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Chen B, Goldstein N, Dziubek J, Zhao S, Harrahill A, Sundai A, Choi S, Prevosto V, Wang F. Reverse engineering placebo analgesia. BIORXIV : THE PREPRINT SERVER FOR BIOLOGY 2024:2024.02.12.579946. [PMID: 38405975 PMCID: PMC10888847 DOI: 10.1101/2024.02.12.579946] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 02/27/2024]
Abstract
Placebo analgesia is a widely observed clinical phenomenon. Establishing a robust mouse model of placebo analgesia is needed for careful dissection of the underpinning circuit mechanisms. However, previous studies failed to observe consistent placebo effects in rodent models of chronic pain. We wondered whether strong placebo analgesia can be reverse engineered using general anesthesia-activated neurons in the central amygdala (CeA GA ) that can potently suppress pain. Indeed, in both acute and chronic pain models, pairing a context with CeA GA -mediated pain relief produced robust context-dependent analgesia, exceeding that induced by morphine in the same paradigm. We reasoned that if the analgesic effect was dependent on reactivation of CeA GA neurons by conditioned contextual cues, the analgesia would still be an active treatment, rather than a placebo effect. CeA GA neurons indeed receive monosynaptic inputs from temporal lobe areas that could potentially relay contextual cues directly to CeA GA . However, in vivo imaging showed that CeA GA neurons were not re-activated in the conditioned context, despite mice displaying a strong analgesic phenotype, supporting the notion that the cue-induced pain relief is true placebo analgesia. Our results show that conditioning with activation of a central pain-suppressing circuit is sufficient to engineer placebo analgesia, and that purposefully linking a context with an active treatment could be a means to harness the power of placebo for pain relief.
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Zadro S, Stapleton P. Does Reiki Benefit Mental Health Symptoms Above Placebo? Front Psychol 2022; 13:897312. [PMID: 35911042 PMCID: PMC9326483 DOI: 10.3389/fpsyg.2022.897312] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/16/2022] [Accepted: 05/20/2022] [Indexed: 12/05/2022] Open
Abstract
Background Reiki is an energy healing technique or biofield therapy in which an attuned therapist places their hands on or near the client's body and sends energy to the client to activate the body's ability to heal itself and restore balance. It was developed in Japan at the end of the 19th century by Mikao Usui of Kyoto. Given the enormous international socioeconomic burden of mental health, inexpensive, safe, and evidenced-based treatments would be welcomed. Reiki is safe, inexpensive, and preliminary research suggests it may assist in treating a wide variety of illnesses. Given that Reiki is a biofield therapy, growing in use, and not yet accepted by the dominant biomedical paradigm, it is important to establish its effectiveness over placebo. This study aimed to examine Reiki's effectiveness over placebo in treating symptoms of mental health and to explore parameters for its effectiveness. Method A systematic review of randomized placebo-controlled trials (RPCTs) examining Reiki's effectiveness in treating symptoms of mental health in adults was conducted through a systematic search of PubMed, PsycINFO, MEDLINE, CINAHL, Web of Science, Scopus, Embase, and ProQuest. Fourteen studies met the inclusion criteria, and risk of bias was assessed using Cochrane's Revised ROB 2 assessment tool. This was followed by a grading of recommendations, assessment, development and evaluations (GRADE) assessment. Results The evidence to date suggests that Reiki consistently demonstrates a greater therapeutic effect over placebo for some symptoms of mental health. The GRADE level of evidence is high for clinically relevant levels of stress and depression, moderate to high for clinically relevant levels of anxiety, low to moderate for normal levels of stress, and low to moderate for burnout, and low for normal levels of depression and anxiety. Conclusion The results suggest that, Reiki may be more effective in treating some areas of mental health, than placebo, particularly if symptoms are clinically relevant. To date, there are a small number of studies in each area, therefore findings are inconclusive and, more RCTs controlling for placebo in Reiki research are needed. Most included studies were also assessed as having a risk of bias of some concern. Incorporating Reiki as a complementary treatment to mainstream psychotherapy for depression, stress, and anxiety may be appropriate. Systematic Review Registration [https://www.crd.york.ac.uk/], identifier [CRD42020194311].
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Affiliation(s)
- Sonia Zadro
- School of Psychology, Bond University, Gold Coast, QLD, Australia
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Qiu Y, Mao Z, Yun D. Can the add-on placebo effect augment the physical and mental health outcomes of exercise? A meta-analysis. Appl Psychol Health Well Being 2021; 14:483-498. [PMID: 34749434 DOI: 10.1111/aphw.12315] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/06/2021] [Revised: 10/06/2021] [Accepted: 10/06/2021] [Indexed: 11/29/2022]
Abstract
This study aimed to clarify whether the add-on placebo effect can augment the psychological and physiological benefits of exercise. The inclusion criteria were met by 18 studies with 1,221 participants. The add-on placebo effects promoted a more positive affect (g = 0.430), greater self-esteem (g = 0.454), improved cardiorespiratory fitness (g = 0.273), and decreased perceived exertion (g = 0.476) and blood pressure (g = 0.268). Improved affect benefits were moderated by placebo type (elaboration > external medium), self-selected exercise intensity (no > yes), and exercise type (running > nonspecific). The results support the proposal that the add-on placebo effect can provide significant positive benefits for exercisers, particularly in terms of psychological responses.
