Further Studies on the “Pharmacology” of Placebo Administration1

Lasagna, Louis; Laties, Victor G.; Dohán, Judit

doi:10.1172/jci103635

Cited by 113 publications

(44 citation statements)

References 4 publications

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“…The landmark studies of Lasagna et al [14,15], however, soon clarified that the same patient may display a placebo reaction in one experimental set and not in another, casting doubts on the view of a consistent placebo reactor. Certain predispositions become associated with placebo reactivity only in certain situations [13,16].…”

Section: Treatment Outcome As a Multifactorial Productmentioning

confidence: 99%

The Clinical Inadequacy of the Placebo Model and the Development of an Alternative Conceptual Framework

Fava

Guidi

Rafanelli

et al. 2017

Psychother Psychosom

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Placebo effects are often attributed to clinical interactions and contextual factors that affect expectations of the patient about the treatment and result in symptom changes. The prevailing conceptualization consists of an undifferentiated placebo response that needs to be minimized in controlled investigations and maximized in clinical practice. However, treatment outcome is the cumulative result of the interaction of several classes of variables with a selected treatment: living conditions (housing, nutrition, work environment, social support), patient characteristics (age, sex, genetics, general health conditions, personality, well-being), illness features and previous therapeutic experience, self-management, and treatment setting (physician's attitude and attention, illness behavior). Such variables may be therapeutic or countertherapeutic, and are unlikely to be simply additive. In certain patients their interactive combination may lead to clinical improvement, whereas in other cases it may produce no effect, and, in a third group, it may lead to worsening of the condition. Maximizing patients' expectations does not necessarily result in sustained effects and, in due course, may actually lead to worsening of the condition (violation of expectations). In this paper, we outline a multifactorial conceptual model that may have implications for the design of clinical trials as well as for clinical practice, with special reference to psychopharmacology and psychotherapy. The effects of drug treatment may be potentiated by specific nonpharmacological treatment strategies, and this synergism may disclose significant differences against placebo. Medical outcomes may be unsatisfactory not because technical interventions are missing, but because our conceptual models and thinking are inadequate.

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Section: Treatment Outcome As a Multifactorial Productmentioning

confidence: 99%

The Clinical Inadequacy of the Placebo Model and the Development of an Alternative Conceptual Framework

Fava

Guidi

Rafanelli

et al. 2017

Psychother Psychosom

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show abstract

“…Thus, these and other characteristics of the pain may be important factors in determining the efficacy of placebo analgesia. Although Lasagna et al (2) noted anecdotally that patients with the most severe pain appeared less likely to respond to an analgesic placebo, we are unaware of any systematic studies on this problem.…”

mentioning

confidence: 91%

“…Although placebo treatment involves administration of an inert substance, the power of the act itself to elicit analgesia is well known. Placebo shows such characteristics of a pharmacologically active drug as a dose-response curve (peak effect, cumulative action, and gradual decline) (1-3), as well as tolerance (2) and side effects (4-6). Beecher (7) has pointed out that, although over 33% of patients with various clinical pains respond to placebo with significant analgesia, only about 3% of subjects with experimental pain have an analgesic response.…”

mentioning

confidence: 99%

Role of pain in placebo analgesia.

Levine¹,

Gordon²,

Bornstein³

et al. 1979

Proc. Natl. Acad. Sci. U.S.A.

107

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The hypothesis that perceived pain intensity can influence placebo analgesia was tested. One hundred and seven subjects rated their pain from 0 to 10 on a visual analog scale after a standard wisdom tooth extraction. The expected course of such postoperative pain in the absence of therapy or placebo is a steady increase; this was confirmed by blind administration of the placebo. When placebos were given intravenously in view of the patients, some (placebo nonresponders) reported that their pain increased, whereas others (placebo responders) reported that their pain either decreased or remained the same over the next 60 min. A placebo response was more likely to occur if the pain rating 5 min prior to placebo administration (initial pain) was greater than 2.6. Furthermore, placebo responders with initial pain above this 2.6 level reported significantly greater mean analgesia than those with lower initial pain. Indeed, responders with initial pain less than 2.6 reported no change in ain during the 60 min after administration of a placebo. When their initial pain level was greater than 2.6, they reported a steady decline in pain over this period. However, above the 2.6 level there was no obvious relationship between the magnitude of the placebo analgesia and the initial pain.

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“…A legrégebben a gyógyszerek színének szerepével foglalkoznak Lasagna et al, 1958;Leslie 1954 , bár ezek a korai közlemények inkább vélekedéseken, mint adatokon alapultak. Viszonylag korán kiderült azonban, hogy a betegeknek valóban vannak elvárásaik a színekkel kapcsolatban Blackwell et al, 1972, Buckalew and Ross, 1991, Schapira et al, 1970 .…”

Section: A 'Teljes Gyógyszerhatás' Elemei Színek Formák Betegtájékunclassified

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2016

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Further Studies on the “Pharmacology” of Placebo Administration1

Cited by 113 publications

References 4 publications

The Clinical Inadequacy of the Placebo Model and the Development of an Alternative Conceptual Framework

The Clinical Inadequacy of the Placebo Model and the Development of an Alternative Conceptual Framework

Role of pain in placebo analgesia.

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