Magister Scientiae Dentium - MSc(Dent) / Background and aim: Managing orthodontic pain traditionally involves the prescription of non-steroidal anti-inflammatory drugs combined with other analgesic medication. Sugar-free chewing gum has been advocated in the control of orthodontic pain due to its mechanical and physiological effects on periodontal tissue; however, the literature is scant. The ‘placebo effect’ that conventional sugar-free chewing gum may have in the relief of orthodontic pain has not been documented. The aim of this study was to compare the effectiveness of conventional sugar-free chewing gum in reducing orthodontic pain associated with fixed appliances with a placebo (sugar-free sweets) medicament. Objectives: The objectives of the study were to determine if there were differences in pain reporting between the sugar-free chewing gum and the placebo, to ascertain whether gender influenced pain scores and to observe any differences in pain reporting between different orthodontic techniques.

This study was undertaken with the objective of assessing whether the ingestion of a Multivitamin Complex with Calcium and Magnesium would be efficacious in reducing stress. Tlrree hundred subjects who were suffering from stress were selected in Gauteng and Kwa-Zulu Natal, South Africa. The selection was based on a stress questionnaire. The subjects took a battery of tests and questionnaires to assess the level ofthe stress they were experiencing. A 30 day supply of effeiVescent tablets was given to all subjects - half placebos and half the vitamin supplement. These were randomly allocated. At the end of30 days a further battery oftests were administered. The results were statistically analysed. It was found that both the placebo and the vitamin supplement proved beneficial but the Multivitamin Complex with Calcium and Magnesium had a greater effect in reducing and helping to manage stress. / Psychology / M.A. (Psychology)

Introdução: O presente estudo tem como objetivo avaliar a eficácia da estimulação magnética transcraniana de repetição (EMTr) em freqüência excitatória, aplicada ao córtex pré-frontal dorsolateral direito (CPFDLd), quando adicionada ao tratamento vigente de pacientes com transtorno obsessivocompulsivo (TOC) resistente. Método: 30 pacientes com TOC resistente ao tratamento foram alocados aleatoriamente para receber EMTr ativa ou placebo, sendo que a condição de tratamento permaneceu oculta para pacientes e avaliador. O tratamento vigente permaneceu estável por ao menos 8 semanas. A EMTr foi realizada com uma bobina em formato de oito à freqüência de 10Hz, com 110% do limiar motor em 30 sessões diárias de 40 séries de 5 segundos com 25 segundos de intervalo. A gravidade dos sintomas foi avaliada inicialmente, após 2 e 6 semanas de tratamento e 2 e 6 semanas de seguimento com a escala de Yale-Brown para avaliação de sintomas obsessivo-compulsivos (Y-BOCS), Escala de Impressão Clínica Global (CGI), Escala de Hamilton para ansiedade (HAM-A), Escala de Hamilton para depressão com 17 itens (HAM-D17), e inventário SF-36 de qualidade de vida. A medida primária de eficácia foi definida como redução de 30% ou mais nos escores da Y-BOCS e avaliação melhor ou muito melhor na sub-escala de melhora clínica da CGI ao término do seguimento. Resultados: A análise da medida primária de eficácia revelou que apenas um paciente em cada grupo preencheu critérios de resposta para o tratamento com EMTr (P=1.00). A análise de medidas repetidas dos escores de Y-BOCS mostrou um efeito significativo do tempo (F=7.33, P=0.002). Entretanto, não foi observada diferença entre os grupos ou interação grupo/tempo. A análise de medidas repetidas da CGI (gravidade), HAM-D17 e HAM-A também mostrou efeito significativo do tempo (P<0.001, =0.001 e <0.001 respectivamente), novamente sem diferença significativa entre os grupos ou interação. Conclusão: EMTr excitatória aplicada ao CPFDLd de pacientes com TOC resistente ao tratamento não foi diferente de placebo na redução de sintomas obsessivo-compulsivos ou melhora da impressão clínica global. Entretanto, ocorreu uma resposta placebo significativa / Introduction: The present study aims to evaluate the efficacy of added excitatory repetitive transcranial magnetic stimulation (rTMS), applied to the right dorsolateral prefrontal cortex in patients with treatment resistant obsessive-compulsive disorder (OCD). Methods: 30 treatment resistant OCD outpatients were randomized to receive either active or sham rTMS, remaining both patients and rater blind to treatment condition. Baseline treatment was kept stable for at least 8 weeks, and rTMS was performed with a figure-of-eight coil at 10Hz, 110% of motor threshold at 30 daily sessions of 40 trains of 5 seconds with 25 seconds interval. Symptom severity was determined at baseline and after 2 and 6 weeks of treatment and further 2 and 6 weeks of follow-up, using the Yale-Brown Obsessive Compulsive Scale (Y-BOCS), Clinical