Abstract
Given its presence in almost every clinical trial, the placebo is the most frequently studied substance in clinical research. Demonstration of treatment efficacy demands that the target (active) agent must be shown to be statistically significantly superior to an inert substance (placebo) not believed to be a specific therapy for the target condition. In clinical practice, enhancing the non-specific factors that contribute to an enhanced treatment outcome is desirable to maximize the likelihood of therapeutic benefit. Variables affecting the impact of placebo on clinical research and practice remain poorly understood, however, as they have not been systematically studied. The present article will discuss behavioral factors that have been found to be relevant in placebo mechanisms.
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References
Evans D (2003) Placebo = the belief effect. Harper Collins Publishers, London
Shapiro AK (1964) A historical and heuristic definition of the placebo. Psychiatry 27:52
Shapiro AK (1968) Modern perspectives in world psychiatry. Oliver and Boyd, Edinburgh
Haas H, Fink H, Hartfelder G (1959) Fortschritte der Arzneimitelforschung. Birhauser, Basel
Shelly JH, Baur MP (1999) Paul Martini: the first clinical pharmacologist? Lancet 353:1870–1873
Pepper OHP (1945) A note on placebo. Ann J Pharm 117:409–412
Beecher HK (1955) The powerful placebo. JAMA 159:1602–1606
Kaptchuk T, Stason WB, Davis RB et al (2006) Sham device vs. inert pill: randomised cotrolled trial of two placebo treatments. BMJ 332:391–397
Price DD, Finniss DG, Benedetti F (2008) A comprehensive review of the placebo effect: recent advances and current thought. Ann Rev Psychol 59:565–590
International Headache Society Committee on Clinical Trials in Migraine (1991) Guidelines for controlled trials of drugs in migraine: first edition. Cephalalgia 11:1–12
Petrovic P, Kalso E, Petersson et al (2002) Science 295:1737–1740
Wager TD, Rilling JK, Smith EE et al (2004) Science 303:1162–1167
Sherman R, Hickner J (2008) Academic physicians use placebo in clinical practice and believe in mind-body connection. J Gen Intern Med 23:7–10
Tilburt JC, Emanuel EJ, Kaptchuk TJ et al (2008) Prescribing “placebo treatments”: results of national survey of US internists and rheumatologists. BMJ 337:1938
Hrobjartrsson A, Gotzsche PC (2001) Is the placebo powerless? An analysis of clinical trials comparing placebo with no treatment. NEJM 344:210
Amanzio M, Pollo A, Maggi G et al (2001) Response variability to analgesics: a role for non-specific activation of endogenous opioids. Pain 90:205–215
Kwekkeboom KL (1997) The placebo effect in symptom management. Oncol Nurs Forum 24:1393–1399
Diener HC, Tfelt-Hansen P, Dahlof C et al (2004) Topiramate in migraine prophylaxis: results from a placebo-controlled trial with propranolol as an active control. J Neurol 251:943–950
Mathew NT, Frishberg BM, Gawel M (2005) Botulinum toxin type A (BOTOX) for the prophylactic treatment of chronic daily headache: a randomized, double-blind, placebo-controlled trial. Headache 45:293–307
Weihrauch TR, Gauler TC (1999) Placebo-efficacy and adverse events in controlled clinical trials. Drug Res 49:385–393
Lasagna L, Laties VC, Dohan JL (1958) Further studies on the “pharmacology of a placebo administration. J Clin Invest 37:533–537
Silberman S (2009) Placebos are getting more effective. Drug makers want to know why. Wired Magazine 17:9
Gauler TC, Weihrauch TR (1997) Placebo-ein wirksames und ungefahrliches Medikament?. Urban & Swarzenberg, Munich
Reid B (2002) The nocebo effect: placebo’s evil twin. The Washington Post H:201–203
Herper M, Langreth R (2010) The nothing cure. Forbes March 29:24–26
Silberstein SD, Gobel H, Jensen R et al (2006) Botulinum toxin type A in the prophylactic treatment of chronic daily headache: a randomized, double-blind, placebo-controlled trial. Headache 26:790–800
Diener HC, Dowson AJ, Ferrari M et al (1999) Unbalanced randomization influences placebo responses: scientific versus ethical issues around the use of placebo in migraine trials. Cephalalgia 19:699–700
Levine JD, Gordon NC (1984) Influence of the method of drug administration on analgesic response. Nature 312:755–756
Amanzio M, Pollo A, Maggi G et al (2001) Response variability to analgesics: a role for non-specific activation of endogenous opioids. Pain 90:205–215
Benedetti F, Pollo A, Lopiano L et al (2003) Conscious expectation and unconscious conditioning in analgesic; motor and hormonal placebo/nocebo responses. J Neurosci 23:4315–4323
Benedetti F, Amanzio m, Maggi G (1995) Potentiation of placebo analgesia by proglumide. Lancet 346:1231
Gracely RH, Dubner R, Deeter WD et al (1985) Clinicians expectations influence placebo analgesia. Lancet 5:43
Pollo A, Amanzio M, Arslanian A et al (2001) Response expectancies in placebo analgesia and their clinical relevance. Pain 93:77–84
Bridge JA et al (2004) Effects of study sites on clinical research. Am J Psychiatry 166:42–49
Brody H (1997) The doctor as therapeutic agent: a placebo effect research Agenda. In: Harrington A (ed) The placebo effect: an interdisciplinary exploration. Harvard University Press, Cambridge
Ernst E (2001) Towards a scientific understanding of placebo effects. In Understanding the Placebo Effect in Complementary Medicine. Theory, Practice, and Research. Churchill Livingstone, London
Braithwaite A, Cooper P (1981) Analgesic effects of branding in treatment of headaches. BMJ 282:1576–1578
Waber RL, Shiv B, Carmon Z (2008) Commercial features of placebo and therapeutic efficacy. JAMA 299:1016–1017
de Craen AJ, Roos PJ, de Vries AL et al (1996) Effect of colour of drugs: systematic review of perceived effect of drugs and their effectiveness. BMJ 313:1624–1626
Cattaneo AD, Lucchelli PE, Filippuci G (1970) Sedative effects of placebo treatment. Eur J Clin Pharmacol 3:43–45
Hussain MZ, Ahad A (1970) Tablet colour in anxiety states. BMJ 3:466
Jospe M (1978) The placebo effect in healing. Heath, Lexington
Harrington A (1999) The placebo effect: an interdisciplinary phenomenon. Harvard University Press, Cambridge
Geers Al, Helfer SG, Kosbab K et al (2005) Reconsidering the role of personality in placebo effects: dispositional optimism, situational expectations, and the placebo response. J Psychosom Res 58:121–127
Crow R, Gage H, Hampson S et al (1999) The role of expectancies in the placebo effect and their use in the delivery of healthcare. Health Technol Assess 3:1–96
Ho TW, Fan X, Rodges A et al (2009) Age effects on placebo response rates in clinical trials of acute agents for migraine: pooled analysis of rizatriptan trials in adults. Cephalalgia 29:711–718
Stewart-Williams S, Podd J (2004) Expectancy model vs. conditioning model. Psychol Bull 2:324–340
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Weeks, R.E., Newman, E. Behavioral factors in the placebo response. Neurol Sci 32 (Suppl 1), 3–8 (2011). https://doi.org/10.1007/s10072-011-0555-y
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DOI: https://doi.org/10.1007/s10072-011-0555-y