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Affiliation(s)
- Yue Qiu
- School of Psychology, Beijing Sport University, Beijing, China
| | - Zhixiong Mao
- School of Psychology, Beijing Sport University, Beijing, China
| | - Dongting Yun
- School of Psychology, Beijing Sport University, Beijing, China
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Shaw A. 'A tool to help me through the darkness': suffering and healing among teacher-practitioners of Ashtanga yoga. Anthropol Med 2021; 28:320-340. [PMID: 34293979 DOI: 10.1080/13648470.2021.1949942] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
Abstract
Yoga is widely regarded as beneficial for physical and emotional health, and as a safe ancillary intervention for managing a range of psychological conditions. Evidence of injury, harm, and abuse in yoga traditions is difficult to square with this emphasis on healing. Drawing mainly from on online memoirs by long-term practitioners of Ashtanga yoga, this paper examines the relationship between suffering and healing in yoga, showing how long-term abuse can be perpetuated and injury sustained in a system widely understood and labelled by its practitioners as therapeutic. The paper argues that elements of healing and harm are present in the rituals of practice, the concepts that support it, and the power structure of the Ashtanga system. The system's organizational dynamics together with a therapeutic discourse that links suffering to its transcendence enabled the same kinds of abuse and trauma that Ashtanga yoga is purported to heal. The analysis raises questions about the overarching narrative of yoga as safe and healthy, and about the connections between healing and harm within therapeutic traditions.
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Affiliation(s)
- Alison Shaw
- Institute of Social and Cultural Anthropology, University of Oxford, Oxford, UK.,Department of Psychiatry and Biobehavioral Sciences, University of California, Los Angeles, CA, USA
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Rajagopalan V, Chouhan RS, Pandia MP, Lamsal R, Bithal PK, Rath GP. Effect of Stellate Ganglion Block on Intraoperative Propofol and Fentanyl Consumption in Patients with Complex Regional Pain Syndrome Undergoing Surgical Repair of Brachial Plexus Injury: A Randomized, Double-blind, Placebo-controlled Trial. Neurol India 2021; 68:617-623. [PMID: 32643674 DOI: 10.4103/0028-3886.288992] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
Abstract
Introduction Stellate ganglion block (SGB) is commonly performed to treat chronic painful conditions, such as complex regional pain syndrome (CRPS) and postherpetic neuralgia. However, whether it is effective in reducing anesthesia and analgesia requirement during surgery (acute pain) is not known. Materials and Methods Sixty American Society of Anesthesiologists (ASA) physical status I and II patients with CRPS type II undergoing surgery for repair of brachial plexus injury were randomized (1:1) to receive SGB with either 10 mL of 0.5% bupivacaine (Group B) or a matching placebo (Group S) before induction of anesthesia. Results There was a significant reduction in the requirement of total intraoperative propofol (1659.7 ± 787.5 vs. 2500.7 ± 740.9 mg, P = 0.0003) and fentanyl (190.0 ± 82.5 vs. 327.3 ± 139.3, P = 0.0001) in Group B compared with Group S. Similarly, in Group B, the time to first analgesic was much longer (328 ± 219 vs. 64 ± 116 min, P = 0.000) and postoperative fentanyl requirement for 24 h was lesser compared to Group S (0.6 ± 1.1 vs. 2.1 ± 1.3 μg/kg, P = 0.000). Conclusion SGB is effective in reducing the requirement of intraoperative propofol and fentanyl as well as decreasing opioid requirement in the postoperative period in patients with CRPS type II undergoing surgery.
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Affiliation(s)
- Vanitha Rajagopalan
- Department of Neuroanaesthesiology and Critical Care, All India Institute of Medical Sciences, New Delhi, India
| | - Rajendra Singh Chouhan
- Department of Neuroanaesthesiology and Critical Care, All India Institute of Medical Sciences, New Delhi, India
| | - Mihir Prakash Pandia
- Department of Neuroanaesthesiology and Critical Care, All India Institute of Medical Sciences, New Delhi, India
| | - Ritesh Lamsal
- Department of Anaesthesia and Intensive Care, National Academy of Medical Sciences, Kathmandu, Nepal
| | | | - Girija Prasad Rath
- Department of Neuroanaesthesiology and Critical Care, All India Institute of Medical Sciences, New Delhi, India
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Bao GC. The idealist and pragmatist view of qi in tai chi and qigong: A narrative commentary and review. JOURNAL OF INTEGRATIVE MEDICINE-JIM 2020; 18:363-368. [PMID: 32636157 DOI: 10.1016/j.joim.2020.06.004] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/15/2020] [Accepted: 06/05/2020] [Indexed: 11/28/2022]
Abstract
Qi, often translated as "vital energy," is a central concept in tai chi and qigong that has puzzled physicians, scientists, and people in the West. To date, qi is not falsifiable by the scientific method and thus cannot be subject to scientific inquiry, leading many to criticize it as "pseudoscientific." Even as medical research reveals the health benefits of tai chi and qigong, many wonder how to treat this seemingly outdated concept when promoting these meditative practices. While some tai chi and qigong practitioners insist on the existence of qi, more skeptical thinkers suggest that a scientific understanding should replace this "superstitious" idea. Integrative health professionals must be equipped to discuss this concept intelligently by considering a couple of subtle, clarifying points often missing from the discussion. First, science's inability to verify qi's existence does not affirm its nonexistence. In fact, under the philosophical system of idealism, qi might not be said to be less real than things that are verifiable by science. Similarly, under the instrumental and pragmatic view of science, health professionals should be cautious not to declare what is metaphysically real or unreal but instead what is useful and not useful. Second, even though qi may be pseudoscientific, it remains useful and indispensable to the correct practice of tai chi and qigong. Tai chi and qigong practitioners routinely visualize and perceive the flow of qi to guide their movements, breathing, and mental activity. As such, qi and related metaphysical concepts serve as a useful mental model during practice, and belief in them may be viewed as an "expedient means" to achieve one's health goals.
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Affiliation(s)
- George Chengxi Bao
- Section of Hospital Medicine, Division of General Internal Medicine, Department of Medicine, Weill Cornell Medicine, New York 10038, USA.
