Effects of placebos without deception compared with no treatment: A systematic review and meta‐analysis

Charlesworth, James E G; Petkovic, Grace; Kelley, John M.; Hunter, Monika; Onakpoya, Igho; Roberts, Nia; Miller, Franklin G.; Howick, Jeremy

doi:10.1111/jebm.12251

Cited by 159 publications

(152 citation statements)

References 37 publications

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“…Conditioned placebo analgesia can be mediated by processes not accessible by reportable expectancy, and that there is a transition from expectancy-mediated processes to more involuntary analgesic processes as those initial expectancies are reinforced through repeated experience. These results parallel emerging evidence from other studies, suggesting that placebo analgesia might sometimes occur in the absence of belief (Charlesworth et al, 2017). Therefore, informing study participants about the realm of the placebo phenomenon and its mechanisms presents no negative reactions or negative consequences and may help engage potential factors that favor outcome improvements.…”

Section: Laboratory (Open-label) Placebo Studiessupporting

confidence: 88%

“…A handful of studies have shown that long-term placebo effects can also be elicited under open-label conditions, in which patients are explicitly informed that they will receive a placebo (Blease, Colloca, & Kaptchuk, 2016; Charlesworth et al, 2017). This is counterintuitive since placebos supposedly work because people believe they do, but (presumably) knowing a treatment is a mere sugar pill makes it difficult to believe they will work.…”

Section: Do Placebos Require Deception? the Mysterious Case Of Opementioning

confidence: 99%

“…The clinical conditions were IBS, depression, allergic rhinitis, back pain, and ADHD (Charlesworth et al, 2017). However, the meta-analysis involves only five trials that were small, had different control groups (TAU vs waiting-list group), often included positive suggestions alongside the open-label placebos, one involved elements of partial conditioning (ADHD amphetamine treatment and placebos) and were rated as having a moderate risk of bias.…”

Section: Clinical Open-label Placebo Trialsmentioning

confidence: 99%

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Placebos Without Deception: Outcomes, Mechanisms, and Ethics

Colloca

Howick

2018

International Review of Neurobiology

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Scientific research indicates that open-label and dose-extending placebos (that patients know are placebos) can elicit behavioral, biological, and clinical outcome changes. In this chapter, we present the state-of-the-art evidence and ethical considerations about open-label and dose-extending placebos, discussing the perspective of giving placebos with a rational, as dose extension of active drugs, or expectancy boosters. Previous comprehensive reviews of placebo use have considered how to harness placebo effects in medicine and the need to focus on elements of the clinical encounter as well as patient–clinician relations. Here, we illustrate the similarities and differences between standard (deceptive) placebos, open-label placebos and dose-extending placebos. We conclude that placebos without deception would override ethical barriers to their clinical use. This paves the way to future large-scale, pragmatic randomized trials that investigate the potential of ethical open-label and dose-extending placebos to improve patients’ outcomes, and reduce side effects.

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Section: Laboratory (Open-label) Placebo Studiessupporting

confidence: 88%

Section: Do Placebos Require Deception? the Mysterious Case Of Opementioning

confidence: 99%

Section: Clinical Open-label Placebo Trialsmentioning

confidence: 99%

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Placebos Without Deception: Outcomes, Mechanisms, and Ethics

Colloca

Howick

2018

International Review of Neurobiology

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“…Promising is the case of dose-extending placebos (e.g., placebo given along with active medication) that mimic the psychobiological responses that are associated with the effectiveness of the medications with the potential of reducing side effects and costs [32]. Although prescription of placebos is not yet regulated in any part of the world and additional research is necessary on its short- and long-term effects, open-label prescription of placebos could be considered as a possible future watch and wait strategy or for use in long-term conditions when other treatment options have failed [33]. …”

Section: Resultsmentioning

confidence: 99%

Implications of Placebo and Nocebo Effects for Clinical Practice: Expert Consensus