Global Impression Scale (CGI), Hamilton Anxiety Rating Scale (HAM-A), Hamilton Depression Rating Scale (HAM-D17) and SF-36 quality of life inventory. The primary outcome measure was defined as 30% or more improvement in Y-BOCS scores and a much improved or improved score at the CGIimprovement subscale by the end of follow up. Results: The analysis of primary outcome measure revealed that only one patient on each group met response criteria for treatment with rTMS (P=1.00). Repeated-measures analysis of Y-BOCS scores showed a significant effect of time (F=7.33, P=0.002). However, no significant group effect or group by time interaction was observed. Repeated measures analysis of CGI (severity), HAM-D17 and HAM-A also showed a significant effect of time (P<0.001, =0.001 and <0.001 respectively) with no significant group effect or group by time interaction. Conclusion: Excitatory rTMS delivered to the rDLPFC of treatment resistant OCD patients was not different from placebo in reducing obsessive-compulsive symptoms or improving clinical global impression. However, a significant placebo response occurred

INTRODUÇÃO: A rinite alérgica é uma condição clínica comum que apresenta sintomas diversos num significante número de pacientes, deteriorando a qualidade de vida daqueles refratários aos tratamentos usuais (anti-histamínicos e corticosteróides nasais tópicos). Apresentando princípios curativos similares, a imunoterapia sublingual e a homeopatia podem reduzir os sintomas e a necessidade de medicamentos na rinite alérgica, embora a eficácia e a efetividade de ambas terapêuticas não sejam ainda suficientemente conhecidas. OBJETIVOS: O objetivo deste estudo foi avaliar a efetividade clínica do tratamento homeopático individualizado prolongado, comparativamente ao placebo, em adultos portadores de rinite alérgica perene. MÉTODOS: Um total de 41 pacientes com rinite alérgica perene foi alocado numa primeira fase duplo-cego e placebo-controlada durante seis meses, sendo tratada com doses sublinguais semanais de medicamentos homeopáticos individualizados ou placebo. Após esta fase inicial fechada, todos os pacientes foram convidados a participar de uma segunda fase controlada aberta, em que receberiam tratamento homeopático pelo período máximo de 36 meses, e os resultados foram comparados com a melhora da fase inicial. O escore dos sinais e sintomas, a necessidade de medicamentos de resgate e a qualidade de vida foram mensurados por questionários e avaliações clínicas pessoais, aplicadas por um mesmo avaliador independente, antes e após cada fase. As doses dos medicamentos homeopáticos e de resgate utilizados, assim como os efeitos colaterais, foram documentados num diário pessoal. Os desfechos clínicos primário e secundários foram, respectivamente, os escores dos sinais e sintomas alérgicos específicos e gerais. Títulos da IgE total foram mensurados antes e após cada fase. RESULTADOS: Após os seis meses da fase placebo-controlada inicial, na análise por protocolo de todos os pacientes incluídos no estudo, não foram observadas diferenças significativas entre os grupos ativo e placebo nos escores clínicos, na utilização de drogas de resgate, na qualidade de vida e nos títulos da IgE total. Entretanto, as análises dos subgrupos da segunda fase mostraram uma crescente e significativa melhora nos desfechos clínicos primário e secundários após 12 meses de tratamento homeopático individualizado, comparativamente à variação de melhora dos mesmos pacientes na fase inicial fechada. Diferença significativa na qualidade de vida foi observada apenas após o segundo ano de tratamento homeopático. CONCLUSÃO: Neste estudo, o tratamento homeopático foi acompanhado de um significante efeito placebo. A efetividade da homeopatia pôde ser observada após 12 meses da terapêutica, apresentando efeito preventivo de longa duração após 36 meses de tratamento homeopático individualizado. / INTRODUCTION: Allergic rhinitis is a common clinical condition which presented several symptoms in a significant number of patients, deteriorating the quality of life in those resistant to the usual treatments (antihistamines and topical nasal corticosteroids). Presenting similar curative principles, sublingual immunotherapy and homeopathy can reduce symptoms and medication requirements in allergic rhinitis, although the efficacy and effectiveness of both therapeutics are not still sufficiently known. OBJECTIVES: The objective of this study was to evaluate clinical effectiveness of prolonged individualized homeopathic treatment, compared with placebo, in adults with perennial allergic rhinitis. METHODS: A total of 41 adults with perennial allergic rhinitis were enrolled in a first double-blind placebo-controlled phase for six months, and treated on a weekly basis with sublingual doses of single individualized homeopathic medicines or placebo. After this closed initial phase, all patients were invited to participate in an open label controlled