Placebo effect in child and adolescent psychiatric trials

Parellada, Mara; Moreno, Carmen; Moreno, Miguel; Espliego, Ana; Portugal, Enrique; Arango, Celso

doi:10.1016/j.euroneuro.2011.09.007

Cited by 35 publications

(43 citation statements)

References 98 publications

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“…It has been suggested that children and adolescents generally show larger PR than adults (6,8). Our experimental approach clearly confirms this age effect.…”

Section: Placebo Analgesia Responsessupporting

confidence: 86%

“…Several psychological and neurodevelopmental reasons may account for the larger PR in children. First, children may be predisposed to larger PR due to their higher suggestibility (6). Suggestibility changes over the processes of neurodevelopment (43) and has been shown to increase steadily from an early age, to peak between 9 and 12 years, and to decline thereafter (44).…”

Section: Placebo Analgesia Responsesmentioning

confidence: 99%

“…Suggestibility changes over the processes of neurodevelopment (43) and has been shown to increase steadily from an early age, to peak between 9 and 12 years, and to decline thereafter (44). Moreover, conceptualizing placebo processes as learning phenomena (45), children may show higher PR due to their possible facilitated learning capacities, openness to new experiences and learning motivation (46). Also, Parellada et al…”

Section: Placebo Analgesia Responsesmentioning

confidence: 99%

“…(2002) pointed out that children's framing and belief system might be not yet modulated by experience as it is in adults (6). Similarly, their prediction and prejudice system is not yet shaped by learning.…”

Section: Placebo Analgesia Responsesmentioning

confidence: 99%

“…This is especially noteworthy since evidence from the small number of pediatric clinical trials studies suggests that PR might be even more pronounced in children compared to adults (6)(7)(8). Clinical trials of local anesthetics (9,10) as well as a venipuncture study (11) emphasize the significance of PR in children.…”

Section: Introductionmentioning

confidence: 99%

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Expectancy-Induced Placebo Analgesia in Children and the Role of Magical Thinking

Kempler

Kossowsky

Schwarz

et al. 2014

The Journal of Pain

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Expectations and beliefs shape the experience of pain. This is most evident in context-induced, placebo analgesia, which has recently been shown to interact with the trait of magical thinking (MT) in adults. In children, placebo analgesia and the possible roles that MT and gender might play as modulators of placebo analgesia have remained unexplored. Using a paradigm in which heat-pain stimuli were applied to both forearms, we investigated whether MT and gender can influence the magnitude of placebo analgesia in children. Participants were 49 right-handed children (aged 6-9 years) who were randomly assigned -stratified for MT and gender -to either an analgesia-expectation or a controlexpectation condition. For both conditions, the placebo was a blue-colored hand disinfectant that was applied to the children's forearms. Independent of MT, the placebo treatment significantly increased both heat pain threshold and tolerance. The threshold placebo effect was more pronounced for girls than boys. In addition, independent of the expectation treatment, low-MT boys showed a lower tolerance increase on the left compared to the right side. Finally, MT specifically modulated tolerance on the right forearmside: low-MT boys showed an increase, whereas high-MT boys showed a decrease in heat pain tolerance. This study documented a substantial expectation-induced placebo analgesia response in children (girls > boys) and demonstrated MT and gender-dependent laterality effects in pain perception. The findings may help improve individualized pain management for children. PERSPECTIVE: The study documents the first experimental evidence for a substantial expectancy-induced placebo analgesia response in healthy children from 6 to 9 years of age. Moreover, the effect was substantially higher than the placebo response typically found in adults. The findings may help improve individualized pain management for children. Conflicts of Interest and Source of FundingThe authors declare that there is no conflict of interest. This research was supported by the University of Basel.Running Title: Placebo Analgesia and Magical Thinking in Children Krummenacher et al., 2014 1 Abstract Objective: Higher brain functions such as expectations and beliefs shape the experience of pain. This is most evident in context-induced placebo analgesia (PA), which was recently shown in adults to interact with the trait of magical thinking (MT).In children, PA and the possible relationship between PA and MT has remained unexplored.Methods: Using a lateralized heat-pain paradigm, we investigated the possible modulatory role of PA expectation and MT in response to nociceptive stimuli on the right and left forearm.Participants were 49 right-handed children (6-9 years). In a between-subjects design, half of them were either randomly -stratified for MT and gender -assigned to an analgesia-expectation or a control-expectation condition. Results:Results indicate that, independent of MT, the placebo procedure significantly increased both heat pain threshold (...

