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Review
. 2023 Feb;37(1):59-71.
doi: 10.1007/s00482-022-00685-3. Epub 2023 Jan 13.

[Placebo effects in analgesia : Influence of expectations on the efficacy and tolerability of analgesic treatment]

[Article in German]
Angelika Kunkel  1 , Ulrike Bingel  2
Affiliations
Review

[Placebo effects in analgesia : Influence of expectations on the efficacy and tolerability of analgesic treatment]

[Article in German]
Angelika Kunkel et al. Schmerz. 2023 Feb.

Abstract
in English, German

Expectations of patients influence the perception and neuronal processing of acute and chronic pain and modulate the effectiveness of analgesic treatment. The expectation of treatment is not only the most important determinant of placebo analgesia. Expectations of treatment also influence the efficacy and tolerability of "active" pharmacological and non-pharmacological treatment of pain. Recent insights into the psychological and neurobiological mechanisms underlying the clinically relevant effects of treatment expectations enable and call for the systematic integration and modulation of treatment expectations into analgesic treatment concepts. Such a strategy promises to optimize analgesic treatment and to prevent or reduce the burden of unwanted side effects and the misuse of analgesics, particularly of opioids. This review highlights the current concepts, recent achievements and also challenges and key open research questions.

Erwartungen von Patienten beeinflussen die Wahrnehmung und neuronale Verarbeitung akuter und chronischer Schmerzen und modulieren die Wirksamkeit einer analgetischen Behandlung. Die Behandlungserwartung ist nicht nur die wichtigste Determinante der Placeboanalgesie. Behandlungserwartungen beeinflussen auch Wirksamkeit und Verträglichkeit „aktiver“ pharmakologischer und nichtpharmakologischer Schmerzbehandlungen. Jüngste Erkenntnisse über die psychologischen und neurobiologischen Mechanismen, die den Effekten von Behandlungserwartungen zugrunde liegen, ermöglichen und fordern die systematische Integration und Modulation von Behandlungserwartungen in schmerzmedizinischen Behandlungskonzepten. Eine solche Strategie verspricht, die Schmerztherapie zu optimieren und die Belastung durch unerwünschte Nebenwirkungen sowie den Missbrauch von Analgetika zu verhindern oder zu verringern. Diese Übersicht beleuchtet aktuelle Konzepte, neueste Errungenschaften, aber auch Herausforderungen und offene Forschungsfragen.

Keywords: Communication; Expectation effects; Nocebo hyperalgesia; Pain perception; Treatment expectation.

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