Bakgrund: Akupunktur har sedan 1984 varit godkänt av socialstyrelsen som behandling mot smärta och används idag flitigt av fysioterapeuter som behandlingsform mot flertal diagnoser där evidensen visat sig vara stark. 80% av befolkningen har någon gång i livet drabbats av ländryggssmärta. Syftet: Att med en litteratursammanställning jämföra effekten av smärtlindring mellan akupunktur och placebo nålar vid ländryggssmärta. Metod: Studien inkluderade 3 artiklar inom området ländryggssmärta, akupunktur och placebo nålar och deras effekt som smärtlindrande behandling. Artiklarna har kvalitetsgranskat enligt Fribergs kvalitetsanalys. Resultat: 2 av 3 studier visade på att akupunktur hade en bättre smärtlindrande effekt än placebo nålar vid ländryggssmärta. Akupunktur visade även på en längre smärtlindrande effekt efter avslutad behandling och vid tre månaders uppföljning. Konklusion: Mer forskning behövs trots att akupunktur visade på bättre smärtlindrande effekt då underlaget var för litet för att kunna dra en slutgiltig slutsats.

A placebo effect is a real and beneficial psychobiological phenomenon following the administration of a substance or procedure that has no inherent power to produce an effect. Nocebo effects, on the other hand are genuine and detrimental psychobiological phenomenon following the administration of and inert substance or procedure. These effects have been extensively studied but are not well understood. Central to the development of a placebo effect is the anticipation of benefit or the anticipation of harm. Indeed, expectancy and conditioning are thought to be the two primary mechanisms involved in the acquisition of the placebo effect. The neurotransmitter Dopamine (DA) is integral to expectancy and reward and as such has recently been considered a key player in the mechanisms of the placebo effect. Based on this line of inquiry this study sought to investigate the role DA might have in the development of the placebo effect as observed in pain using an animal (mouse) model. It was proposed that DA is involved in the acquisition and maintenance of the placebo effect. Specifically it was proposed that the DA agonist cocaine would enhance the magnitude and duration of the placebo analgesia and that the DA antagonists SCH23390 and eticlopride would together or separately block the acquisition of the placebo analgesia. These proposals were assessed by utilizing supra-spinal (hotplate) and spinal (tail flick latency) protocols. Results indicated that cocaine enhanced placebo analgesia in spinal but not supra-spinal measures and that the DA antagonists SCH23390 and eticlopride each contributed to the acquisition, rather than the blockade, of placebo analgesia in both spinal and supra-spinal models. In fact, the most profound effect was observed when both antagonists were administered together rather than separately on supra-spinal measures but not spinal measures resulting in an enduring nocebo effect contradicting all predictions. The novel results presented in this study raises more questions than they answer, warranting more detailed exploration of the mechanisms of DA and its relationship with placebo effects.

Placeboeffekten; att få klinisk effekt av inaktiv behandling är ett fenomen som tilldrar sig allt större intresse. Trots att mekanismerna bakom effekten ännu är långt ifrån helt klarlagda så finns en stor mängd forskning som visar att placebobehandling på olika vis kan vara av klinisk relevans. Bland de mest imponerande demonstrationerna av placeboeffekten är de experiment som visar att s.k. klassisk betingning kan påverka immunförsvaret. Experiment har visat att detta är möjligt både hos gnagare och människor: en medicin administreras samtidigt som ett neutralt gustatoriskt stimulus i vad som kallas betingningsfasen. När denna genomförts kan associationen mellan smak och farmakologisk effekt vara så stark att samma smak, på egen hand, kan framkalla nämnd effekt. I detta arbete sammanfattas kort begrepp och forskning kring placebo i allmänhet och betingad placebo i synnerhet. Vetenskapliga belägg för betingad placebos förmåga till immunpåverkan granskas, och det mesta tyder på att sådan är möjlig i praktiken. Därefter diskuteras möjliga kliniska tillämpningar av betingad placebo i form av medicinsk dosreduktion. Avslutningsvis följer en kort genomgång av det stora kunskapsgapet mellan beläggen för denna dosreduktions kliniska relevans, och dess lämplighet inom konventionell vård.

