Bakgrund: Placebo finns i en mängd olika former, allt från läkemedel till manipulation av utrsutning. Hur placebo fungerar i kroppen är svårt att fastslå, trots detta har positiva effekter påvisats genom minskad kronisk smärta (Finnis et al., 2010), sömnlöshet (Belanger et al., 2007) och depression (Kirsch et al., 2008). Tidigare studier visar även att styrkelyftare ökar sin maximala styrka med hjälp av placebo. Metod: Studien är en cross-over experimentell design där totalt 19 deltagare medverkat. Två stycken kapslar, en på 300 mg och en större på 450 mg används för att se skillnader i ett trial making test och ett beeptest. Syftet med studien är att undersöka och kvantifiera placeboeffekten. Studien baseras på hypotsen att priset på, och mängden av ett placebopreparat påverkar resultatet i ett test för fysisk prestation (beeptest) och i ett test som mäter koncentrationsförmågan (Trial making test). Resultat: Trial making test del a visade ingen signifikant skillnad mellan kapsel a och kapsel b (p=0,699). Trial making test del b rapporterade inte någon signifikant skillnad mellan kapsel a och b (p=0,161). Vid beeptestet rapporterades det även här ingen signifikant skillnad mellan kapsel a och b (p=0.839). Slutsats: Det är svårt att dra en slutsats om vi lyckats övertala deltagarna tillräckligt för att bevisa att en placeboeffekt påverkar resultatet i ett beeptest och i ett trial making test. En annan fråga vi ställer oss är om beeptestet är rätt val av test för att testa placebons effekt eftersom mycket runt omkring kan ha påverkat deltagarna, exempelvis av varandra och hur de presterar. Detta är något som vi tror kan ha påverkat resultatet.

Mémoire numérisé par la Direction des bibliothèques de l'Université de Montréal.

In religious faith I am finding the similar principle to the placebo effect. Placebo effect is associated to human belief and it is so powerful phenomenon that if the new drug in medicine is tested it has to be done through double-blind studies to eliminate the effect of placebo. Without this elimination, even non-working medicaments are having positive impact. In medicine, a placebo is commonly used to cure physiological or psychological problem, to achieve the effect, result. But there are other ways where we can meet placebo and is not it so easily recognized. Placebo can be a message, political doctrine or religious belief. Placebo investigates a mysterious area of effect without apparent cause, it is merely a reflection of our state of mind. Religion wraps its doctrine in sparkly packaging, tinsel, so that it is easily consumable and friendly. But under the wrapping is nothing but a placebo pill, we are attracted to, and which we may or may not believe will work. The pill is nothing, has no content, it is empty. It is in some way false, fake and illusory. But the most interesting part is that works reliably for decades.

