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

Abstract

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.

Effects of an epilepsy‐specific Internet intervention (Emyna) on depression: Results of the ENCODE randomized controlled trial

“…Other limitations of this trial concern reliance on self‐report measures as well as lack of comparison against an active control or a placebo intervention. Such comparisons are rare in studies of psychological interventions and fraught with conceptual problems, because the placebo concept can be applied more easily to drug research …”

Pathophysiology and management of sensitive skin: position paper from the special interest group on sensitive skin of the International Forum for the Study of Itch (IFSI)

“…[57][58][59] Nocebo effectsthe opposite to placebo effectscan be described as negative treatment consequences, not only due to the treatment mechanisms, but also due to the negative expectations of the patient. [57][58][59] Nocebo effectsthe opposite to placebo effectscan be described as negative treatment consequences, not only due to the treatment mechanisms, but also due to the negative expectations of the patient.…”

“…59,83,84 Placebo effects can be defined as beneficial treatment effects that cannot be ascribed to the treatment mechanisms itself, but that is a consequence of the expectation of patients. This frequently results in a feeling of insecurity and ambiguity for both professionals and patients.…”

“…For example, placebo effects for itch can be induced by verbal suggestions or a combination of verbal suggestions and conditioning. 59 In view of the unclear diagnosis and therapeutical options for sensitive skin, it might be particularly important to study these mechanisms and treatment options of placebo effects for people with sensitive skin. for expectancies about itch decrease, when participants are informed about the fact that they receive a placebo treatment.…”

Oxytocin Enhancement of the Placebo Effect May Be a Novel Therapy for Working Memory Impairments

“…The pharmacological enhancement of cognitive functions to augment the efficacy of learning-based interventions has therefore received considerable attention during the last years [3]. Placebo effects in the form of creating psychological expectancies strongly modulate therapeutic outcome [4] and can have positive effects in some domains [5], but studies to date have failed to demonstrate expectancy-induced cognitive enhancement per se [6]. Recent findings that the neuropeptide oxytocin can enhance placebo-induced analgesia in men [7] (however, see also [8] for a lack of effects in a study including both sexes), and acceptance of expert advice [9] suggest its potential use as an adjunct to expectancy induction in the cognitive domain.…”