Tese (doutorado) - Universidade Estadual de Campinas. Faculdade de Educação / Bibliografia: fl. [118]-21 / Made available in DSpace on 2018-09-14T20:38:00Z (GMT). No. of bitstreams: 1 Goldenberg_Sergio_D.pdf: 6512761 bytes, checksum: 1b148104c2753b09a57a0c970edd3f94 (MD5) Previous issue date: 1976 / Doutorado

According to the network theory of psychoneuroimmunology, (Hyland, 2011a), the placebo response is a short-term, problem solving response to a variety of inputs processed via the ‘infornet’. However, within the current infornet model of placebo response, these inputs are categorized as either conscious verbal inputs, or inputs learnt via traditional conditioning mechanisms. This thesis investigates the extent to which other ‘higher-order’ subliminal inputs may also play a part in determining placebo response. The findings presented here found no reliable effect of subliminal priming information on placebo response in a short-term placebo context. Further research is needed to determine if subliminally presented information is more likely to be used within a long-term placebo context. The lack of consistency in findings across this set of experiments supports replication criticisms leveled at the subliminal priming field, and the claim that differences in trivial contextual details may be the underlying cause of these inconsistencies. Theoretical and practical implications of these findings are also discussed.

No description available.

Background: The placebo effect and the placebo response is a misunderstood phenomenon and their potential is wildly underestimated. Most people, including health care professionals, consider the placebo effect to be a “make believe” effect which only affects gullible people. It is argued that the nurse is in an unusually advantageous position to observe and facilitate the placebo effect and make use of the benefits for the patients. Observation of said response is made by many authors but there is little to no research on the placebo effect from a nursing standpoint. Some of the research results can however be translated to the nurse profession and used in clinical settings. Aim: The purpose is to describe areas where the placebo effect may affect nursing of the patient. Method: A literature review format was chosen to comprise existing knowledge on the placebo effect, which can be applied for nursing. Results: Themes that arose from examination of chosen literature included: Emotional state, Expectation and Conditioning, Conscious and Social learning and Patient-caregiver relationship. Many of the observed interventions could be applied using the nursing philosophy of Hildegard Peplau. Conclusion: The placebo effect can be used by the nurse to improve the result of the patient´s treatment. If placebo becomes a focus in nursing research the results could be more applicable to benefit patients than if researched by other professional groups.

In clinical trials of drug treatments for women’s sexual dysfunction, placebo responses have often been substantial. Little is known about the nature and time course of symptom reduction with placebo treatment. It is also unknown to what extent placebo responses might be associated with individual characteristics, such as demographic variables, that influence responsiveness to treatment. Finally, it is unknown how sexual behavior during placebo treatment changes and whether changes in sexual behavior account for variability in outcomes. In the present work I investigated potential between-trial, between-person, and within-person variables that might explain variability in response to placebo treatment of sexual dysfunction in women. Study 1 consisted of a systematic review of the clinical trial literature to estimate the magnitude and predictors of placebo response across previous trials. Study 2 was an analysis of a small sample of women who were randomized to receive placebo in a recent clinical trial. These preliminary studies provided evidence of a relatively large clinical response among women randomized to placebo in controlled clinical trials of sexual dysfunction treatments. In addition, I found evidence of a possible effect of psychosocial variables on placebo response. In Study 3, I further tested the nature and correlates of placebo response in a sample of 50 women with sexual arousal and desire problems. These data were drawn from a 12-week double-blind randomized controlled trial in which measurement of symptom severity took place at baseline, 4 weeks, 8 weeks, and 12 weeks, allowing for longitudinal analysis. Change in sexual function during placebo treatment peaked at 4 weeks and remained relatively stable through post-treatment. Furthermore, change in sexual function was clinically meaningful in approximately one-third of the sample. Symptom improvement appeared to be in part a function of increased frequency of satisfying sexual encounters during treatment, although there remained additional variability in outcomes that could not be explained by the available data. The findings are discussed with reference to enhancing both clinical trial design and psychological therapies in the treatment of sexual dysfunction in women. / text