phase, in that they would receive homeopathic treatment for the maximum period of 36 months, and the results were compared with the improvement of the initial phase. Signs and symptoms scores, rescue medication requirements and quality of life were assessed by questionnaires and personal clinical evaluation by a same independent researcher, before and after each phase. Applied homeopathic and rescue drugs dosage, and side effects were documented by diary cards. Primary and secondary clinical outcome were, respectively, specific and general allergic signs and symptoms scores. Total IgE titles were performed before and after each phase. RESULTS: After six months of placebo-controlled phase, analyzing all patients included in the study per protocol, we observed no significant difference between treatment and placebo groups in primary and secondary clinical outcomes, use of rescue drugs, quality of life and total IgE. However, second phase subgroups analysis showed a significant and growing improvement of clinical symptoms after 12 months of individualized homeopathic treatment, comparatively to the same patients\' variation in closed initial phase. Significant difference in quality of life score were observed only after second homeopathic treatment year. CONCLUSION: In this study, homeopathic treatment was accompanied by a significant placebo effect. Effectiveness of homeopathy could be seen after 12 months of therapy, presenting preventive effect of long duration after 36 months of individualized homeopathic treatment.

Introdução: O presente estudo tem como objetivo avaliar a eficácia da estimulação magnética transcraniana de repetição (EMTr) em freqüência excitatória, aplicada ao córtex pré-frontal dorsolateral direito (CPFDLd), quando adicionada ao tratamento vigente de pacientes com transtorno obsessivocompulsivo (TOC) resistente. Método: 30 pacientes com TOC resistente ao tratamento foram alocados aleatoriamente para receber EMTr ativa ou placebo, sendo que a condição de tratamento permaneceu oculta para pacientes e avaliador. O tratamento vigente permaneceu estável por ao menos 8 semanas. A EMTr foi realizada com uma bobina em formato de oito à freqüência de 10Hz, com 110% do limiar motor em 30 sessões diárias de 40 séries de 5 segundos com 25 segundos de intervalo. A gravidade dos sintomas foi avaliada inicialmente, após 2 e 6 semanas de tratamento e 2 e 6 semanas de seguimento com a escala de Yale-Brown para avaliação de sintomas obsessivo-compulsivos (Y-BOCS), Escala de Impressão Clínica Global (CGI), Escala de Hamilton para ansiedade (HAM-A), Escala de Hamilton para depressão com 17 itens (HAM-D17), e inventário SF-36 de qualidade de vida. A medida primária de eficácia foi definida como redução de 30% ou mais nos escores da Y-BOCS e avaliação melhor ou muito melhor na sub-escala de melhora clínica da CGI ao término do seguimento. Resultados: A análise da medida primária de eficácia revelou que apenas um paciente em cada grupo preencheu critérios de resposta para o tratamento com EMTr (P=1.00). A análise de medidas repetidas dos escores de Y-BOCS mostrou um efeito significativo do tempo (F=7.33, P=0.002). Entretanto, não foi observada diferença entre os grupos ou interação grupo/tempo. A análise de medidas repetidas da CGI (gravidade), HAM-D17 e HAM-A também mostrou efeito significativo do tempo (P<0.001, =0.001 e <0.001 respectivamente), novamente sem diferença significativa entre os grupos ou interação. Conclusão: EMTr excitatória aplicada ao CPFDLd de pacientes com TOC resistente ao tratamento não foi diferente de placebo na redução de sintomas obsessivo-compulsivos ou melhora da impressão clínica global. Entretanto, ocorreu uma resposta placebo significativa / Introduction: The present study aims to evaluate the efficacy of added excitatory repetitive transcranial magnetic stimulation (rTMS), applied to the right dorsolateral prefrontal cortex in patients with treatment resistant obsessive-compulsive disorder (OCD). Methods: 30 treatment resistant OCD outpatients were randomized to receive either active or sham rTMS, remaining both patients and rater blind to treatment condition. Baseline treatment was kept stable for at least 8 weeks, and rTMS was performed with a figure-of-eight coil at 10Hz, 110% of motor threshold at 30 daily sessions of 40 trains of 5 seconds with 25 seconds interval. Symptom severity was determined at baseline and after 2 and 6 weeks of treatment and further 2 and 6 weeks of follow-up, using the Yale-Brown Obsessive Compulsive Scale (Y-BOCS), Clinical Global Impression Scale (CGI), Hamilton Anxiety Rating Scale (HAM-A), Hamilton Depression Rating Scale (HAM-D17) and SF-36 quality of life inventory. The primary outcome measure was defined as 30% or more improvement in Y-BOCS scores and a much improved or improved score at the CGIimprovement subscale by the end of follow up. Results: The analysis of primary outcome measure revealed that only one patient on each group met response criteria for treatment with rTMS (P=1.00). Repeated-measures analysis of Y-BOCS scores showed a significant effect of time (F=7.33, P=0.002). However, no significant group effect or group by time interaction was observed. Repeated measures analysis of CGI (severity), HAM-D17 and HAM-A also showed a significant effect of time (P<0.001, =0.001 and <0.001 respectively) with no significant group effect or group by time interaction. Conclusion: Excitatory rTMS delivered to the rDLPFC of treatment resistant OCD patients was not different from placebo in reducing obsessive-compulsive symptoms or improving clinical global impression. However, a significant placebo response occurred

