Lecture 10 - Placebo and Expectancy

If the pa2ent believes a substance is harmful it can

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Unformatted text preview: reduc3on –  On average, 33% of Ss in placebo pain studies report pain reduc3on Are many drug effects simply placebo effects? •  Placebo effects were discovered in the 1950s –  Administering a simple sugar pill or water alleviated symptoms or even cured some diseases •  However, it s a minority view that it s all placebo •  Nonetheless, some placebo effects may be present in all drug effects –  How do you dissociate placebo from other effects? Nocebo ( I will harm ) (Walter Kennedy, 1961) A nocebo response occurs when a drug ­ trial's subject's symptoms are worsened by the administra3on of a placebo. If the pa2ent believes a substance is harmful it can cause nega2ve effects. The Nocebo Effect •  Emo3onal state, depression, anxiety, anger, hopelessness •  Nega3ve health care provider •  No love in the family •  Cynicism, suspicion and pessimis3c expecta3ons •  Medical students disease (hypochondriasis) •  Cardiac neurosis is a nocebo – 75% of chest pain is due to anxiety. Nocebo Effect •  Approximately ¼ of pa3ents receiving a placebo voluntarily report adverse side effects •  When prompted, between 27% and 71% report adverse side effects •  Usually general complaints (difficulty concentra3ng, nausea, fa3gue) Placebo/Nocebo Evidence Based Medicine •  All drugs and procedures need to be tested against the placebo/nocebo effect, as high as 70% in most medica3ons and opera3ons. •  Treatment benefit = therapeu3c gain + natural history of illness + placebo effect ­nocebo effect •  Note that if the nocebo...
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