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7
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Abstract
Enveloped viruses such as SAR-CoV-2 are sensitive to heat and are destroyed by temperatures tolerable to humans. All mammals use fever to deal with infections and heat has been used throughout human history in the form of hot springs, saunas, hammams, steam-rooms, sweat-lodges, steam inhalations, hot mud and poultices to prevent and treat respiratory infections and enhance health and wellbeing. This paper reviews the evidence for using heat to treat and prevent viral infections and discusses potential cellular, physiological and psychological mechanisms of action. In the initial phase of infection, heat applied to the upper airways can support the immune system's first line of defence by supporting muco-ciliary clearance and inhibiting or deactivating virions where they first lodge. This may be further enhanced by the inhalation of steam containing essential oils with anti-viral, mucolytic and anxiolytic properties. Heat applied to the whole body can further support the immune system's second line of defence by mimicking fever and activating innate and acquired immune defences and building physiological resilience. Heat-based treatments also offer psychological benefits and enhanced mental wellness by focusing attention on positive action, enhancing relaxation and sleep, inducing 'forced-mindfulness', and invoking the power of positive thinking and 'remembered wellness'. Heat is a cheap, convenient and widely accessible therapeutic modality and while no clinical protocols exist for using heat to treat COVID-19, protocols that draw from traditional practices and consider contraindications, adverse effects and infection control measures could be developed and implemented rapidly and inexpensively on a wide scale. While there are significant challenges in implementing heat-based therapies during the current pandemic, these therapies present an opportunity to integrate natural medicine, conventional medicine and traditional wellness practices, and support the wellbeing of both patients and medical staff, while building community resilience and reducing the likelihood and impact of future pandemics.
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Affiliation(s)
- Marc Cohen
- Extreme Wellness Institute, Melbourne, VIC, Australia
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8
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Abstract
Enveloped viruses such as SAR-CoV-2 are sensitive to temperature and are destroyed by temperatures tolerable to humans. All mammals use fever to deal with infections and heat has been used throughout human history in the form of hot springs, saunas, hammams, steam-rooms, sweat-lodges, steam inhalations, hot mud and poultices to prevent and treat respiratory infections and enhance health and wellbeing. This paper reviews the evidence for using heat to treat and prevent viral infections and discusses potential cellular, physiological and psychological mechanisms of action. In the initial phase of infection, heat applied to the upper airways can support the immune system's first line of defence by supporting muco-ciliary clearance and inhibiting or deactivating virions in the place where they first lodge. This may be further enhanced by the inhalation of steam containing essential oils with anti-viral, mucolytic and anxiolytic properties. Heat applied to the whole body can further support the immune system's second line of defence by mimicking fever and activating innate and acquired immune defences and building physiological resilience. Heat-based treatments also offer psychological benefits by directing focus on positive action, enhancing relaxation and sleep, inducing 'forced-mindfulness', and invoking the power of positive thinking and remembered wellness. Heat is a cheap, convenient and widely accessible therapeutic modality and while no clinical protocols exist for using heat to treat COVID-19, protocols that draw from traditional practices and consider contraindications, adverse effects and infection control measures could be developed and implemented rapidly and inexpensively on a wide scale. While there are significant challenges in implementing heat-based therapies during the current pandemic, these therapies present an opportunity to integrate natural medicine, conventional medicine and traditional wellness practices, and support the wellbeing of both patients and medical staff, while building community resilience and reducing the likelihood and impact of future pandemics.
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Affiliation(s)
- Marc Cohen
- Extreme Wellness Institute, Melbourne, VIC, Australia
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Singh S, Radhakrishna N, Rajagopalan V, Chouhan R, Pandia M. Effect of preoperative transcutaneous electrical nerve stimulation on intraoperative anesthetic drug consumption and pain scores in patients undergoing lumbar discectomy under general anesthesia. INDIAN JOURNAL OF PAIN 2020. [DOI: 10.4103/ijpn.ijpn_2_20] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
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10
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Szymański H, Szajewska H. Efficacy of Lactobacillus Reuteri DSM 17938 for the Treatment of Acute Gastroenteritis in Children: Protocol of a Randomized Controlled Trial. JMIR Res Protoc 2017; 6:e164. [PMID: 28835355 PMCID: PMC5587886 DOI: 10.2196/resprot.7924] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/26/2017] [Revised: 06/19/2017] [Accepted: 07/10/2017] [Indexed: 11/13/2022] Open
Abstract
BACKGROUND Acute gastroenteritis (AGE) is one of the most common diseases among children. Oral rehydration therapy is the key treatment. However, despite proven efficacy, it remains underused. This is because oral rehydration solution neither reduces the frequency of bowel movements and fluid loss nor shortens the duration of illness. Hence, there is interest in adjunctive treatments. According to the 2014 guidelines developed by the European Society for Paediatric Gastroenterology, Hepatology and Nutrition, the use of the following probiotics may be considered in the management of children with AGE in addition to rehydration therapy: Lactobacillus rhamnosus GG (low quality of evidence; strong recommendation) and Saccharomyces boulardii (low quality of evidence; strong recommendation). Less compelling evidence is available for Lactobacillus reuteri DSM 17938 (very low quality of evidence; weak recommendation). OBJECTIVE Considering that evidence on L reuteri remains limited, the goal of the study is to assess the effectiveness of L reuteri DSM 17938 in the treatment of AGE in children. Children vaccinated and not vaccinated against rotavirus will be evaluated separately. METHODS This will be a double-blind, placebo-controlled, randomized trial. Children between 1 and 60 months of age with AGE, defined as a change in stool consistency to loose or liquid form (according to the Bristol Stool Form scale or Amsterdam Stool Form scale) and/or an increase in the frequency of evacuations (typically ≥3 in 24 h) lasting for no longer than 5 days, will be recruited. A total of 72 children will receive either L reuteri DSM 17938 at a dose of 2×108colony-forming units twice daily or matching placebo for 5 consecutive days. A similar sample size for rotavirus vaccinated and nonvaccinated children is planned. The primary outcome measure is the duration of diarrhea. Two separate studies and reports for rotavirus vaccinated and nonvaccinated children are planned. RESULTS The recruitment started in January 2017 and is planned to be finalized in June 2018 for rotavirus nonvaccinated children. The recruitment of rotavirus-vaccinated children may be slower due to a relatively low coverage rate in Poland. Data analysis and submission to a peer-reviewed journal is expected within 3 months after completion of the study. CONCLUSION This study will add to current knowledge on the efficacy of L reuteri DSM 17938 for the management of AGE. TRIAL REGISTRATION ClinicalTrials.gov NCT02989350; https://clinicaltrials.gov/ct2/show/NCT02989350 (Archived by WebCite at http://www.webcitation.org/6slOFkyTH).
