary : Evidence from both empirical studies and clinical practice indicates that substantial reductions in pain can be observed following placebo treatment. Generally, these effects are attributed to expectancy and/or classic conditioning. However, other psychological processes that could bias the observed responses to placebo treatment may lead to a systematic over- or underestimate of the magnitude of the placebo effect. First, demand characteristics could encourage participants or patients to respond in a way consistent with their perceptions of the study’s or treatment’s aims. Second, knowledge of being in a study, or receiving treatment, could lead to changes in behavior and reporting as a result of the Hawthorne effect. Third, response shift may invalidate pre-post intervention comparisons if the criteria for evaluating the relevant symptom change as a result of the intervention. This chapter reviews evidence for these three processes as they relate to placebo effects for pain.

Placebo and Pain

Placebo and Pain
  • Author : Luana Colloca,Franklin G. Miller
  • Publisher :Unknown
  • Release Date :2013-08-28
  • Total pages :312
  • ISBN : 9780128064344
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Summary : The defining circumstances and reasons for promoting healing processes based on placebo and avoiding (undesirable) nocebo effects in clinical practice represent a challenge for translational and patient-oriented medicine. Exploiting placebos and placebo effects for the benefit of the patient requires a rigorous evaluation of potential benefits and harms associated with these interventions. Moreover, any attempts to harness placebo benefits and mitigate nocebo effects in clinical practice should be done consistently with professional norms and integrity, and ethical-legal requirements of informed consent. This chapter systematically discusses the complex issue of professional and ethical requirements in using placebos and placebo effects in pain-related research and practices. Within this scope, some important questions need to be addressed as well: (a) Can placebo analgesic effects produce clinically significant benefits? (b) What translational research is being done, or should be done? (c) What work is being done in this area to enable and encourage doctors to incorporate ethically the concept of placebo and nocebo effects into their work?

Placebo and Pain

Placebo and Pain
  • Author : Damien Finniss
  • Publisher :Unknown
  • Release Date :2013-08-28
  • Total pages :312
  • ISBN : 9780128064085
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Summary : The placebo effect has been a topic of interest in medicine for many hundreds of years. A historical evaluation of the topic demonstrates how the origin of the word, and its initial use in society and in medicine, has shaped its meaning over many years. In fact, the understanding of placebo effects is only now changing, largely due to an exponential rise in dedicated research into placebo mechanisms, clinical applications, and publications promoting re-evaluation of many longstanding interpretations of the topic. Placebo has been one key element in the overall history of medicine, and therefore the history of placebo is an important component of the appreciation of the history of medicine.

Placebo and Pain

Placebo and Pain
  • Author : Serge Marchand
  • Publisher :Unknown
  • Release Date :2013-08-28
  • Total pages :312
  • ISBN : 9780128064139
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Summary : There is good evidence that placebo and nocebo responses reflect more than a psychologic reappraisal of pain perception. In fact, pain perception is the endpoint of several endogenous pain inhibitory and facilitatory mechanisms that trigger descending pain modulation mechanisms to the spinal cord. Measuring the ability of placebo and nocebo to act on these mechanisms will demonstrate that their effects are not only a reinterpretation of higher centers of the same nociceptive signal, but are acting at the source of this signal at the spinal level. This information is important considering that the capacity to trigger endogenous pain modulation mechanisms is a good predictor of pain chronification. This chapter addresses the importance of psychologic factors on endogenous pain facilitatory and inhibitory mechanisms in the central nervous system, from the cortex to the spinal cord, and their role in treatments targeting the same mechanisms.

Placebo and Pain

Placebo and Pain
  • Author : Karin Meissner,Klaus Linde
  • Publisher :Unknown
  • Release Date :2013-08-28
  • Total pages :312
  • ISBN : 9780128064306
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Summary : More invasive and impressive therapeutic rituals are generally believed to be more powerful interventions than less impressive ones. This chapter reviews and discusses evidence from randomized clinical trials and meta-analyses for such a differential effectiveness of placebo interventions. Evidence from clinical research that different types of placebo are regularly associated with different magnitudes of placebo effect is limited. However, one area where hints from a variety of sources are accumulating is sham acupuncture in the treatment of pain. Furthermore, there is preliminary evidence that sham surgery and ambiguous evidence that sham injections are associated with enhanced placebo effects on pain. Among the factors that may account for a greater effectiveness of such treatment procedures are the lively perceptual context of the procedures themselves, the attention and enhanced emotional support by healthcare providers, and the increased expectation and motivation of patients. A differential effectiveness of placebo control procedures in clinical trials would have important implications for clinical research.

