Understanding the mechanisms of placebo and nocebo effects
Although placebos have long been considered a nuisance in clinical research, over recent years they have become an active and productive field of research. Indeed, the placebo effect represents an elegant model to understand how the brain works. It is worth knowing that there is not a single but m...
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| Format: | Article |
| Language: | English |
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SMW supporting association (Trägerverein Swiss Medical Weekly SMW)
2020-09-01
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| Series: | Swiss Medical Weekly |
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| Online Access: | https://www.smw.ch/index.php/smw/article/view/2865 |
| _version_ | 1826997124599906304 |
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| author | Elisa Frisaldi Aziz Shaibani Fabrizio Benedetti |
| author_facet | Elisa Frisaldi Aziz Shaibani Fabrizio Benedetti |
| author_sort | Elisa Frisaldi |
| collection | DOAJ |
| description |
Although placebos have long been considered a nuisance in clinical research, over recent years they have become an active and productive field of research. Indeed, the placebo effect represents an elegant model to understand how the brain works. It is worth knowing that there is not a single but many placebo effects, with different mechanisms across different systems, medical conditions and therapeutic interventions. For example, brain mechanisms of expectation, anxiety and reward are all involved, as well as a variety of learning phenomena. There is also some experimental evidence of different genetic variants in placebo responsiveness. Pain and Parkinson’s disease represent the most productive models to better understand the neurobiology of the placebo effect. In these medical conditions the neural networks involved have indeed been identified: that is, opioid, cannabinoid, cholecystokinin, cyclooxygenase, and dopamine modulatory networks in pain; and part of the basal ganglia circuitry in Parkinson’s disease. Overall, there is today compelling evidence that placebos and drugs share common biochemical pathways and activate the same receptor pathways, which suggests possible interference between social stimuli and therapeutic rituals on one hand and pharmacological agents on the other. The same holds true for the nocebo effect, the opposite phenomenon of placebo. The assessment of patients’ expectations should become the rule in clinical trials in order to allow us a better interpretation of therapeutic outcomes when comparing placebo and active treatment groups. Administering drugs covertly is another way to identify the placebo psychobiological component without the administration of any placebo, and this provides important information on the role of patient’s expectations in the therapeutic outcome. A further in-depth analysis of placebo and nocebo phenomena will certainly provide important information in the near future for a better understanding of human biology, medicine and society.
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| first_indexed | 2024-04-11T04:26:27Z |
| format | Article |
| id | doaj.art-ce5c5398553e40c59ae2deeb429ab660 |
| institution | Directory Open Access Journal |
| issn | 1424-3997 |
| language | English |
| last_indexed | 2025-02-18T09:56:37Z |
| publishDate | 2020-09-01 |
| publisher | SMW supporting association (Trägerverein Swiss Medical Weekly SMW) |
| record_format | Article |
| series | Swiss Medical Weekly |
| spelling | doaj.art-ce5c5398553e40c59ae2deeb429ab6602024-11-02T09:09:09ZengSMW supporting association (Trägerverein Swiss Medical Weekly SMW)Swiss Medical Weekly1424-39972020-09-01150353610.4414/smw.2020.20340Understanding the mechanisms of placebo and nocebo effectsElisa Frisaldi0Aziz Shaibani1Fabrizio Benedetti2University of Turin Medical School, Neuroscience Department, Turin, ItalyNerve and Muscle Center of Texas, Baylor College of Medicine, Houston, Texas, USAUniversity of Turin Medical School, Neuroscience Department, Turin, Italy; Medicine and Physiology of Hypoxia, Plateau Rosà, Switzerland Although placebos have long been considered a nuisance in clinical research, over recent years they have become an active and productive field of research. Indeed, the placebo effect represents an elegant model to understand how the brain works. It is worth knowing that there is not a single but many placebo effects, with different mechanisms across different systems, medical conditions and therapeutic interventions. For example, brain mechanisms of expectation, anxiety and reward are all involved, as well as a variety of learning phenomena. There is also some experimental evidence of different genetic variants in placebo responsiveness. Pain and Parkinson’s disease represent the most productive models to better understand the neurobiology of the placebo effect. In these medical conditions the neural networks involved have indeed been identified: that is, opioid, cannabinoid, cholecystokinin, cyclooxygenase, and dopamine modulatory networks in pain; and part of the basal ganglia circuitry in Parkinson’s disease. Overall, there is today compelling evidence that placebos and drugs share common biochemical pathways and activate the same receptor pathways, which suggests possible interference between social stimuli and therapeutic rituals on one hand and pharmacological agents on the other. The same holds true for the nocebo effect, the opposite phenomenon of placebo. The assessment of patients’ expectations should become the rule in clinical trials in order to allow us a better interpretation of therapeutic outcomes when comparing placebo and active treatment groups. Administering drugs covertly is another way to identify the placebo psychobiological component without the administration of any placebo, and this provides important information on the role of patient’s expectations in the therapeutic outcome. A further in-depth analysis of placebo and nocebo phenomena will certainly provide important information in the near future for a better understanding of human biology, medicine and society. https://www.smw.ch/index.php/smw/article/view/2865PlacebonocebopainParkinson’s diseaseDepressionimmune system |
| spellingShingle | Elisa Frisaldi Aziz Shaibani Fabrizio Benedetti Understanding the mechanisms of placebo and nocebo effects Swiss Medical Weekly Placebo nocebo pain Parkinson’s disease Depression immune system |
| title | Understanding the mechanisms of placebo and nocebo effects |
| title_full | Understanding the mechanisms of placebo and nocebo effects |
| title_fullStr | Understanding the mechanisms of placebo and nocebo effects |
| title_full_unstemmed | Understanding the mechanisms of placebo and nocebo effects |
| title_short | Understanding the mechanisms of placebo and nocebo effects |
| title_sort | understanding the mechanisms of placebo and nocebo effects |
| topic | Placebo nocebo pain Parkinson’s disease Depression immune system |
| url | https://www.smw.ch/index.php/smw/article/view/2865 |
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