Implications of Placebo and Nocebo Effects for Clinical Practice: Expert Consensus

Andrea W M Evers¹, Luana Colloca², Charlotte Blease³, Marco Annoni⁴, Lauren Y Atlas⁵, Fabrizio Benedetti⁶, Ulrike Bingel⁷, Christian Büchel⁸, Claudia Carvalho⁹, Ben Colagiuri¹⁰, Alia J Crum¹¹, Paul Enck¹², Jens Gaab¹³, Andrew L Geers¹⁴, Jeremy Howick¹⁵, Karin B Jensen¹⁶, Irving Kirsch¹⁷, Karin Meissner¹⁸, Vitaly Napadow¹⁹, Kaya J Peerdeman¹, Amir Raz²⁰, Winfried Rief²¹, Lene Vase²², Tor D Wager²³, Bruce E Wampold^{24

25}, Katja Weimer²⁶, Katja Wiech²⁷, Ted J Kaptchuk¹⁷, Regine Klinger²⁸, John M Kelley¹⁷

Affiliations

¹ Health, Medical and Neuropsychology Unit, Institute of Psychology, Leiden University, Leiden, the Netherlands.
² Departments of Pain Translational Symptoms Science and Anaesthesiology, School of Nursing and Medicine, University of Maryland Baltimore, Baltimore, Maryland, USA.
³ General Medicine and Primary Care, Beth Israel Deaconess Medical Center, Boston, Massachusetts, USA.
⁴ Institute of Biomedical Technologies, National Research Council, Rome, Italy.
⁵ Section on Affective Neuroscience and Pain, NIH, Bethesda, Massachusetts, USA.
⁶ Physiology and Neuroscience, University of Turin Medical School, Turin, Italy.
⁷ Department of Neurology, University Hospital Essen, Essen, Germany.
⁸ Department of Systems Neuroscience, University Medical Center Hamburg-Eppendorf, Hamburg, Germany.
⁹ Department of Clinical and Health Psychology, Instituto Universitário de Ciências Psicológicas, Lisbon, Portugal.
¹⁰ School of Psychology, University of Sydney, Sydney, New South Wales, Australia.
¹¹ Department of Psychology, Stanford University, Stanford, California, USA.
¹² Department of Psychosomatic Medicine and Psychotherapy, University Hospital Tübingen, Tübingen, Germany.
¹³ Faculty of Psychology, University of Basel, Basel, Switzerland.
¹⁴ Department of Psychology, University of Toledo, Toledo, Ohio, USA.
¹⁵ Nuffield Department of Primary Care Health Sciences, University of Oxford, Oxford, United Kingdom.
¹⁶ Department of Clinical Neuroscience, Karolinska Institute, Stockholm, Sweden.
¹⁷ Beth Israel Deaconess Medical Center, Program in Placebo Studies, Boston, Massachusetts, USA.
¹⁸ Division of Health Promotion, University of Applied Sciences, Coburg, Germany.
¹⁹ Athinoula A. Martinos Center for Biomedical Imaging, Charlestown, Massachusetts, USA.
²⁰ Departments of Psychiatry, Neurology and Neurosurgery, McGill University, Montreal, Québec, Canada.
²¹ Department of Clinical Psychology and Psychotherapy, Philipps University of Marburg, Marburg, Germany.
²² Department of Psychology and Behavioural Sciences, Aarhus University, Aarhus, Denmark.
²³ Department of Psychology and Neuroscience, University of Colorado, Boulder, Colorado, USA.
²⁴ Department of Counseling Psychology, University of Wisconsin-Madison, Madison, Wisconsin, USA.
²⁵ Modum Bad Psychiatric Center, Vikersund, Norway.
²⁶ Clinic for Psychosomatic Medicine and Psychotherapy, University Hospital Ulm, Ulm, Germany.
²⁷ Nuffield Department of Clinical Neurosciences, University of Oxford, Oxford, United Kingdom.
²⁸ Center for Anesthesiology and Intensive Care Medicine, University Medical Center Hamburg-Eppendorf, Hamburg, Germany.

PMID: 29895014
PMCID: PMC6191882
DOI: 10.1159/000490354

Implications of Placebo and Nocebo Effects for Clinical Practice: Expert Consensus

Andrea W M Evers et al. Psychother Psychosom. 2018.

. 2018;87(4):204-210.

doi: 10.1159/000490354. Epub 2018 Jun 12.