Placebo and Pain

Placebo and Pain
  • Author : Falk Eippert,Christian Büchel
  • Publisher :Unknown
  • Release Date :2013-08-28
  • Total pages :312
  • ISBN : 9780128064146
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Summary : Placebo analgesia is an illustrative example of the impact that psychological factors can have on the experience of pain. While this form of pain modulation is mediated by multiple neurobiological mechanisms, one influential explanation posits that a descending pain control system contributes to placebo effects in pain. Here, we first give an overview of descending pain control as established in animal studies, focusing on an opioid-dependent system that includes the periaqueductal gray (PAG) and rostral ventromedial medulla (RVM) as core regions and controls nociceptive processing already at the level of the spinal cord. We then review functional magnetic resonance imaging (fMRI) and positron emission tomography (PET) studies that provide evidence for an involvement of this system in placebo analgesia. Finally, we have a look at the role of the spinal cord in placebo analgesia, focusing on spinal fMRI studies.

Placebo and Pain

Placebo and Pain
  • Author : Ulrike Bingel
  • Publisher :Unknown
  • Release Date :2013-08-28
  • Total pages :312
  • ISBN : 9780128064207
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Summary : The observation that cognitive factors, such as beliefs, expectations and prior experiences, not only modulate the perception of pain but also the therapeutic benefit and adverse effects of pharmacologic treatments is not new. However, to date, the contribution of cognitive factors to pharmacotherapy is still poorly understood and far from being systematically exploited to maximize treatment outcome. This chapter gives an overview on the contribution of placebo and nocebo mechanisms to the outcome of analgesic treatments, insights into the neurobiologic mechanisms by which both factors combine or interact, and discusses implications for clinical care and the design of clinical studies.

Placebo and Pain

Placebo and Pain
  • Author : Marta Peciña,Jon-Kar Zubieta
  • Publisher :Unknown
  • Release Date :2013-08-28
  • Total pages :312
  • ISBN : 9780128064115
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Summary : Cognitive and emotional processes that are engaged during the administration of an otherwise inactive agent, a placebo, are capable of activating internal mechanisms that modify physiology. A network of regions, including the rostral anterior cingulate, dorsolateral prefrontal and orbitofrontal cortices, insula, nucleus accumbens, amygdala, medial thalamus and periaqueductal gray, appear to be involved in placebo responses. Opioid and dopamine neurotransmission in these areas modulates various elements of the placebo effect, which appear to include the representation of its subjective value, updates of verbally-induced expectations over time, the recall of the pain and placebo experience and changes in affective state and in pain ratings. Inter-individual variability in the circuitry involved in placebo responses might shed light on individual differences involved in the regulation of stress responses, neuroendocrine and autonomic functions, mood, reward and integrative cognitive processes, such as decision-making, as regions involved in these processes largely overlap and correspond to those involved in placebo responses.

Placebo and Pain

Placebo and Pain
  • Author : Jian Kong,Randy L. Gollub
  • Publisher :Unknown
  • Release Date :2013-08-28
  • Total pages :312
  • ISBN : 9780128064191
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Summary : For thousands of years, both acupuncture and placebo (as a therapeutic ritual) have been used in healing. It is only recently that scientists have begun rigorously investigating the efficacy of acupuncture treatment. Recent meta analysis suggests that acupuncture treatment is only moderately more effective than sham treatment on some pain disorders such as osteoarthritis, headache, musculoskeletal and shoulder pain, which suggests that non-specific components are important contributors to the therapeutic benefits of acupuncture treatment. This chapter discusses the challenges involved in acupuncture research, specifically with regard to defining inert (sham) acupuncture treatment in a way that is consistent with ancient traditional acupuncture theory. It then introduces several studies that have been performed in an attempt to investigate the dissociation and interaction between sham and verum (real) acupuncture treatments, and concludes with questions that are essential for acupuncture researchers to address in the future to advance this field.

Placebo and Pain

Placebo and Pain
  • Author : Donald D. Price,Lene Vase
  • Publisher :Unknown
  • Release Date :2013-08-28
  • Total pages :312
  • ISBN : 9780128064283
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Summary : Persistent pain conditions, such as irritable bowel syndrome (IBS), are often accompanied by primary and widespread secondary hyperalgesia, as evidenced by higher pain ratings in response to induced heat stimuli. These forms of hyperalgesia are not static but are dynamically maintained by impulse input from colorectal tissues as well as descending inhibition and facilitation. Two phenomena that closely relate to descending control are nocebo and placebo effects. The latter occur in relation to treatments and are partly mediated by desire for relief, expected pain intensity, and reduced negative emotions. These factors can predict clinical outcomes and could be very useful in managing placebo responses in clinical trials. Evidence also exists that tonic peripheral input and descending inhibition/facilitation interact synergistically such that removing either component alone has potent anti-hyperalgesic effects in the case of IBS. This principle may apply to other persistent pain conditions, including neuropathic pain.