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“…It has been suggested that children and adolescents generally show larger PR than adults (6,8). Our experimental approach clearly confirms this age effect.…”

Section: Placebo Analgesia Responsessupporting

confidence: 86%

Section: Placebo Analgesia Responsesmentioning

confidence: 99%

Section: Placebo Analgesia Responsesmentioning

confidence: 99%

Section: Placebo Analgesia Responsesmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

See 3 more Smart Citations

Expectancy-Induced Placebo Analgesia in Children and the Role of Magical Thinking

Kempler

Kossowsky

Schwarz

et al. 2014

The Journal of Pain

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Efficacy, Safety, and Acceptability of Pharmacologic Treatments for Pediatric Migraine Prophylaxis

et al. 2020

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IMPORTANCE Migraine is one of the most common neurologic disorders in children and adolescents. However, a quantitative comparison of multiple preventive pharmacologic treatments in the pediatric population is lacking.OBJECTIVE To examine whether prophylactic pharmacologic treatments are more effective than placebo and whether there are differences between drugs regarding efficacy, safety, and acceptability.DATA SOURCES Systematic review and network meta-analysis of studies in MEDLINE, Cochrane, Embase, and PsycINFO published through July 2, 2018.STUDY SELECTION Randomized clinical trials of prophylactic pharmacologic treatments in children and adolescents diagnosed as having episodic migraine were included. Abstract, title, and full-text screening were conducted independently by 4 reviewers. DATA EXTRACTION AND SYNTHESIS Data extraction was conducted according to PreferredReporting Items for Systematic Reviews and Meta-Analysis network meta-analysis guidelines. Quality was assessed with the Cochrane Risk of Bias tool. Effect sizes, calculated as standardized mean differences for primary outcomes and risk ratios for discontinuation rates, were assessed in a random-effects model. MAIN OUTCOMES AND MEASURESPrimary outcomes were efficacy (ie, migraine frequency, number of migraine days, number of headache days, headache frequency, or headache index), safety (ie, treatment discontinuation owing to adverse events), and acceptability (ie, treatment discontinuation for any reason).RESULTS Twenty-three studies (2217 patients) were eligible for inclusion. Prophylactic pharmacologic treatments included antiepileptics, antidepressants, calcium channel blockers, antihypertensive agents, and food supplements. In the short term (<5 months), propranolol (standard mean difference, 0.60; 95% CI, 0.03-1.17) and topiramate (standard mean difference, 0.59; 95% CI, 0.03-1.15) were significantly more effective than placebo. However, the 95% prediction intervals for these medications contained the null effect. No significant long-term effects for migraine prophylaxis relative to placebo were found for any intervention. CONCLUSIONS AND RELEVANCEProphylactic pharmacologic treatments have little evidence supporting efficacy in pediatric migraine. Future research could (1) identify factors associated with individual responses to pharmacologic prophylaxis, (2) analyze fluctuations of migraine attack frequency over time and determine the most clinically relevant length of probable prophylactic treatment, and (3) identify nonpharmacologic targets for migraine prophylaxis.

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Placebo Effects

Louhiala¹

2020

Placebo Effects: The Meaning of Care in Medicine

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Placebo effect in child and adolescent psychiatric trials

Cited by 35 publications

References 98 publications

Expectancy-Induced Placebo Analgesia in Children and the Role of Magical Thinking

Expectancy-Induced Placebo Analgesia in Children and the Role of Magical Thinking

Efficacy, Safety, and Acceptability of Pharmacologic Treatments for Pediatric Migraine Prophylaxis

Placebo Effects

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