Authors

Affiliations

¹ Health, Medical and Neuropsychology Unit, Institute of Psychology, Leiden University, Leiden, the Netherlands.
² Departments of Pain Translational Symptoms Science and Anaesthesiology, School of Nursing and Medicine, University of Maryland Baltimore, Baltimore, Maryland, USA.
³ General Medicine and Primary Care, Beth Israel Deaconess Medical Center, Boston, Massachusetts, USA.
⁴ Institute of Biomedical Technologies, National Research Council, Rome, Italy.
⁵ Section on Affective Neuroscience and Pain, NIH, Bethesda, Massachusetts, USA.
⁶ Physiology and Neuroscience, University of Turin Medical School, Turin, Italy.
⁷ Department of Neurology, University Hospital Essen, Essen, Germany.
⁸ Department of Systems Neuroscience, University Medical Center Hamburg-Eppendorf, Hamburg, Germany.
⁹ Department of Clinical and Health Psychology, Instituto Universitário de Ciências Psicológicas, Lisbon, Portugal.
¹⁰ School of Psychology, University of Sydney, Sydney, New South Wales, Australia.
¹¹ Department of Psychology, Stanford University, Stanford, California, USA.
¹² Department of Psychosomatic Medicine and Psychotherapy, University Hospital Tübingen, Tübingen, Germany.
¹³ Faculty of Psychology, University of Basel, Basel, Switzerland.
¹⁴ Department of Psychology, University of Toledo, Toledo, Ohio, USA.
¹⁵ Nuffield Department of Primary Care Health Sciences, University of Oxford, Oxford, United Kingdom.
¹⁶ Department of Clinical Neuroscience, Karolinska Institute, Stockholm, Sweden.
¹⁷ Beth Israel Deaconess Medical Center, Program in Placebo Studies, Boston, Massachusetts, USA.
¹⁸ Division of Health Promotion, University of Applied Sciences, Coburg, Germany.
¹⁹ Athinoula A. Martinos Center for Biomedical Imaging, Charlestown, Massachusetts, USA.
²⁰ Departments of Psychiatry, Neurology and Neurosurgery, McGill University, Montreal, Québec, Canada.
²¹ Department of Clinical Psychology and Psychotherapy, Philipps University of Marburg, Marburg, Germany.
²² Department of Psychology and Behavioural Sciences, Aarhus University, Aarhus, Denmark.
²³ Department of Psychology and Neuroscience, University of Colorado, Boulder, Colorado, USA.
²⁴ Department of Counseling Psychology, University of Wisconsin-Madison, Madison, Wisconsin, USA.
²⁵ Modum Bad Psychiatric Center, Vikersund, Norway.
²⁶ Clinic for Psychosomatic Medicine and Psychotherapy, University Hospital Ulm, Ulm, Germany.
²⁷ Nuffield Department of Clinical Neurosciences, University of Oxford, Oxford, United Kingdom.
²⁸ Center for Anesthesiology and Intensive Care Medicine, University Medical Center Hamburg-Eppendorf, Hamburg, Germany.

PMID: 29895014
PMCID: PMC6191882
DOI: 10.1159/000490354

Abstract

Background: Placebo and nocebo effects occur in clinical or laboratory medical contexts after administration of an inert treatment or as part of active treatments and are due to psychobiological mechanisms such as expectancies of the patient. Placebo and nocebo studies have evolved from predominantly methodological research into a far-reaching interdisciplinary field that is unravelling the neurobiological, behavioural and clinical underpinnings of these phenomena in a broad variety of medical conditions. As a consequence, there is an increasing demand from health professionals to develop expert recommendations about evidence-based and ethical use of placebo and nocebo effects for clinical practice.

Methods: A survey and interdisciplinary expert meeting by invitation was organized as part of the 1st Society for Interdisciplinary Placebo Studies (SIPS) conference in 2017. Twenty-nine internationally recognized placebo researchers participated.

Results: There was consensus that maximizing placebo effects and minimizing nocebo effects should lead to better treatment outcomes with fewer side effects. Experts particularly agreed on the importance of informing patients about placebo and nocebo effects and training health professionals in patient-clinician communication to maximize placebo and minimize nocebo effects.

Conclusions: The current paper forms a first step towards developing evidence-based and ethical recommendations about the implications of placebo and nocebo research for medical practice, based on the current state of evidence and the consensus of experts. Future research might focus on how to implement these recommendations, including how to optimize conditions for educating patients about placebo and nocebo effects and providing training for the implementation in clinical practice.

Keywords: Clinical practice; Evidence-based ethical recommendations; Nocebo effect; Patient-clinician communication; Patient’s expectancies; Placebo effect.

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Comment in

"Consensus on Placebo and Nocebo Effects Connects Science with Practice:" Reply to "Questioning the Consensus on Placebo and Nocebo Effects".
Evers AWM, Colloca L, Blease C, Gaab J, Jensen KB, Atlas LY, Beedie CJ, Benedetti F, Bingel U, Büchel C, Bussemaker J, Colagiuri B, Crum AJ, Finniss DG, Geers AL, Howick J, Klinger R, Meeuwis SH, Meissner K, Napadow V, Petrie KJ, Rief W, Smeets I, Wager TD, Wanigasekera V, Vase L, Kelley JM, Kirsch I; on behalf of the Consortium of Placebo Experts. Evers AWM, et al. Psychother Psychosom. 2021;90(3):213-214. doi: 10.1159/000514435. Epub 2021 Feb 25. Psychother Psychosom. 2021. PMID: 33631769 No abstract available.

References

1. Kaptchuk TJ, Miller FG. Placebo effects in medicine. N Engl J Med. 2015;373:8–9. - PubMed
1. Enck P, Bingel U, Schedlowski M, Rief W. The placebo response in medicine: minimize, maximize or personalize? Nat Rev Drug Discov. 2013;12:191–204. - PubMed
1. Benedetti F, Placebo Effects . ed 2. New York: Oxford University Press; 2015. Understanding the Mechanisms in Health and Disease.
1. Colagiuri G, Schenk LA, Kessler MD, Dorsey SG, Colloca L. The placebo effect: from concepts to genes. Neuroscience. 2015;307:171–190. - PMC - PubMed
1. Wager TD, Atlas L. The neuroscience of placebo effects: connecting context, learning and health. Nat Rev Neurosci. 2015;16:403–417. - PMC - PubMed

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Implications of Placebo and Nocebo Effects for Clinical Practice: Expert Consensus

Affiliations

Implications of Placebo and Nocebo Effects for Clinical Practice: Expert Consensus

Authors

Affiliations

Abstract

Comment in

References

MeSH terms

Grants and funding

LinkOut - more resources

Full Text Sources

Other Literature Sources

Molecular Biology Databases

Research Materials