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Affiliation(s)
- Henryk Szymański
- Department of Pediatrics, St Hedwig of Silesia Hospital, Trzebnica, Poland
| | - Hania Szajewska
- Department of Pediatrics, The Medical University of Warsaw, Warsaw, Poland
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11
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Forester-Miller H. Self-Hypnosis Classes to Enhance the Quality of Life of Breast Cancer Patients. AMERICAN JOURNAL OF CLINICAL HYPNOSIS 2017; 60:18-32. [PMID: 28557674 DOI: 10.1080/00029157.2017.1316234] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
Abstract
The Healing Skills Project, consisting of five, four-session self-hypnosis classes, was a pilot-study to evaluate the impact of self-hypnosis on the quality of life for breast cancer patients. The impact of self-hypnosis in women with breast cancer was measured using a self-report instrument, the Functional Assessment of Cancer Therapy-Breast, pre- and post-intervention (Brady, et al., 1997; Maratia, Cedillo, & Rejas, 2016). After employing the self-hypnosis interventions, statistically significant changes were noted on 16 of the 36 items, despite the small sample size (N = 23). In summary, participants reported significantly less trouble meeting the needs of their family; less side effects; felt less ill, sad, and nervous; had less worry about dying and their condition getting worse; less shortness of breath; less swelling or tenderness in their arms; and less worry about the effects of stress on their illness. Participants also reported being significantly more able to enjoy life and sleep well; enjoy the usual things they do for fun; more content with their quality of life; feeling more attractive and more like a woman. Additionally, on a brief evaluation of the intervention form 86% of the participants indicated that the self-hypnosis classes were very useful and 100% indicated that it contributed to a noticeably improved quality of life. The pilot study offers support for the value of teaching self-hypnosis to breast cancer patients. This article includes an outline of the protocol for the four-session self-hypnosis classes.
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12
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Coste J, Montel S. Placebo-related effects: a meta-narrative review of conceptualization, mechanisms and their relevance in rheumatology. Rheumatology (Oxford) 2017; 56:334-343. [PMID: 27477808 DOI: 10.1093/rheumatology/kew274] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/03/2015] [Indexed: 12/19/2022] Open
Abstract
For decades in medicine, the placebo effect has been conceptualized as a subjective psychological effect associated with an inert substance and considered to be a nuisance noise in the assessment of therapeutic effects in clinical trials. However, research on placebo has undergone substantial developments since the mid-1980s in several fields of knowledge (including methodology, psychology and neurosciences) that challenge this traditional view. Using a meta-narrative approach, this review of conceptualizations, determinants, mechanisms and models of placebo effects shows that placebo effects are genuine biopsychosocial phenomena strongly affected by context and factors surrounding the patient and treatments. Psychological experiments and neurobiological and neuroimaging studies have identified various types of placebo responses, driven by different mechanisms (especially but not only expectation and conditioning) and associated with different chemical, structural and functional features. Insights into the mechanisms involved in placebo responses have led to opportunities for ethical enhancements of these mechanisms in clinical practice, notably by improving the patient-doctor interaction and refining the therapeutic ritual. These developments should be carefully considered in rheumatology settings, in which placebo effects are both prevalent and significant, with the potential to improve patient care.
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Affiliation(s)
- Joël Coste
- APEMAC, EA 4360, Paris Descartes University, University of Lorraine.,Biostatistics and Epidemiology Unit, Hôtel Dieu, Assistance Publique, Hôpitaux de Paris
| | - Sébastien Montel
- APEMAC, EA 4360, Paris Descartes University, University of Lorraine.,Department of Psychology, University Paris Saint Denis, Paris, France
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13
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Irish AK, Erickson CM, Wahls TL, Snetselaar LG, Darling WG. Randomized control trial evaluation of a modified Paleolithic dietary intervention in the treatment of relapsing-remitting multiple sclerosis: a pilot study. Degener Neurol Neuromuscul Dis 2017; 7:1-18. [PMID: 30050374 PMCID: PMC6053098 DOI: 10.2147/dnnd.s116949] [Citation(s) in RCA: 37] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022] Open
Abstract
BACKGROUND/OBJECTIVE A Paleolithic diet may improve fatigue and quality of life in progressive multiple sclerosis (MS) patients, but past research has evaluated the effects of this dietary intervention in combination with other treatments such as exercise. Thus, the purpose of this pilot study was to evaluate a modified Paleolithic dietary intervention (MPDI) in the treatment of fatigue and other symptoms in relapsing-remitting MS (RRMS). METHODS We measured the effects of a MPDI in 17 individuals with RRMS. Of 34 subjects randomly assigned to control (maintain usual diet) and intervention (MPDI) groups, nine subjects (one man) completed the control group and eight subjects (one man) completed the MPDI. RESULTS Significant improvements were seen in Fatigue Severity Scale score and also in Multiple Sclerosis Quality of Life-54 and time to complete (dominant hand) 9-Hole Peg Test from baseline in MPDI subjects compared to controls. Increased vitamin K serum levels were also observed in MPDI subjects postprotocol compared to controls. CONCLUSION A Paleolithic diet may be useful in the treatment and management of MS, by reducing perceived fatigue, increasing mental and physical quality of life, increasing exercise capacity, and improving hand and leg function. By increasing vitamin K serum levels, the MPDI may also reduce inflammation.
