Clinical relevance of contextual factors as triggers of placebo and nocebo effects in musculoskeletal pain

被引:185
作者
Rossettini, Giacomo [1 ]
Carlino, Elisa [2 ]
Testa, Marco [1 ]
机构
[1] Univ Genoa, Dept Neurosci Rehabil Ophthalmol Genet Maternal &, Campus Savona Via Magliotto 2, I-17100 Savona, Italy
[2] Univ Turin, Med Sch, Turin, Italy
关键词
Placebo; Nocebo; Contextual factors; Clinical reasoning; Pain; Expectation; Conditioning; Learning; Therapeutic encounter; Therapeutic relationship; LOW-BACK-PAIN; RANDOMIZED CONTROLLED-TRIALS; PATIENT EXPECTATIONS; HEALTH-CARE; THERAPEUTIC ALLIANCE; INFORMED-CONSENT; MANUAL THERAPY; HEALING TOUCH; BEHAVIORAL INTERVENTIONS; FIBROMYALGIA SYNDROME;
D O I
10.1186/s12891-018-1943-8
中图分类号
R826.8 [整形外科学]; R782.2 [口腔颌面部整形外科学]; R726.2 [小儿整形外科学]; R62 [整形外科学(修复外科学)];
学科分类号
摘要
Placebo and nocebo effects are embodied psycho-neurobiological responses capable of modulating pain and producing changes at different neurobiological, body at perceptual and cognitive levels. These modifications are triggered by different contextual factors (CFs) presented in the therapeutic encounter between patient and healthcare providers, such as healing rituals and signs. The CFs directly impact on the quality of the therapeutic outcome: a positive context, that is a context characterized by the presence of positive CFs, can reduce pain by producing placebo effects, while a negative context, characterized by the presence of negative CFs, can aggravate pain by creating nocebo effects. Despite the increasing interest about this topic; the detailed study of CFs as triggers of placebo and nocebo effects is still lacked in the management of musculoskeletal pain. Increasing evidence suggest a relevant role of CFs in musculoskeletal pain management. CFs are a complex sets of internal, external or relational elements encompassing: patient's expectation, history, baseline characteristics; clinician's behavior, belief, verbal suggestions and therapeutic touch; positive therapeutic encounter, patient-centered approach and social learning; overt therapy, posology of intervention, modality of treatment administration; marketing features of treatment and health care setting. Different explanatory models such as classical conditioning and expectancy can explain how CFs trigger placebo and nocebo effects. CFs act through specific neural networks and neurotransmitters that were described as mediators of placebo and nocebo effects. Available findings suggest a relevant clinical role and impact of CFs. They should be integrated in the clinical reasoning to increase the number of treatment solutions, boosts their efficacy and improve the quality of the decision-making. From a clinical perspective, the mindful manipulation of CFs represents a useful opportunity to enrich a well-established therapy in therapeutic setting within the ethical border. From a translational perspective, there is a strong need of research studies on CFs close to routine and real-world clinical practice in order to underline the uncertainty of therapy action and help clinicians to implement knowledge in daily practice.
引用
收藏
页数:15
相关论文
共 222 条
[1]   Mechanisms of the placebo response in pain in osteoarthritis [J].
Abhishek, A. ;
Doherty, M. .
OSTEOARTHRITIS AND CARTILAGE, 2013, 21 (09) :1229-1235
[2]  
Alfano M, 2015, AM J BIOETHICS, V15, P3, DOI 10.1080/15265161.2015.1074302
[3]   Response variability to analgesics: a role for non-specific activation of endogenous opioids [J].
Amanzio, M ;
Pollo, A ;
Maggi, G ;
Benedetti, F .
PAIN, 2001, 90 (03) :205-215
[4]   Neuropharmacological dissection of placebo analgesia: Expectation-activated opioid systems versus conditioning-activated specific subsystems [J].
Amanzio, M ;
Benedetti, F .
JOURNAL OF NEUROSCIENCE, 1999, 19 (01) :484-494
[5]   Lessons Learned From Nocebo Effects in Clinical Trials for Pain Conditions and Neurodegenerative Disorders [J].
Amanzio, Martina ;
Palermo, Sara ;
Skyt, Ina ;
Vase, Lene .
JOURNAL OF CLINICAL PSYCHOPHARMACOLOGY, 2016, 36 (05) :475-482
[6]   Activation likelihood estimation meta-analysis of brain correlates of placebo analgesia in human experimental pain [J].
Amanzio, Martina ;
Benedetti, Fabrizio ;
Porro, Carlo A. ;
Palermo, Sara ;
Cauda, Franco .
HUMAN BRAIN MAPPING, 2013, 34 (03) :738-752
[7]   Placebo Effects and the Ethics of Therapeutic Communication: A Pragmatic Perspective [J].
Annoni, Marco ;
Miller, Franklin G. .
KENNEDY INSTITUTE OF ETHICS JOURNAL, 2016, 26 (01) :79-103
[8]  
[Anonymous], 2016, BR J SPORTS MED
[9]   Patients' Expectations Predict Surgery Outcomes: A Meta-Analysis [J].
Auer, Charlotte J. ;
Glombiewski, Julia A. ;
Doering, Bettina K. ;
Winkler, Alexander ;
Laferton, Johannes A. C. ;
Broadbent, Elizabeth ;
Rief, Winfried .
INTERNATIONAL JOURNAL OF BEHAVIORAL MEDICINE, 2016, 23 (01) :49-62
[10]   Characteristics of therapeutic alliance in musculoskeletal physiotherapy and occupational therapy practice: a scoping review of the literature [J].
Babatunde, Folarin ;
MacDermid, Joy ;
MacIntyre, Norma .
BMC HEALTH SERVICES RESEARCH, 2017, 17