This study was undertaken with the objective of assessing whether the ingestion of a Multivitamin Complex with Calcium and Magnesium would be efficacious in reducing stress. Tlrree hundred subjects who were suffering from stress were selected in Gauteng and Kwa-Zulu Natal, South Africa. The selection was based on a stress questionnaire. The subjects took a battery of tests and questionnaires to assess the level ofthe stress they were experiencing. A 30 day supply of effeiVescent tablets was given to all subjects - half placebos and half the vitamin supplement. These were randomly allocated. At the end of30 days a further battery oftests were administered. The results were statistically analysed. It was found that both the placebo and the vitamin supplement proved beneficial but the Multivitamin Complex with Calcium and Magnesium had a greater effect in reducing and helping to manage stress. / Psychology / M.A. (Psychology)

INTRODUÇÃO: A rinite alérgica é uma condição clínica comum que apresenta sintomas diversos num significante número de pacientes, deteriorando a qualidade de vida daqueles refratários aos tratamentos usuais (anti-histamínicos e corticosteróides nasais tópicos). Apresentando princípios curativos similares, a imunoterapia sublingual e a homeopatia podem reduzir os sintomas e a necessidade de medicamentos na rinite alérgica, embora a eficácia e a efetividade de ambas terapêuticas não sejam ainda suficientemente conhecidas. OBJETIVOS: O objetivo deste estudo foi avaliar a efetividade clínica do tratamento homeopático individualizado prolongado, comparativamente ao placebo, em adultos portadores de rinite alérgica perene. MÉTODOS: Um total de 41 pacientes com rinite alérgica perene foi alocado numa primeira fase duplo-cego e placebo-controlada durante seis meses, sendo tratada com doses sublinguais semanais de medicamentos homeopáticos individualizados ou placebo. Após esta fase inicial fechada, todos os pacientes foram convidados a participar de uma segunda fase controlada aberta, em que receberiam tratamento homeopático pelo período máximo de 36 meses, e os resultados foram comparados com a melhora da fase inicial. O escore dos sinais e sintomas, a necessidade de medicamentos de resgate e a qualidade de vida foram mensurados por questionários e avaliações clínicas pessoais, aplicadas por um mesmo avaliador independente, antes e após cada fase. As doses dos medicamentos homeopáticos e de resgate utilizados, assim como os efeitos colaterais, foram documentados num diário pessoal. Os desfechos clínicos primário e secundários foram, respectivamente, os escores dos sinais e sintomas alérgicos específicos e gerais. Títulos da IgE total foram mensurados antes e após cada fase. RESULTADOS: Após os seis meses da fase placebo-controlada inicial, na análise por protocolo de todos os pacientes incluídos no estudo, não foram observadas diferenças significativas entre os grupos ativo e placebo nos escores clínicos, na utilização de drogas de resgate, na qualidade de vida e nos títulos da IgE total. Entretanto, as análises dos subgrupos da segunda fase mostraram uma crescente e significativa melhora nos desfechos clínicos primário e secundários após 12 meses de tratamento homeopático individualizado, comparativamente à variação de melhora dos mesmos pacientes na fase inicial fechada. Diferença significativa na qualidade de vida foi observada apenas após o segundo ano de tratamento homeopático. CONCLUSÃO: Neste estudo, o tratamento homeopático foi acompanhado de um significante efeito placebo. A efetividade da homeopatia pôde ser observada após 12 meses da terapêutica, apresentando efeito preventivo de longa duração após 36 meses de tratamento homeopático individualizado. / INTRODUCTION: Allergic rhinitis is a common clinical condition which presented several symptoms in a significant number of patients, deteriorating the quality of life in those resistant to the usual treatments (antihistamines and topical nasal corticosteroids). Presenting similar curative principles, sublingual immunotherapy and homeopathy can reduce symptoms and medication requirements in allergic rhinitis, although the efficacy and effectiveness of both therapeutics are not still sufficiently known. OBJECTIVES: The