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A Review of the Theoretical and Biological Understanding of the Nocebo and Placebo Phenomena.
Clin Ther. 2017 Mar; 39(3):469-476.CT

Abstract

PURPOSE

Placebos are commonly used in experimental and patient populations and are known to influence treatment outcomes. The mechanism of action of placebos has been investigated by several researchers. This review investigates the current knowledge regarding the theoretical and biological underpinning of the nocebo and placebo phenomena.

METHOD

Literature was searched using PubMed using the following keywords: nocebo, placebo, μ-opioid, dopamine, conditioning, and expectancy. Relevant papers were selected for review by the authors.

FINDINGS

The roles of conditioning and expectancy, and characteristics associated with nocebo and placebo responses, are discussed. These factors affect nocebo and placebo responses, although their effect sizes vary greatly, depending on inter-individual differences and different experimental paradigms. The neurobiology of the nocebo and placebo phenomena is also reviewed, emphasizing the involvement of reward pathways, such as the μ-opioid and dopamine pathways. Neurobiological pathways have been investigated in a limited range of experimental paradigms, with the greatest efforts on experimental models of placebo analgesia. The interconnectedness of psychological and physiological drivers of nocebo and placebo responses is a core feature of these phenomena.

IMPLICATIONS

Further research is needed to fully understand the underpinnings of the nocebo and placebo phenomena. Neurobiology pathways need to be investigated in experimental paradigms that model the placebo response to a broader range of pathologies. Similarly, although many psychological factors and inter-individual characteristics have been identified as significant mediators and moderators of nocebo and placebo responses, the factors identified to date are unlikely to be exhaustive.

Authors+Show Affiliations

Deakin University, IMPACT Strategic Research Centre, School of Medicine, Barwon Health, Geelong, Australia; Department of Psychiatry, The University of Melbourne, Parkville, Victoria, Australia; The Centre for Youth Mental Health, Parkville, Victoria, Australia. Electronic address: seetald@barwonhealth.org.au.Deakin University, IMPACT Strategic Research Centre, School of Medicine, Barwon Health, Geelong, Australia; Department of Psychiatry, The University of Melbourne, Parkville, Victoria, Australia; The Florey Institute for Neuroscience and Mental Health, Parkville, Victoria, Australia.Psychiatry and Mental Health Department, Centro Hospitalar Lisboa Norte, Lisbon, Portugal; Faculdade de Medicina da Universidade de Lisboa, Lisbon, Portugal.Deakin University, IMPACT Strategic Research Centre, School of Medicine, Barwon Health, Geelong, Australia; Department of Psychiatry, The University of Melbourne, Parkville, Victoria, Australia; The Centre for Youth Mental Health, Parkville, Victoria, Australia; The Florey Institute for Neuroscience and Mental Health, Parkville, Victoria, Australia.

Pub Type(s)

Journal Article
Review

Language

eng

PubMed ID

28161116

Citation

Dodd, Seetal, et al. "A Review of the Theoretical and Biological Understanding of the Nocebo and Placebo Phenomena." Clinical Therapeutics, vol. 39, no. 3, 2017, pp. 469-476.
Dodd S, Dean OM, Vian J, et al. A Review of the Theoretical and Biological Understanding of the Nocebo and Placebo Phenomena. Clin Ther. 2017;39(3):469-476.
Dodd, S., Dean, O. M., Vian, J., & Berk, M. (2017). A Review of the Theoretical and Biological Understanding of the Nocebo and Placebo Phenomena. Clinical Therapeutics, 39(3), 469-476. https://doi.org/10.1016/j.clinthera.2017.01.010
Dodd S, et al. A Review of the Theoretical and Biological Understanding of the Nocebo and Placebo Phenomena. Clin Ther. 2017;39(3):469-476. PubMed PMID: 28161116.
* Article titles in AMA citation format should be in sentence-case
TY - JOUR T1 - A Review of the Theoretical and Biological Understanding of the Nocebo and Placebo Phenomena. AU - Dodd,Seetal, AU - Dean,Olivia M, AU - Vian,João, AU - Berk,Michael, Y1 - 2017/02/01/ PY - 2016/10/19/received PY - 2017/01/03/revised PY - 2017/01/05/accepted PY - 2017/2/6/pubmed PY - 2017/9/25/medline PY - 2017/2/6/entrez KW - conditioning KW - dopamine KW - expectancy KW - nocebo KW - pharmacology KW - placebo KW - treatment KW - µ-opioid SP - 469 EP - 476 JF - Clinical therapeutics JO - Clin Ther VL - 39 IS - 3 N2 - PURPOSE: Placebos are commonly used in experimental and patient populations and are known to influence treatment outcomes. The mechanism of action of placebos has been investigated by several researchers. This review investigates the current knowledge regarding the theoretical and biological underpinning of the nocebo and placebo phenomena. METHOD: Literature was searched using PubMed using the following keywords: nocebo, placebo, μ-opioid, dopamine, conditioning, and expectancy. Relevant papers were selected for review by the authors. FINDINGS: The roles of conditioning and expectancy, and characteristics associated with nocebo and placebo responses, are discussed. These factors affect nocebo and placebo responses, although their effect sizes vary greatly, depending on inter-individual differences and different experimental paradigms. The neurobiology of the nocebo and placebo phenomena is also reviewed, emphasizing the involvement of reward pathways, such as the μ-opioid and dopamine pathways. Neurobiological pathways have been investigated in a limited range of experimental paradigms, with the greatest efforts on experimental models of placebo analgesia. The interconnectedness of psychological and physiological drivers of nocebo and placebo responses is a core feature of these phenomena. IMPLICATIONS: Further research is needed to fully understand the underpinnings of the nocebo and placebo phenomena. Neurobiology pathways need to be investigated in experimental paradigms that model the placebo response to a broader range of pathologies. Similarly, although many psychological factors and inter-individual characteristics have been identified as significant mediators and moderators of nocebo and placebo responses, the factors identified to date are unlikely to be exhaustive. SN - 1879-114X UR - https://www.unboundmedicine.com/medline/citation/28161116/A_Review_of_the_Theoretical_and_Biological_Understanding_of_the_Nocebo_and_Placebo_Phenomena_ L2 - https://linkinghub.elsevier.com/retrieve/pii/S0149-2918(17)30048-6 DB - PRIME DP - Unbound Medicine ER -