Objectives: Most weight loss medications target reductions in energy intake while neglecting energy expenditure, a critical predictor of weight loss/regain. This pilot study examined the effect of short-acting methylphenidate (MPH) on resting energy expenditure (REE), thermic effect of food (TEF), physical activity energy expenditure (PAEE), and how changes in energy expenditure relate to changes in body composition in youth and adults living with obesity. Methods: This study was a randomized, double-blind, placebo-controlled two-parallel arm study. In total, 19 participants were screened, of which 14 participants were randomized into the study, but complete data was only collected for 12, and only analyzed for 10 participants. Those 10 participants aged 28.8 ± 6.9 yrs. (5 Male, 5 Female) were randomized to receive either MPH (0.5 mg/kg) (n = 5) or placebo (n =5) twice daily for 60 days. Participants’ REE and TEF (indirect calorimetry), were measured at baseline (no drug/placebo), and day 60 post-treatment (drug/placebo). Participants’ PAEE (Actical) was measured between screening and baseline for a 1-week period (no drug/placebo), and on day 53 for a 1-week period (drug/placebo). Participants’ anthropometrics were measured using DEXA at baseline, and day 60 post-treatment. Results: From baseline to day 60, MPH showed a relative difference to placebo in relative REE (Relative REE: F(1, 8) = 4.235, p = 0.074, d = 0.83, 2 = 0.346) of 10%, evidenced by a 6% increase in relative REE kcal/kg (18.53 ± 1.97 Kcal/day/kg at baseline, 19.71 ± 2.52 Kcal/day/kg at final) for the MPH group, and a 4% decrease (19.08 2.36 Kcal/day/kg at baseline, 18.26 ± 2.04 Kcal/day/kg at final) in placebo, translating to moderate-effect size (Cohen’s d=0.63) favouring MPH. From baseline to day 60, there were no significant differences between groups on changes in TEF (TEF AUC: F(1, 8) = 0.079, p = 0.785, d = 0.15, 2 = 0.010) or any PAEE variables such as sedentary behavior (SB: F (1, 8) = 0.455, p = 0.52, d = 0.02, 2 = 0.054), light physical activity (LPA: F (1, 8) = 0.504, p = 0.50, d = 0.16, 2 = 0.059), moderate physical activity (MPA: F (1, 8) = 0.281, p = 0.61, d = 0.19, 2 = 0.034), moderate-to-vigorous physical activity (MVPA: F (1, 8) = 0.120, p = 0.74, d = 0.15, 2 = 0.015), or vigorous physical activity (VPA: F (1, 8) = 3.495, p = 0.098, d = 0.91, 2 = 0.304) . Mean change in body weight (kg) resulted in a weight loss of roughly -2.66 ± 2.00 kg in the MPH group and -1.64 ± 1.41 kg in the placebo group, differences that were not statistically significant. Mean change in both groups for body fat% of -0.33 ± 2.08 %, mean change in fat mass of -1.05 ± 2.59 kg, and finally a mean change in fat-free mass of -0.06 ± 1.19 kg was reported. Changes in relative REE were inversely correlated with changes in body weight (r = -0.599, p = 0.067), body fat (r = -0.524, p = 0.12) and fat mass (r = -0.599, p = 0.096). These associations were stronger in the MPH group. Conclusions: Our data suggests that MPH administration may lead to a meaningful increase in relative REE, and these suggested changes were associated with reductions in adiposity among individuals with obesity. These preliminary findings suggest that MPH should be further examined using a larger sample size and study duration to determine its effectiveness in promoting weight loss and maintenance of weight loss in individuals with obesity, a population at high risk of morbidity and premature mortality.

Made available in DSpace on 2015-04-14T13:36:07Z (GMT). No. of bitstreams: 1 395365.pdf: 1650433 bytes, checksum: 314debda01604f166f617cfc3552807d (MD5) Previous issue date: 2005-06-15 / Introdu??o: A efic?cia do cloridrato de sertralina para prevenir Hipotens?o Arterial Intradial?tica (HID) n?o est? estabelecida. M?todos: Foi realizado um estudo duplo cego cruzado, randomizado, controlado com placebo em 18 pacientes, que apresentaram mais de 15 epis?dios de hipotens?o nas ?ltimas 25 sess?es de hemodi?lise. Um grupo recebeu oito semanas de sertralina 50mg/dia seguido de oito semanas de placebo. Outro grupo recebeu placebo seguido de sertralina. Apenas os dados das quatro semanas finais de cada per?odo foram considerados. As seguintes vari?veis foram avaliadas: peso, ultrafiltra??o, press?o arterial, epis?dios de hipotens?o, interven??es de enfermagem, dados laboratoriais e escore depressivo (Invent?rio de Depress?o de Beck). Os dados foram analisados usando o m?todo estat?stico usual e modelo que identifica a interfer?ncia do efeito de per?odo, e do efeito de intera??o entre per?odo e tratamento. Resultados: Antes do estudo, o n?mero de epis?dios de hipotens?o por sess?o foi de 0,8 ? 0,1 [mediana 0,7 (0,6 0,9], significativamente maior que 0,5 ? 0,4 [0,33 (0,08 0,83)] usando sertralina (p = 0,027) e que 0,3 ? 0,2 [0,21 (0,17 0,42)] usando placebo (p = 0,001). O n?mero de epis?dios de hipotens?o e de interven??es de enfermagem foi similar durante o per?odo de uso de placebo ou sertralina. Efeito de intera??o entre per?odo e tratamento foi observado para escore depressivo e sucesso de ultrafiltra??o. Efeito de per?odo foi observado para as vari?veis de peso pr? e p?s-di?lise e sucesso de ultrafiltra??o. Efeito de tratamento foi observado para as vari?veis de ganho de peso interdial?tico e ultrafiltra??o, que foram maiores no grupo em uso de placebo e para n?mero de epis?dios de hipotens?o/sess?o, que foi menor nesse grupo. Conclus?es: O uso de sertralina n?o foi efetivo em prevenir os epis?dios de hipotens?o intradial?tica no presente estudo.