Fragile X Syndrome (FXS) is a disorder caused by a congenital mutation of the FMR1 gene on the X chromosome. FXS is associated with moderate to severe intellectual disability and is one known cause of autism spectrum disorders. There are no approved medications to treat FXS symptoms. In 2013, Seaside Therapeutics completed two Phase 3 studies of an investigational medication, STX209, for treatment of social withdrawal in FXS. Efficacy results for these studies were not positive. Clinical trials of psychoactive drugs often fail to show a statistical difference from placebo controls and a robust response to placebo is often cited as a reason for the failure. Retrospective studies of baseline variables in clinical trials have identified characteristics that were associated with an increased likelihood of responding to placebo. Such information is valuable for the design of future clinical trials and no such studies have been conducted in FXS. This study was a post-hoc analysis of data from Seaside Therapeutics' Phase 3 clinical trials in FXS. Baseline variables for subjects receiving placebo were pooled for analysis. To determine if a subject responded to placebo, the parent-rated ABC-SA and the ABC-IR were used. Clinician-rated assessments, including the CGI-S and CGI-I, were examined as well. Two-sample t-testing, one-way ANOVA testing, and correlation coefficients were calculated to compare the responses of subjects with different baseline characteristics. General linear regression modeling was used to determine if there were multiple baseline variables that could predict placebo response. Logistic regression modeling was used to determine if the baseline variables could predict whether a subject had a higher chance of being a treatment responder. A total of 287 subjects were randomized and completed the Phase 3 studies. Analyses for this study were conducted in a subgroup containing 106 subjects who received placebo. 76% improved during the study on the ABC-SA, indicating that there was a strong placebo effect on the study. None of the dichotomous baseline variables were associated with statistically significant differences in ABC-SA, ABC-IR, CGI-S, or CGI-I scores. Placebo-treated subjects in the 209FX302 study who were taking antipsychotics improved less on the CGI-S than those not on those medications. A similar pattern was observed on the ABC-IR and ABC-SA. Other categorical baseline variables were tested and there was no difference in the mean changes. The CGI-S score at baseline appeared to predict a statistically significant difference in the ABC-IR as more severe subjects were more likely to show a larger change in the ABC-IR. Similar, although not statistically significant results were seen with ABC-SA, CGI-I, and CGI-S changes, in that more severe subjects had greater responses to placebo. ABC-IR score changes were correlated independently with each of the ABC-C subscales but also with parental distress, CGI-S, and VAS-Anxiety. Only one variable, the ABC-IR at baseline, was significantly correlated with the ABC-SA score change, the rest of the variables were not significant. A multiple linear regression model predicting placebo response for the ABC-SA included only the baseline ABC-SA score. When the studies were modeled separately, the 209FX302 model contained additional variables including gender, antipsychotic use, and ABC-stereotypy scores. For the ABC-IR change model, the highest correlation coefficient was found in the 209FX301 study with ABC-IR, gender, Vineland-communication, maternal FMR1 status, and ABC-SL included in the model. 70% of the placebo treated subjects improved on the ABC-SA by at least 25%. Placebo responders were less frequently observed in clinician-rated assessments such as the CGI-I and CGI-S. In logistic regression models, for the ABC-IR response, a higher score on the hyperactivity subscale of the ABC-C was predictive of a lower placebo response. The CGI-S model was statistically significant and included the subject's age, race and ABC-IS score. The ABC-SA response could be modeled only in the 209FX302 study with gender and ADHD medication use remaining in the model. Also in the 209FX302 study, subjects were far less likely to be a responder on the ABC-IR or a total responder, if they were taking antipsychotic medications. Results of this study indicate that the ABC-SA is not recommended in future trials in the FXS patient population. Future trials should also allow ADHD and antipsychotic medication use as they were associated with a lower placebo response in some analyses. In addition, due to their inclusion in regression models, future studies should consider baseline variables such as parental stress and Vineland scores, and when designing study eligibility criteria or stratification variables.

Prior research has reported that individual differences influence both placebo and nocebo responses. The present study examined how individual personality, as well as trust, influence placebo/nocebo belief and symptom reporting after receiving an inert capsule that for some was described as an active “cognitively-enhancing” trial medication. Individuals (N = 104) were randomly assigned to one of three conditions: condition A participants were told they’d received the medication, condition B participants were told they’d received a placebo, and condition C participants were told, via random assignment, each would receive either the medication or placebo (after the experiment this condition listed the group – medication or placebo - each believed s/he was in). The study was completed in the UNT Student Health and Wellness Center to provide context in a medical setting. Of the 104 participants, 46 (44.2%) were either placed by experimental design or self-report in the medication group. Participants with a belief in medication ingestion, regardless of condition (i.e., A or C), reported significantly more symptoms (M = 16.65, SD = 3.178), than participants who believed they had ingested a placebo (M = 14.21, SD = 2.58), t (102) = 4.32, p = .001. Aspects of Neuroticism and Extroversion, as well as trust were correlated with symptom reporting and/or placebo/nocebo responses. It appears that that personality is part of a combination including trust, context and expectations. It is recommended that future research on personality and placebo effects consider the role of individual factors, context and communication of expectations.