objective of this study was to evaluate clinical effectiveness of prolonged individualized homeopathic treatment, compared with placebo, in adults with perennial allergic rhinitis. METHODS: A total of 41 adults with perennial allergic rhinitis were enrolled in a first double-blind placebo-controlled phase for six months, and treated on a weekly basis with sublingual doses of single individualized homeopathic medicines or placebo. After this closed initial phase, all patients were invited to participate in an open label controlled phase, in that they would receive homeopathic treatment for the maximum period of 36 months, and the results were compared with the improvement of the initial phase. Signs and symptoms scores, rescue medication requirements and quality of life were assessed by questionnaires and personal clinical evaluation by a same independent researcher, before and after each phase. Applied homeopathic and rescue drugs dosage, and side effects were documented by diary cards. Primary and secondary clinical outcome were, respectively, specific and general allergic signs and symptoms scores. Total IgE titles were performed before and after each phase. RESULTS: After six months of placebo-controlled phase, analyzing all patients included in the study per protocol, we observed no significant difference between treatment and placebo groups in primary and secondary clinical outcomes, use of rescue drugs, quality of life and total IgE. However, second phase subgroups analysis showed a significant and growing improvement of clinical symptoms after 12 months of individualized homeopathic treatment, comparatively to the same patients\' variation in closed initial phase. Significant difference in quality of life score were observed only after second homeopathic treatment year. CONCLUSION: In this study, homeopathic treatment was accompanied by a significant placebo effect. Effectiveness of homeopathy could be seen after 12 months of therapy, presenting preventive effect of long duration after 36 months of individualized homeopathic treatment.

<div>This dissertation redefines the placebo effect in light of new empirical observations and certain strands of philosophical ethics. </div>Chapter 1 critically reviews available definitions of placebo responsiveness against their abilities to hang together the diversity of empirical observations and emerging research interests. Projecting Wittgenstein's example of a child learning pain language, Chapter 2 redefines the phenomenon as a particular kind of experience of meaning and reconsiders clinical empathy in terms of the loss and recovery of language that belongs to illness experience and diagnosis. Chapter 3 broadens the account of psychosomatic responsiveness from the experience of meaning to the experience of values, utilising Canguilhem's definition of health and Nietzsche's genealogical account of the health of values. Chapter 4 explores the foregoing by recounting how Wittgenstein's moral philosophy might hold together the traditional ethical and bioethical question of what makes life worth living with psychosomatic responsiveness.

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Thèse présentée en vue de l’obtention du grade de Philosophiae Doctor (Ph.D.) en Psychologie, option Neuropsychologie clinique / La douleur est un enjeu central dans le domaine médical. La gestion efficace de la douleur aiguë est cruciale pour prévenir la douleur chronique. Parmi les diverses conditions cliniques, la douleur est prédominante chez les patients ayant subi un trauma orthopédique, persistant plusieurs jours après la blessure, avec un risque élevé de complications. Cependant, les traitements pharmacologiques, comme les opiacés et les anti-inflammatoires non stéroïdiens, bien que couramment utilisés, peuvent avoir des effets négatifs sur la consolidation osseuse et la santé générale. Dans ce contexte, il apparaît pertinent d’explorer des méthodes d’intervention alternatives, telles que la stimulation magnétique transcrânienne répétitive (SMTr). Bien que cette technique soit prometteuse pour le traitement de la douleur chronique, son efficacité dans les douleurs aiguës reste incertaine. De plus, l’effet placebo, qui joue un rôle dans les traitements de la douleur, a souvent été sous-estimé dans les études antérieures sur la SMTr. Par ailleurs, le taux de réponse à la SMTr varie beaucoup chez les individus. Ainsi, mieux comprendre les effets spécifiques de la SMTr et de l’effet placebo associé pourrait améliorer son efficacité. Cette thèse visait donc à combler ces lacunes en poursuivant deux objectifs principaux. Le premier était d’explorer l’effet placebo associé à l’utilisation d’un protocole multisessions de SMTr en phase aiguë chez des patients ayant subi une fracture du membre supérieur. Dans cette étude, un groupe a reçu une intervention de SMTr sham, tandis que l’autre a uniquement bénéficié des soins orthopédiques usuels. Les résultats ont révélé