Motivation and emotion/Book/2024/Pain and placebo

Pain and placebo
What is the placebo effect in pain management and how does it work?

Multimedia presentation (3 min)

Overview

Case study highlighting the process of a patient successfully managing a source of pain via a placebo treatment

• What is a placebo
• How does a placebo impact pain management
• how to healthcare providers implement the use of a placebo successfully and ethically

Focus questions: What is a placebo response? What is a nocebo response? How do placebos effect the body? How are placebo treatments implemented? What are the ethical implications of a placebo?

Figure 1: A bottle of placebo tablets.

What is a placebo?

• A placebo is a treatment that does not itself have an effect itself, instead relying on the expectations of the patient. (Colloc, 2019)
• A placebo response is the outcome in which the patients symptoms reduce from a placebo. (Belcher et al., 2018)
• A nocebo response is the outcome in which the patients symptoms worsen from a placebo. (Belcher et al., 2018)
• Placebo analgesia is the treatment of pain using a placebo. (Muller et al., 2016)
  

How does a placebo manage pain?

• The placebo response can activate various bodily functions, such as hormones or neurotransmitters, that help mediate pain. (Abhishek & Doherty, 2013)
• Primarily effected by and increase in endogenous opioids and dopamine, and a decrease in cholecystokinin. (Abhishek & Doherty, 2013)
• Various brain regions such as the frontal cortex, thalamus, hypothalamus and anterior insula and there activity can be either increased or decreased due to the placebo response, leading to pain reduction. (Abhishek & Doherty, 2013)
  

How are placebo treatments implemented?

• Placebo treatments can be implemented with a variety of strategies, such as conditioning, observational/social learning and verbal cues. (Belcher et al., 2018)
• Placebo treatments can vary in effectiveness from patient to patient, depending on personality traits/individual differences. (Holmes, Tiwari & Kennedy, 2016) (Perfitt, Plunkett & Jones, 2020)

Methods to treatment.

• Conditioning can be used to associate a placebo with another drug, in order to associate the placebo with that drugs effects. (Belcher et al., 2018)
• The belief that the placebo will help with the patients symptoms can be created via verbal cues, such as a doctor stating that the placebo will help. (Belcher et al., 2018)
• The belief that the placebo will help with the patients symptoms can be created via social/observational learning, for instance seeing another person use the placebo as a successful treatment. (Belcher et al., 2018)

Individual differences.

• Placebo treatments can be successful or unsuccessful depending on the individual differences of the patient. (Perfitt, Plunkett & Jones, 2020)
• Some personality traits are associated with placebo success, such as extraversion, optimisim and religiosity. (Holmes, Tiwari & Kennedy, 2016)
• Inversely, some personality traits are associated with nocebo effects, such as pessimism and anxiety. (Perfitt, Plunkett & Jones, 2020)
• The cause/type of the pain can also effect which individual differences impact success rates. (Holmes, Tiwari & Kennedy, 2016)

Quiz

1 Placebo treatments can influence the activity of brain regions:

	True
	False

2 Individual differences do not impact the success of a placebo:

	True
	False

Conclusion

• The Conclusion is arguably the most important section
• Suggested word count: 150 to 330 words
• It should be possible for someone to only read the Overview and the Conclusion and still get a pretty good idea of the problem and what is known based on psychological science

Suggestions for this section: What is the answer to the sub-title question based on psychological theory and research? What are the answers to the focus questions? What are the practical, take-home messages? (Even for the topic development, have a go at the likely take-home message)

See also

• Placebo (Wikipedia)

References

Colloca, L. (2019). The Placebo Effect in Pain Therapies. Annual Review of Pharmacology and toxicology, 59, 191-211. https://doi.org/10.1146/annurev-pharmtox-010818-021542

Muller, M., Kamping, S., Benrath, J., Skowronek, H., Shmitz, J., Klinger, R., & Flor, H. (2016). Treatment history and placebo responses to experimental and clinical pain in chronic pain patients. European journal of pain, 20(9), 1530-1541. https://doi-org.ezproxy.canberra.edu.au/10.1002/ejp.877

Abhishek, A., & Doherty, M. (2013). Mechanisms of the placebo response in pain in osteoarthritis. Osteoarthritis and Cartilage, (21(9), 1229-1235. https://doi.org/10.1016/j.joca.2013.04.018

Belcher, M. A,. Ferre, S., Martinez, E. P., & Colloca, L. (2018). Role of placebo effects in pain and neuropsychiatric disorders, Progress in Neuro-Psychopharnacology and Biological Psychiatry, (87), 298-306. https://doi.org/10.1016/j.pnpbp.2017.06.003

Holmes, R. D., Tiwari, A. K., & Kennady, J. L. (2016) Mechanisms of the placebo effect in pain and psychiatric disorders, The Pharmacogenomics Journal, (16(6), 491-500. https://doi.org/10.1038/tpj.2016.15

Perfitt, J. S,. Plunkett, N., & Jones, S. (2020). Placebo effect in the managment of chronic pain, BJA Education, (20(11), 382-387. https://doi.org/10.1016/j.bjae.2020.07.002

External links

Provide external links to highly relevant resources such as presentations, news articles, and professional sites. Use sentence casing. For example:

• Six top tips for writing a great essay (University of Melbourne)
• The importance of structure (skillsyouneed.com)

Suggestions for this section: Only select links to major external resources about the topic Present in alphabetical order Include the source in parentheses after the link