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Clinical relevance of contextual factors as triggers of placebo and nocebo effects in musculoskeletal pain.
BMC Musculoskelet Disord. 2018 01 22; 19(1):27.BM

Abstract

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.

Authors+Show Affiliations

Department of Neuroscience, Rehabilitation, Ophthalmology, Genetics, Maternal and Child Health, University of Genova, Campus of Savona. Via Magliotto, 2, 17100, Savona, Italy.Department of Neuroscience, University of Turin Medical School, Turin, Italy.Department of Neuroscience, Rehabilitation, Ophthalmology, Genetics, Maternal and Child Health, University of Genova, Campus of Savona. Via Magliotto, 2, 17100, Savona, Italy. marco.testa@unige.it.

Pub Type(s)

Journal Article
Review

Language

eng

PubMed ID

29357856

Citation

Rossettini, Giacomo, et al. "Clinical Relevance of Contextual Factors as Triggers of Placebo and Nocebo Effects in Musculoskeletal Pain." BMC Musculoskeletal Disorders, vol. 19, no. 1, 2018, p. 27.
Rossettini G, Carlino E, Testa M. Clinical relevance of contextual factors as triggers of placebo and nocebo effects in musculoskeletal pain. BMC Musculoskelet Disord. 2018;19(1):27.
Rossettini, G., Carlino, E., & Testa, M. (2018). Clinical relevance of contextual factors as triggers of placebo and nocebo effects in musculoskeletal pain. BMC Musculoskeletal Disorders, 19(1), 27. https://doi.org/10.1186/s12891-018-1943-8
Rossettini G, Carlino E, Testa M. Clinical Relevance of Contextual Factors as Triggers of Placebo and Nocebo Effects in Musculoskeletal Pain. BMC Musculoskelet Disord. 2018 01 22;19(1):27. PubMed PMID: 29357856.
* Article titles in AMA citation format should be in sentence-case
TY - JOUR T1 - Clinical relevance of contextual factors as triggers of placebo and nocebo effects in musculoskeletal pain. AU - Rossettini,Giacomo, AU - Carlino,Elisa, AU - Testa,Marco, Y1 - 2018/01/22/ PY - 2017/08/03/received PY - 2018/01/15/accepted PY - 2018/1/24/entrez PY - 2018/1/24/pubmed PY - 2018/8/28/medline KW - Clinical reasoning KW - Conditioning KW - Contextual factors KW - Expectation KW - Learning KW - Nocebo KW - Pain KW - Placebo KW - Therapeutic encounter KW - Therapeutic relationship SP - 27 EP - 27 JF - BMC musculoskeletal disorders JO - BMC Musculoskelet Disord VL - 19 IS - 1 N2 - 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. SN - 1471-2474 UR - https://www.unboundmedicine.com/medline/citation/29357856/Clinical_relevance_of_contextual_factors_as_triggers_of_placebo_and_nocebo_effects_in_musculoskeletal_pain_ L2 - https://bmcmusculoskeletdisord.biomedcentral.com/articles/10.1186/s12891-018-1943-8 DB - PRIME DP - Unbound Medicine ER -