With increasing life expectancy and global population of older adults, preserving cog- nitive function throughout life represents a growing priority. Numerous approaches to cognitive enhancement exist, but few have scientific merit. Among the most preva- lent – and commercialized – approaches are cognitive training (“brain training”) and non-invasive brain stimulation through electric currents applied at the surface of the scalp. The present dissertation describes a collection of work contextualizing the appeal of these cognitive enhancement methods and addressing some of the most pervasive limitations of research in this field thus far. One largely ignored issue in cognitive intervention research pertains to people’s expectations of programs and their relationship with intervention outcomes. In a series of initial studies, we developed and validated the Expectation Assessment Scale (EAS), a tool created to measure as well as prime expectations of outcomes in the context of cognitive enhancement interventions. In our first two studies, we probed expectations of cognitive training or non-invasive brain stimulation in over 1,000 young, middle-aged, and older adults. Ratings on the EAS suggested that older adults may have particularly high expectations of cognitive training, but that expectations can be primed to increase or decrease – at least in hypothetical scenarios. We used these data to assess the psychometric properties of the EAS with item-response theory, and confirmed its internal consistency. Next, we incorporated the EAS into two cognitive enhancement trials, one in- vestigating a computerized cognitive training intervention in nearly 100 older adults and another examining non-invasive brain stimulation in nearly 100 young adults. Both trials had a double-blind balanced-placebo design in which participants were assigned to the intervention or control condition, and then subdivided to receive ei- ther high or low expectation priming (i.e., primed to have high or low expectations of the program’s effectiveness). Although expectation ratings replicated our previous findings, results from these trials suggest little, if any, effect of either expectations or the intervention on performance outcomes. We nevertheless found that participants enjoyed their assigned program and that those who received high expectation prim- ing tended to report a more positive experience. Our findings put into question the effectiveness of such interventions and support the need for more rigorous trials of cognitive enhancement.

Pain is the oldest medical condition and has been referenced through the ages. TENS is a non-invasive treatment for pain. Despite conflicting reports of treatment outcomes, TENS has enjoyed widespread clinical utilization. Seminal work by Sluka and colleagues reported low frequency TENS produces anti-hyperalgesia through µ-opioid receptors and high frequency TENS produces anti-hyperalgesia through ä-opioid receptors in an animal model of inflammation. The experimental results suggested that pain can be reduced by both high and low frequency TENS but by differing opioid receptors. These important findings require translational experiments to be conducted in humans. Providing an adequate placebo for experimental investigation of any physical intervention presents as a challenge. An improvement in the placebo intervention is critical to ascertain the true effects of TENS on painful conditions. Clinical TENS experiments often only examine a single outcome - resting pain. Recent work suggests TENS is less effective on resting pain as compared to movement pain. Investigation to determine which outcome measures (pain at rest, movement pain, pain sensitivity, and function) are most likely to be affected by TENS in human subjects with pain are critical to inform the design of future studies. The least investigated parameter for application of TENS electrode site determination. One method of selection employs a technique of finding points on the skin with suspected lower impedance. To date, no literature exists to determine the effectiveness of this clinical practice and speculation has existed for decades regarding the existence of distinct electrical properties associated with specific points on the body. This series of experiments accomplishes the goals of improving the TENS placebo, testing established parameters from basic science experiments in a patient population, testing multiple outcome measures to direct future investigation; and examined the effect of electrode site selection in TENS analgesia. These experiments were the first to establish a placebo that can 100% blind the TENS examiner, to test this placebo in a patient population, and to show that although there are differences in impedance between optimal and sham sites, that this difference had no effect in the amount of analgesia produced by TENS.