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Affiliation(s)
- Amanda K Irish
- Motor Control Laboratories, Department of Health and Human Physiology, College of Liberal Arts and Sciences, The University of Iowa,
| | - Constance M Erickson
- Motor Control Laboratories, Department of Health and Human Physiology, College of Liberal Arts and Sciences, The University of Iowa,
| | - Terry L Wahls
- Veterans Affairs Medical Center
- Department of Internal Medicine, Carver College of Medicine
| | - Linda G Snetselaar
- Department of Epidemiology, College of Public Health, The University of Iowa, Iowa City, IA, USA
| | - Warren G Darling
- Motor Control Laboratories, Department of Health and Human Physiology, College of Liberal Arts and Sciences, The University of Iowa,
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Cavanaugh MT, Quigley PJ, Hodgson DD, Reid JC, Behm DG. Kinesiology Tape or Compression Sleeve Applied to the Thigh Does Not Improve Balance or Muscle Activation Before or Following Fatigue. J Strength Cond Res 2016; 30:1992-2000. [PMID: 26705066 DOI: 10.1519/jsc.0000000000001297] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/26/2022]
Abstract
Cavanaugh, MT, Quigley, PJ, Hodgson, DD, Reid, JC, and Behm, DG. Kinesiology tape or compression sleeve applied to the thigh does not improve balance or muscle activation before or following fatigue. J Strength Cond Res 30(7): 1992-2000, 2016-Compression sleeves (CS) and kinesiology tape (KT) are purported to enhance proprioception, however, there is substantial conflict in the literature. Because the beneficial effects of CS and KT are more evident in the literature with recovery, the objective of this study was to examine the effects of CS and KT on balance under acute nonfatigued and postfatigued conditions. Using a within-subject, repeated-measures design, 12 university participants (5 females and 7 males) performed in a random order CS, KT, and Control conditions. Two trials of each test were conducted before the application of CS or KT (pretest 1), immediately after the application (pretest 2), with posttests at 1 and 10 minutes after 4 sets of unilateral Bulgarian squats to failure (1 minute rest between sets). Tests included a Y balance test (measures: distance reached by nondominant foot in anterior, posterior lateral, and posterior medial directions) and drop jump landing balance test from a 50-cm platform (measures: ground reaction force, electromyography, and center of pressure). The fatigue protocol induced 25.3% decrease in unilateral squat repetitions from set 1 to set 4. There were no significant condition main effects or interactions for any balance measure or EMG before or after fatigue. In conclusion, independent of fatigue, there was no significant effect of CS or KT on balance outcomes immediately and up to 10 minutes following the fatiguing intervention. Thus, nonfatigued or muscles weakened by fatigue did not benefit from CS and KT application.
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Affiliation(s)
- M Tyler Cavanaugh
- School of Human Kinetics and Recreation, Memorial University of Newfoundland, St. John's, Newfoundland, Canada
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15
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Rattehalli RD, Zhao S, Li BG, Jayaram MB, Xia J, Sampson S. Risperidone versus placebo for schizophrenia. Cochrane Database Syst Rev 2016; 12:CD006918. [PMID: 27977041 PMCID: PMC6463908 DOI: 10.1002/14651858.cd006918.pub3] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/11/2023]
Abstract
BACKGROUND Risperidone is the first new-generation antipsychotic drug made available in the market in its generic form. OBJECTIVES To determine the clinical effects, safety and cost-effectiveness of risperidone compared with placebo for treating schizophrenia. SEARCH METHODS On 19th October 2015, we searched the Cochrane Schizophrenia Group Trials Register, which is based on regular searches of CINAHL, BIOSIS, AMED, EMBASE, PubMed, MEDLINE, PsycINFO, and registries of clinical trials. We checked the references of all included studies and contacted industry and authors of included studies for relevant studies and data. SELECTION CRITERIA Randomised clinical trials (RCTs) comparing oral risperidone with placebo treatments for people with schizophrenia and/or schizophrenia-like psychoses. DATA COLLECTION AND ANALYSIS Two review authors independently screened studies, assessed the risk of bias of included studies and extracted data. For dichotomous data, we calculated the risk ratio (RR), and the 95% confidence interval (CI) on an intention-to-treat basis. For continuous data, we calculated mean differences (MD) and the 95% CI. We created a 'Summary of findings table' using GRADE (Grading of Recommendations Assessment, Development and Evaluation). MAIN RESULTS The review includes 15 studies (N = 2428). Risk of selection bias is unclear in most of the studies, especially concerning allocation concealment. Other areas of risk such as missing data and selective reporting also caused some concern, although not affected on the direction of effect of our primary outcome, as demonstrated by sensitivity analysis. Many of the included trials have industry sponsorship of involvement. Nonetheless, generally people in the risperidone group are more likely to achieve a significant clinical improvement in mental state (6 RCTs, N = 864, RR 0.64, CI 0.52 to 0.78, very low-quality evidence). The effect withstood, even when three studies with >50% attrition rate were removed from the analysis (3 RCTs, N = 589, RR 0.77, CI 0.67 to 0.88). Participants receiving placebo were less likely to have a clinically significant improvement on Clinical Global Impression scale (CGI) than those receiving risperidone (4 RCTs, N = 594, RR 0.69, CI 0.57 to 0.83, very low-quality evidence). Overall, the risperidone group was 31% less likely to leave early compared to placebo group (12 RCTs, N = 2261, RR 0.69, 95% CI 0.62 to 0.78, low-quality evidence), but Incidence of significant extrapyramidal side effect was more likely to occur in the risperidone group (7 RCTs, N = 1511, RR 1.56, 95% CI 1.13 to 2.15, very low-quality evidence).When risperidone and placebo were augmented with clozapine, there is no significant differences between groups for clinical response as defined by a less than 20% reduction in PANSS/BPRS scores (2 RCTs, N = 98, RR 1.15, 95% CI 0.93 to 1.42, low-quality evidence) and attrition (leaving the study early for any reason) (3 RCTs, N = 167, RR 1.13, 95% CI 0.53 to 2.42, low quality evidence). One study measured clinically significant responses using the CGI, no effect was evident (1 RCT, N = 68, RR 1.12 95% CI 0.87 to 1.44, low quality evidence). No data were available for extrapyramidal adverse effects. AUTHORS' CONCLUSIONS Based on low quality evidence, risperidone appears to be benefitial in improving mental state compared with placebo, but it also causes more adverse events. Eight out of the 15 included trials were funded by pharmaceutical companies. The currently available evidence isvery low to low quality.
