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The Underestimated Significance of Conditioning in Placebo Hypoalgesia and Nocebo Hyperalgesia.
Pain Res Manag. 2018; 2018:6841985.PR

Abstract

Placebo and nocebo effects are intriguing phenomena in pain perception with important implications for clinical research and practice because they can alleviate or increase pain. According to current theoretical accounts, these effects can be shaped by verbal suggestions, social observational learning, and classical conditioning and are necessarily mediated by explicit expectation. In this review, we focus on the contribution of conditioning in the induction of placebo hypoalgesia and nocebo hyperalgesia and present accumulating evidence that conditioning independent from explicit expectation can cause these effects. Especially studies using subliminal stimulus presentation and implicit conditioning (i.e., without contingency awareness) that bypass the development of explicit expectation suggest that conditioning without explicit expectation can lead to placebo and nocebo effects in pain perception. Because only few studies have investigated clinical samples, the picture seems less clear when it comes to patient populations with chronic pain. However, conditioning appears to be a promising means to optimize treatment. In order to get a better insight into the mechanisms of placebo and nocebo effects in pain and the possible benefits of conditioning compared to explicit expectation, future studies should carefully distinguish both methods of induction.

Authors+Show Affiliations

Department for Clinical Psychology, Psychotherapy, and Experimental Psychopathology, Johannes Gutenberg University Mainz, Mainz, Germany.Department for Clinical Psychology, Psychotherapy, and Experimental Psychopathology, Johannes Gutenberg University Mainz, Mainz, Germany.Department of Cognitive and Clinical Neuroscience, Central Institute of Mental Health, Medical Faculty Mannheim, Heidelberg University, Heidelberg, Germany.

Pub Type(s)

Journal Article
Review

Language

eng

PubMed ID

29670678

Citation

Bräscher, Anne-Kathrin, et al. "The Underestimated Significance of Conditioning in Placebo Hypoalgesia and Nocebo Hyperalgesia." Pain Research & Management, vol. 2018, 2018, p. 6841985.
Bräscher AK, Witthöft M, Becker S. The Underestimated Significance of Conditioning in Placebo Hypoalgesia and Nocebo Hyperalgesia. Pain Res Manag. 2018;2018:6841985.
Bräscher, A. K., Witthöft, M., & Becker, S. (2018). The Underestimated Significance of Conditioning in Placebo Hypoalgesia and Nocebo Hyperalgesia. Pain Research & Management, 2018, 6841985. https://doi.org/10.1155/2018/6841985
Bräscher AK, Witthöft M, Becker S. The Underestimated Significance of Conditioning in Placebo Hypoalgesia and Nocebo Hyperalgesia. Pain Res Manag. 2018;2018:6841985. PubMed PMID: 29670678.
* Article titles in AMA citation format should be in sentence-case
TY - JOUR T1 - The Underestimated Significance of Conditioning in Placebo Hypoalgesia and Nocebo Hyperalgesia. AU - Bräscher,Anne-Kathrin, AU - Witthöft,Michael, AU - Becker,Susanne, Y1 - 2018/01/28/ PY - 2017/10/13/received PY - 2017/12/20/accepted PY - 2018/4/20/entrez PY - 2018/4/20/pubmed PY - 2018/9/25/medline SP - 6841985 EP - 6841985 JF - Pain research & management JO - Pain Res Manag VL - 2018 N2 - Placebo and nocebo effects are intriguing phenomena in pain perception with important implications for clinical research and practice because they can alleviate or increase pain. According to current theoretical accounts, these effects can be shaped by verbal suggestions, social observational learning, and classical conditioning and are necessarily mediated by explicit expectation. In this review, we focus on the contribution of conditioning in the induction of placebo hypoalgesia and nocebo hyperalgesia and present accumulating evidence that conditioning independent from explicit expectation can cause these effects. Especially studies using subliminal stimulus presentation and implicit conditioning (i.e., without contingency awareness) that bypass the development of explicit expectation suggest that conditioning without explicit expectation can lead to placebo and nocebo effects in pain perception. Because only few studies have investigated clinical samples, the picture seems less clear when it comes to patient populations with chronic pain. However, conditioning appears to be a promising means to optimize treatment. In order to get a better insight into the mechanisms of placebo and nocebo effects in pain and the possible benefits of conditioning compared to explicit expectation, future studies should carefully distinguish both methods of induction. SN - 1918-1523 UR - https://www.unboundmedicine.com/medline/citation/29670678/The_Underestimated_Significance_of_Conditioning_in_Placebo_Hypoalgesia_and_Nocebo_Hyperalgesia_ L2 - https://dx.doi.org/10.1155/2018/6841985 DB - PRIME DP - Unbound Medicine ER -