un effet significatif du placebo dans le groupe ayant reçu la SMTr sham, suggérant des bénéfices de l’intervention sur la guérison en termes d’intensité douloureuse et de récupération fonctionnelle. Il est donc impératif que les études futures incluent des groupes témoins pour distinguer les effets spécifiques de la SMTr des effets non spécifiques (p. ex., évolution naturelle de la condition) et de l’effet placebo. Cette étude met aussi en lumière la nécessité d’améliorer les soins en orthopédie, tout en appelant à des recherches supplémentaires pour comprendre le rôle des différents facteurs impliqués (p. ex., utilisation du placebo, cadre thérapeutique, etc.). Le second objectif portait sur la faisabilité et l’efficacité d’un protocole de SMTr (actif vs sham), bonifié par une procédure de conditionnement, dans le cadre d’une douleur expérimentale induite chez des individus en bonne santé. Ce protocole visait à optimiser la réponse à la SMTr en modulant à la fois le seuil de douleur et les attentes de soulagement des participants, un facteur clé influençant la réponse aux interventions analgésiques. Néanmoins, les résultats se sont révélés peu concluants en raison de limitations méthodologiques (p. ex., la procédure de conditionnement utilisée, absence de suggestions verbales, etc.). Ainsi, des études futures pourraient apporter des améliorations au protocole et l’appliquer auprès d’une population souffrant de douleurs cliniques, dont l’expérience douloureuse et les attentes diffèrent de celles des individus en bonne santé. En effet, les individus souffrant de douleurs chroniques ou aiguës sont plus souvent réceptifs aux interventions thérapeutiques, ce qui pourrait améliorer les résultats futurs. / Pain is a common issue in the medical field, and optimal management during the acute phase is critical to preventing chronic pain. Among various clinical conditions, pain is a predominant symptom in orthopedic trauma patients, which persists for several days after the injury, with a high risk of complications. However, managing pain in this population proves to be a significant challenge, as pharmacological treatments such as opioids and non-steroidal anti-inflammatory drugs are frequently used despite their potential adverse effects on bone healing and patients’ overall health. Therefore, exploring alternative intervention methods, such as repetitive transcranial magnetic stimulation (rTMS), is necessary. While rTMS has shown analgesic potential in chronic and experimental pain, its effectiveness in managing acute pain remains uncertain. Moreover, the analgesic placebo effect involved in all pain interventions seems to have been underestimated, if not neglected, in previous rTMS studies. Additionally, the response rate to rTMS varies widely among individuals, such that any endeavour aiming to deepen our understanding of the specific effects of rTMS and associated placebo effects could reveal to be fruitful in optimizing its efficacy. Therefore, this thesis aimed to address these gaps through two main objectives. The first study investigated the placebo effect of a multi-session sham rTMS protocol in the context of acute pain in patients with an upper limb fracture, by comparing their clinical outcomes to a group receiving standard orthopedic care. The results showed a significant placebo effect in the group receiving sham rTMS, suggesting that the placebo intervention benefited the healing trajectory in terms of pain level and functional recovery. This underscores the importance of including control groups in future rTMS studies to better distinguish between the specific effects of rTMS, non-specific effects (such as natural recovery), and the placebo effect. Furthermore, the study indicates that current orthopedic care models could be enhanced by subacute, multi-session interventions, although further validation is needed. The second study focused on the feasibility and effectiveness of an rTMS protocol (active vs sham) enhanced with a conditioning procedure in healthy individuals experiencing experimental pain. This protocol aimed to optimize the response to rTMS by modulating participants' pain thresholds and their expectations of pain relief, a factor known to influence outcomes in analgesic interventions. However, the results of this study were inconclusive, likely due to various methodological limitations (e.g., ineffective conditioning procedure, number of rTMS sessions, crossover design, absence of verbal suggestions, etc.). Although the design of our protocol did not prove effective, future studies could make methodological adjustments and apply this protocol to a population suffering from clinical pain. Thus, it is important to bear in mind that the painful experience of a clinical population differs from that of healthy individuals. Indeed, patients with clinical pain may have different expectations regarding treatments, which could influence their responsiveness to interventions.