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Affiliation(s)
| | - Sai Zhao
- Systematic Review Solutions Ltd5‐6 West Tashan RoadYan TaiTianjinChina264000
| | - Bao Guo Li
- Tianjin Medical University Cancer Institute and HospitalInterventional therapy departmentHuan‐Hu‐Xi Road, Ti‐Yuan‐Bei,He Xi DistrictTianjinChina300060
| | - Mahesh B Jayaram
- Melbourne Neuropsychiatry CentreDepartment of PsychiatryUniversity of MelbourneMelbourneAustralia
| | - Jun Xia
- The University of NottinghamCochrane Schizophrenia GroupInstitute of Mental HealthUniversity of Nottingham Innovation Park, Triumph Road,NottinghamUKNG7 2TU
| | - Stephanie Sampson
- The University of NottinghamInstitute of Mental HealthUniversity of Nottingham Innovation Park, Jubilee CampusNottinghamUKNG7 2TU
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Weger UW, Berger B, Boehm K, Heusser P. The Psychological Dimensions of Placebo-Studies. EUROPEAN PSYCHOLOGIST 2016. [DOI: 10.1027/1016-9040/a000251] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022]
Abstract
Abstract. The placebo effect involves a complex network of psychological variables that are often disregarded by studies enquiring into this effect. It is hence little surprising that these psychological variables confound study outcomes and that experiments investigating the placebo effect often yield radically different results. The current article identifies three categories of psychological and methodological factors that are not systematically considered in placebo research: psychological confounds (Hawthorne effects and demand effects); methodological and data-analysis issues; and clinicians’ expectancy effects. These factors are not necessarily to be seen as mere artifacts, however, because they may constitute favorable components of the placebo effect. A set of benchmark criteria is therefore proposed to allow researchers to capitalize on these components during placebo research rather than have their results confounded by them; and to allow for a more reliable interpretation of study outcomes.
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Affiliation(s)
- Ulrich W. Weger
- Department of Psychology, University of Witten/Herdecke, Germany
- Institute of Integrative Medicine, University of Witten/Herdecke, Germany
| | - Bettina Berger
- Institute of Integrative Medicine, University of Witten/Herdecke, Germany
| | - Katja Boehm
- Institute of Integrative Medicine, University of Witten/Herdecke, Germany
| | - Peter Heusser
- Institute of Integrative Medicine, University of Witten/Herdecke, Germany
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Michałek D, Kołodziej M, Konarska Z, Szajewska H. Efficacy and safety of gelatine tannate for the treatment of acute gastroenteritis in children: protocol of a randomised controlled trial. BMJ Open 2016; 6:e010530. [PMID: 26895988 PMCID: PMC4762119 DOI: 10.1136/bmjopen-2015-010530] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/03/2022] Open
Abstract
INTRODUCTION Worldwide, acute gastroenteritis in children, usually caused by viruses, leads to considerable morbidity and mortality. The treatment is aimed at preventing and treating dehydration, promoting weight gain after rehydration, and reducing the duration and severity of diarrhoea. Effective and inexpensive interventions that could add to the effect of oral rehydration therapy are of interest. Recently, in many European countries, gelatine tannate is being widely marketed for treating acute gastroenteritis. Gelatine tannate is a complex of tannic acid, which possesses astringent and anti-inflammatory properties, and a protective gelatine. Currently, there is no evidence to support the use of gelatine tannate for treating acute gastroenteritis in children and only scant evidence to support the use of gelatine tannate in adults. We aim to assess the efficacy of gelatine tannate for the treatment of acute gastroenteritis in children. METHODS AND ANALYSIS This will be a blind, placebo-controlled, randomised trial. Children younger than 5 years of age with acute gastroenteritis defined as a change in stool consistency to loose or liquid form (according to the Bristol Stool Form scale or Amsterdam Stool Form scale) and/or an increase in the frequency of evacuations (typically ≥ 3 in 24 h), lasting for no longer than 5 days, will be recruited. A total of 72 children will be randomised to receive either gelatine tannate (children younger than 3 years of age will receive 250 mg, 4 times/day, and those older than 3 years of age will receive 500 mg, 4 times/day) or matching placebo for 5 days. The primary outcome measure is the duration of diarrhoea. ETHICS AND DISSEMINATION The Bioethics Committee approved the study protocol. The findings of this trial will be submitted to a peer-reviewed paediatric journal. Abstracts will be submitted to relevant national and international conferences. TRIAL REGISTRATION NUMBER NCT02280759; Pre-results.