Evers

Colloca

Blease

et al. 2018

Psychother Psychosom

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Background: Placebo and nocebo effects occur in clinical or laboratory medical contexts after administration of an inert treatment or as part of active treatments and are due to psychobiological mechanisms such as expectancies of the patient. Placebo and nocebo studies have evolved from predominantly methodological research into a far-reaching interdisciplinary field that is unravelling the neurobiological, behavioural and clinical underpinnings of these phenomena in a broad variety of medical conditions. As a consequence, there is an increasing demand from health professionals to develop expert recommendations about evidence-based and ethical use of placebo and nocebo effects for clinical practice. Methods: A survey and interdisciplinary expert meeting by invitation was organized as part of the 1st Society for Interdisciplinary Placebo Studies (SIPS) conference in 2017. Twenty-nine internationally recognized placebo researchers participated. Results: There was consensus that maximizing placebo effects and minimizing nocebo effects should lead to better treatment outcomes with fewer side effects. Experts particularly agreed on the importance of informing patients about placebo and nocebo effects and training health professionals in patient-clinician communication to maximize placebo and minimize nocebo effects. Conclusions: The current paper forms a first step towards developing evidence-based and ethical recommendations about the implications of placebo and nocebo research for medical practice, based on the current state of evidence and the consensus of experts. Future research might focus on how to implement these recommendations, including how to optimize conditions for educating patients about placebo and nocebo effects and providing training for the implementation in clinical practice.

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“…En otras palabras, saben que la pastilla que ingieren no posee ningún principio activo. Y sorprendentemente, aun así provoca efectos beneficiosos (Carvalho, Caetano, Cunha, Rebouta, Kaptchuk, y Kirsch, 2016;Charlesworth et al, 2017). Les estamos diciendo a los pacientes que la pluma no es mágica, pero la pluma sigue teniendo efecto.…”

Section: Secreto Nº 4: Placebounclassified

Los Siete Secretos Mágicos De La Efectividad Terapéutica

Moix¹,

Carmona²

2018

Pap. Psicol.

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22er psicólogo implica tener que convivir con la sensación de que no sabes nada. Esto en el mejor de los casos porque si crees que sabes mucho significa que estás simplificando la realidad psicológica a niveles infantiles.Esta sensación de ignorancia, de estar perdido, proviene, en parte, del terreno que pisamos los psicólogos cada día. Un campo en el que proliferan una ingente cantidad de teorías, enfoques y prácticas diferentes. Los metaanálisis intentan paliar esta sensación comparando la efectividad de técnicas provenientes de distintas corrientes con la intención de llegar a comprobar cuál es la práctica más apropiada. Sin embargo, la conclusión oficial de la APA (2013) después de comparar diferentes modelos psicoterapéuticos es que: "A diferencia de las marcadas diferencias en cuanto a mejoría entre los pacientes tratados con psicoterapia y los que no, las diferentes formas de psicoterapia producen típicamente resultados relativamente similares". Y las revisiones sobre el tema corroboran dicha conclusión dado que, en general, ningún modelo psicoterapéutico muestra ser más efectivo que los demás (Botella, Maestra, Feixas, Corbella, y Vall, 2015).Así, si somos psicólogos cognitivos podemos empezar a pensar que nuestras teorías no son más explicativas que las psicoanalíticas, o si pertenecemos a una corriente más humanista podemos llegar a la conclusión de que nuestras terapias no son más efectivas que las sistémicas, o si … en definitiva que nuestro camino no es el camino. O que todos los caminos son el camino.Las resistencias ante las evidencias empíricas que no muestran la superioridad de ningún enfoque son obvias porque, a pesar de que ya hace tiempo que se está empezando a observar la similitud entre las corrientes (French, 1933;Rosenzweig, 1936)

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Effects of placebos without deception compared with no treatment: A systematic review and meta‐analysis

Cited by 159 publications

References 37 publications

Placebos Without Deception: Outcomes, Mechanisms, and Ethics

Placebos Without Deception: Outcomes, Mechanisms, and Ethics

Implications of Placebo and Nocebo Effects for Clinical Practice: Expert Consensus

Los Siete Secretos Mágicos De La Efectividad Terapéutica

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