Die prophylaktische retrosternale Einlage eines Gentamicin-Kollagen Schwammes wurde in letzter Zeit in mehreren Studien untersucht und ist wird kontrovers diskutiert. Die vorliegende Studie ist die erste prospektiv randomisierte, Einzelzentrums-Doppelblind-Studie zur Untersuchung der Effektivität, im Hinblick auf die Reduktion sternaler Wundkomplikationen nach herzchirurgischen Eingriffen, eines retrosternal eingelegten Gentamicin-Kollagen-Schwammes. / Prophylactic retrosternal placement of a Gentamicin-collagen sponge has been the subject of several recent clinical studies and is a matter of controversy. The present study is the first controlled, prospective, randomized, double-blind, single-center study to investigate the efficacy of a retrosternal Gentamicin-collagen sponge in reducing sternal wound complications after heart surgery.

Placebo treatments are inert but are known to alleviate symptoms across numerous clinical conditions. One of the most studied placebo effects is placebo analgesia, which is a placebo effect limited to pain relief. This thesis aims to introduce the current state of research regarding the neuroscience of placebo analgesia and specifically to present research findings regarding the neurotransmission. Studies have demonstrated that placebo analgesia can be elicited through two separate processes interacting with each other; manipulation of expectations and through conditioning. These processes seem to affect neurotransmission in different ways. Many brain areas have been found to be correlated to placebo analgesia. Besides the pain-processing brain areas, studies point to that the prefrontal cortex can have a vital role in the placebo analgesic effect. Known neurotransmitters that have shown to be involved in placebo analgesia are endogenous opioids, cholecystokinin (CCK), and endocannabinoids. Studies point to that endogenous opioids are involved in the placebo analgesic effect when elicited by expectation or conditioned by an opioid drug. CCK act on placebo analgesia by affecting the release of endogenous opioids and endocannabinoids seem to be involved in placebo analgesia while it occurs due to conditioning with non-opioid drugs. Getting a better understanding of placebo analgesia and find ways to apply this knowledge in the clinical context could powerfully develop the whole medical society.

<p>The overarching purpose of the current thesis was to assess the long term effects of a treatment program involving flotation-REST for the experience of pain, from the point of view of variables connected with Melzack´s neuromatrix theory, and to examine the extent of a potential attention-placebo effect in connection with flotation-REST.</p><p>The first study (Paper I) aimed to investigate long-term effects of flotation-REST four months after treatment. Seventy patients participated, diagnosed as having stress-related pain. Participants were randomly assigned to either a control group or a flotation-REST group and participated in a total of twelve flotation REST or control sessions. Results indicated that pain areas, stress, anxiety and depression decreased, while sleep quality, optimism, and prolactin increased. Positive effects generally maintained four months after treatment. The second (Paper II) examined the potential effects of attention-placebo. Thirty-two patients who were diagnosed as having stress-related muscular pain were treated for a period of six weeks. Half of the patients were also given attention for a period of 12 weeks, while the remainder received attention for 6 weeks. Participants in both groups exhibited lowered blood pressure, reduced pain, anxiety, depression, stress, and negative affectivity, as well as increased optimism, energy, and positive affectivity. The third (Paper III) investigated whether or not 33 flotation sessions were more effective for stress related ailments as compared to 12 sessions. Participants were 37 patients with stress related ailments. Analyzes for subjective pain and psychological variables typically indicated that 12 sessions were enough to get considerably improvements and no further improvements were noticed after 33 sessions. Finally, the fourth study (Paper IV) aimed to examine whether and how the combination of therapy and flotation tank could be used to treat patients with severe stress problems. Two women on long-term sick-leave participated in the study, which was carried out over a period of one year. Four overarching themes were generated: the therapeutic work model, transformation of feelings, self-insight and meaning. These together constituted a “therapeutic circle” which after a while transformed in to a “therapeutic spiral” of increased meaning and enhanced wellbeing.</p><p>It was therefore concluded that flotation tank therapy is an effective method for the treatment of stress-related pain.</p>