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Affiliation(s)
- Dorota Michałek
- Department of Paediatrics, The Medical University of Warsaw, Warsaw, Poland
| | - Maciej Kołodziej
- Department of Paediatrics, The Medical University of Warsaw, Warsaw, Poland
| | - Zofia Konarska
- Department of Paediatrics, The Medical University of Warsaw, Warsaw, Poland
| | - Hania Szajewska
- Department of Paediatrics, The Medical University of Warsaw, Warsaw, Poland
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Buttle H. Measuring a Journey without Goal: Meditation, Spirituality, and Physiology. BIOMED RESEARCH INTERNATIONAL 2015; 2015:891671. [PMID: 26137495 PMCID: PMC4475556 DOI: 10.1155/2015/891671] [Citation(s) in RCA: 21] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 08/21/2014] [Revised: 11/17/2014] [Accepted: 11/26/2014] [Indexed: 01/08/2023]
Abstract
The secular practice of meditation is associated with a range of physiological and cognitive effects, including lower blood pressure, lower cortisol, cortical thickening, and activation of areas of the brain associated with attention and emotion regulation. However, in the context of spiritual practice, these benefits are secondary gains, as the primary aim is spiritual transformation. Despite obvious difficulties in trying to measure a journey without goal, spiritual aspects involved in the practice of meditation should also be addressed by experimental study. This review starts by considering meditation in the form of the relaxation response (a counterpart to the stress response), before contrasting mindfulness research that emphasizes the role of attention and alertness in meditation. This contrast demonstrates how reference to traditional spiritual texts (in this case Buddhist) can be used to guide research questions involving meditation. Further considerations are detailed, along with the proposal that research should triangulate spiritual textual sources, first person accounts (i.e., neurophenomenology), and physiological/cognitive measures in order to aid our understanding of meditation, not only in the secular context of health benefits, but also in the context of spiritual practice.
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Affiliation(s)
- Heather Buttle
- School of Psychology, Massey University, Private Bag 102904, North Shore Mail Centre, Auckland 0745, New Zealand
- Mind and Life Institute, Amherst College, 271 South Pleasant Street, Amherst, MA 01002, USA
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Zeng C, Wei J, Lei GH. Is chondroitin sulfate plus glucosamine superior to placebo in the treatment of knee osteoarthritis? Ann Rheum Dis 2015; 74:e37. [DOI: 10.1136/annrheumdis-2015-207476] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 02/17/2015] [Indexed: 11/03/2022]
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Pike AJ. Body-mindfulness in physiotherapy for the management of long-term chronic pain. PHYSICAL THERAPY REVIEWS 2013. [DOI: 10.1179/174328808x251957] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/31/2022]
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Weger UW, Loughnan S. Mobilizing unused resources: using the placebo concept to enhance cognitive performance. Q J Exp Psychol (Hove) 2012; 66:23-8. [PMID: 23234490 DOI: 10.1080/17470218.2012.751117] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/27/2022]
Abstract
People have significant psychological resources to improve their well-being and performance, but these resources often go unused and could be better harnessed. In the medical domain, it is well established that these resources can be mobilized under certain conditions, for example in the context of the placebo effect. Here we explored whether the placebo principle can be used to enhance cognitive performance. To do so, we employed a modified placebo induction--a bogus priming method that we told participants would unconsciously enhance their knowledge and that they should hence trust their skills in an upcoming knowledge test. Participant performance was indeed enhanced, compared to a group that did not think the priming process would improve their knowledge. The study documents the relevance of the placebo effect outside the medical and therapeutic setting.
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Affiliation(s)
- Ulrich W Weger
- Department of Psychology, University of Witten-Herdecke, Witten, Germany.
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Grossman M, Agulnik J, Batist G. The Peter Brojde lung cancer centre: a model of integrative practice. ACTA ACUST UNITED AC 2012; 19:e145-59. [PMID: 22670104 DOI: 10.3747/co.19.929] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/22/2023]
Abstract
BACKGROUND The generally poor prognosis and poor quality of life for lung cancer patients have highlighted the need for a conceptual model of integrative practice. Although the philosophy of integrative oncology is well described, conceptual models that could guide the implementation and scientific evaluation of integrative practice are lacking. PURPOSE The present paper describes a conceptual model of integrative practice in which the philosophical underpinnings derive mainly from integrative oncology, with important contributions from Traditional Chinese Medicine (TCM) and the discipline of nursing. The conceptual model is described in terms of its purpose, values, concepts, dynamic components, scientific evidence, clinical approach, and theoretical underpinnings. The model argues that these components delineate the initial scope and orientation of integrative practice. They serve as the needed context for evaluating and interpreting the effectiveness of clinical interventions in enhancing patient outcomes in lung cancer at various phases of the illness. Furthermore, the development of relevant and effective integrative clinical interventions requires new research methods based on whole-systems research. An initial focus would be the identification of interrelationship patterns among variables that influence clinical interventions and their targeted patient outcomes.
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Affiliation(s)
- M Grossman
- McGill School of Nursing, McGill University, Montreal, QC.
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Horowitz S. New Perspectives on the Placebo Effect: Implications for Research and Clinical Practice. ACTA ACUST UNITED AC 2012. [DOI: 10.1089/act.2012.18304] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/29/2023]
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Abstract
It is proposed to discuss how ozonetherapy acts on patients affected by vascular and degenerative diseases. Ozone is a strong oxidant but, if used in small dosages on human blood ex vivo, acts as an acceptable stressor. By instantly reacting with PUFA bound to albumin, ozone is entirely consumed but generates two messengers acting in an early and in a late phase: the former is due to hydrogen peroxide, which triggers biochemical pathways on blood cells and the latter is due to alkenals which are infused into the donor patient. After undergoing a partial catabolism, alkenals enter into a great number of body's cells, where they react with Nrf2-Keap1 protein: the transfer of activated Nrf2 into the nucleus and its binding to antioxidant response element (ARE) is the crucial event able to upregulate the synthesis of antioxidant proteins, phase II enzymes and HO-1. With the progress of ozonetherapy, these protective enzymes are able to reverse the oxidative stress induced by chronic inflammation. Consequently, the repetition of graduated stresses induces a multiform adaptive response able to block the progress of the disease and to improve the quality of life.