Placebo and Pain

Placebo and Pain
  • Author : Anthony Jones,Christopher Brown,Wael El-Deredy
  • Publisher :Unknown
  • Release Date :2013-08-28
  • Total pages :312
  • ISBN : 9780128064122
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Summary : Placebo analgesia has been attributed to the effects of expectations of pain reduction, which are generally thought of as conscious cognitive processes, and classical conditioning which is a learning process that need not be conscious. We propose a model of placebo analgesia that also takes into account anxiety as a possible mediator of some of the effects of expectations on pain, and attentional processes as a moderator of expectancy effects. In this review we will focus on evidence to support this model from electroencephalography (EEG) studies. Because of the high temporal resolution of EEG it provides an appropriate imaging modality to interrogate some of the key components of our proposed model for placebo analgesia. In this chapter we review the contribution that EEG studies have made to our understanding of anticipation of pain, and the role anticipation may have in priming pain perception and determining placebo analgesic responses.

Neurobiology of the Placebo Effect

Neurobiology of the Placebo Effect
  • Author : Anonim
  • Publisher :Unknown
  • Release Date :2018-08-23
  • Total pages :508
  • ISBN : 9780128154175
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Summary : Neurobiology of the Placebo Effect, Part II, Volume 139, the latest release in the International Review of Neurobiology series, is the second part of a two-volume set that provides the latest placebo studies in clinically relevant models. Specific chapters cover the History of placebo effects in medicine, Lumping or Splitting: Towards a taxonomy of placebo and related effects, Theories and brain mechanisms of placebo analgesia, Pain Modulation: From CPM to placebo and nocebo effects in experimental and clinical pain, Modulation of the motor system by placebo and nocebo effects, and the role of sleep in learning placebo effects, amongst other topics. Presents the latest information on placebo studies in clinically relevant models Provides current research and projects on involved brain circuitry and neurotransmitter systems Contains specific chapters on applications

Placebo and Pain

Placebo and Pain
  • Author : Jian-You Guo,Jin-Yan Wang,Fei Luo
  • Publisher :Unknown
  • Release Date :2013-08-28
  • Total pages :312
  • ISBN : 9780128064108
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Summary : The placebo effect is a fascinating yet puzzling phenomenon which has challenged investigators over the past 50 years. Some researchers have initiated investigations of the effects of placebos in animals, and have shown that associative learning is a major way to elicit placebo responses. Pain is the field in which most of the placebo research has been performed. In contrast to numerous studies involving human subjects, the available literature on placebo-induced analgesia in animal models is rare. This chapter introduces a special drug-conditioning procedure, a cue paired with morphine or aspirin, eliciting analgesic responses in a hot plate test. This established placebo analgesia was considered to be transferable from pain to depression and could produce a significant antidepressant effect in a test on depression in mice. Furthermore, the opioid placebo analgesia was found to be mediated exclusively through a μ-opioid receptor in the rat. The pros and cons of studying placebo in animal models are also discussed at the end of this chapter.

Placebo and Pain

Placebo and Pain
  • Author : Arnstein Finset
  • Publisher :Unknown
  • Release Date :2013-08-28
  • Total pages :312
  • ISBN : 9780128064313
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Summary : Research literature on how communication between clinicians and patients may impact pain perception was reviewed. Papers were selected from searches of databases, from reference lists of the papers identified in the search and by personal knowledge of the literature. The studies reviewed provided mixed results regarding the effect of clinicians’ communication behavior on pain perception. There is some evidence that information intended to produce positive expectations may have a positive effect in terms of reduced pain, most strongly when combined with persuasive communication style and/or a warm and empathic atmosphere. A patient-centered communication style was, in some studies, associated with less pain. A few the studies indicated the impact of individual differences, both in terms of clinicians and patient characteristics. Future studies should develop designs which make it possible to differentiate better between the effects of different elements of communication behaviors on pain perception.

Placebo and Pain

Placebo and Pain
  • Author : Wayne B. Jonas,Cindy Crawford,Karin Meissner,Luana Colloca
  • Publisher :Unknown
  • Release Date :2013-08-28
  • Total pages :312
  • ISBN : 9780128064290
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Summary : Management of pain is an essential responsibility in medicine. With the advance of surgical technologies, the use of interventional and other invasive methods to treat pain has become prominent and growing in use. Yet, rarely are these techniques evaluated in a way that can separate their specific impact on pain from expectation and context effects that these rituals share with many other less invasive approaches to pain. In this chapter we examine invasive studies for pain that are compared to sham procedures that mimic the procedure without delivering actual surgery. We describe studies for angina, low back pain, osteoarthritis, and headache, examining quality and outcomes. Remarkably, when compared to a sham group, most invasive procedures do not produce a significant effect on pain. We explore clinical and ethical implications of these data and recommend that more rigorous research be done on invasive procedures before they are adopted for widespread use.