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Affiliation(s)
- Velio Bocci
- Department of Physiology, University of Siena, Italy.
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Abstract
In this article, we scientifically evaluate the bio-oxidative procedure known as oxygen-ozone therapy. Research over a decade has established a comprehensive framework for understanding and recommending this type of autohemotherapy in vascular diseases. In contrast, a non-specific immunomodulation therapy, using heavily oxidized and denatured blood, has been recently used in studies involving a total of approximately 3000 patients and has led to 'disappointing' results. Such a treatment appears to be an inappropriate example of the so-called minor autohemotherapy, and its poor outcomes may discourage any further studies. Therefore it appears necessary to clarify that the use of only a minimal ozone dose and a valid experimental protocol is likely to produce beneficial results. Millions of people suffer from chronic limb, brain, and heart ischemia, and such patients may benefit if appropriate ozone therapy could be implemented. Accordingly, we propose the need for a well designed, multicenter, clinical trial to be conducted.
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Affiliation(s)
- Velis Bocci
- Department of Physiology, University of Siena, Siena, Italy.
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Amichai T, Grossman M, Richard M. Lung cancer patients' beliefs about complementary and alternative medicine in the promotion of their wellness. Eur J Oncol Nurs 2012; 16:520-7. [PMID: 22330059 DOI: 10.1016/j.ejon.2012.01.004] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/12/2011] [Revised: 01/19/2012] [Accepted: 01/20/2012] [Indexed: 10/28/2022]
Abstract
PURPOSE Cancer patients are increasingly turning to complementary and alternative medicine (CAM) because they believe that conventional treatments are not optimizing their overall wellness. However, the relationship between CAM use, wellness, and patient beliefs has received little attention in the nursing literature. This study aimed to understand lung cancer patients' beliefs about CAM use in promoting their own wellness. METHOD An interpretive qualitative design guided the study. Semi-structured interviews were conducted with 12 adult lung cancer outpatients who used CAM. An inductive approach to analysis was taken; this included immersion in the data, open coding, categorization of similar codes, and identification of emerging patterns and themes. RESULTS The patients' beliefs about CAM use in promoting their own wellness were the result of an ongoing adaptive process of belief modification and reformation/transformation that began with their cancer diagnosis. This evolution of patient beliefs comprised four main themes: processing the initial upheaval of beliefs into a life change; developing beliefs that motivated CAM use; validating their new beliefs; and synthesizing these experiences and belief changes into a personal philosophy/meaning of "wellness with cancer." CONCLUSIONS CAM, as a strategy to promote wellness, played an integral role in the experience of wellness with cancer. Patients' experiences with CAM were governed by their underlying beliefs; thus, clinicians should consider their patient's beliefs when discussing CAM strategies. Given the importance of recommendations health professionals should also offer guidance and open discussion of CAM with patients and tailor CAM to their needs.
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Affiliation(s)
- Tamar Amichai
- School of Nursing, McGill University, 3506 University Street, Montreal, Quebec H3A 2A7, Canada.
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Rakel D, Barrett B, Zhang Z, Hoeft T, Chewning B, Marchand L, Scheder J. Perception of empathy in the therapeutic encounter: effects on the common cold. PATIENT EDUCATION AND COUNSELING 2011; 85:390-7. [PMID: 21300514 PMCID: PMC3107395 DOI: 10.1016/j.pec.2011.01.009] [Citation(s) in RCA: 156] [Impact Index Per Article: 12.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/25/2010] [Revised: 01/06/2011] [Accepted: 01/07/2011] [Indexed: 05/13/2023]
Abstract
OBJECTIVE To evaluate the effects of patient-practitioner interaction on the severity and duration of the common cold. METHODS We conducted a randomized controlled trial of 719 patients with new cold onset. Participants were randomized to three groups: no patient-practitioner interaction, "standard" interaction or an "enhanced" interaction. Cold severity was assessed twice daily. Patients randomized to practitioner visits used the Consultation and Relational Empathy (CARE) measure to rate clinician empathy. Interleukin-8 (IL-8) and neutrophil counts were obtained from nasal wash at baseline and 48 h later. RESULTS Patients' perceptions of the clinical encounter were associated with reduced cold severity and duration. Encounters rated perfect on the CARE score had reduced severity (perfect: 223, sub-perfect: 271, p=0.04) and duration (perfect: 5.89 days, sub-perfect: 7.00 days, p=0.003). CARE scores were also associated with a more significant change in IL-8 (perfect: mean IL-8 change 1586, sub-perfect: 72, p=0.02) and neutrophil count (perfect: 49, sub-perfect: 12, p=0.09). CONCLUSIONS When patients perceive clinicians as empathetic, rating them perfect on the CARE tool, the severity, duration and objective measures (IL-8 and neutrophils) of the common cold significantly change. PRACTICE IMPLICATIONS This study helps us to understand the importance of the perception of empathy in a therapeutic encounter.
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Affiliation(s)
- David Rakel
- Department of Family Medicine, University of Wisconsin-Madison, Madison, WI, USA.
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Köteles F, Bárdos G. What makes us sicker? An experimental study on non-specific adverse drug effects. ACTA ACUST UNITED AC 2011. [DOI: 10.1556/cemed.5.2011.4.4] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/19/2022]
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Zebrowski PM, Arenas RM. The "Iowa Way" revisited. JOURNAL OF FLUENCY DISORDERS 2011; 36:144-157. [PMID: 22118392 DOI: 10.1016/j.jfludis.2010.08.001] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/19/2009] [Revised: 08/04/2010] [Accepted: 08/17/2010] [Indexed: 05/31/2023]
Abstract
UNLABELLED This paper attempts to bridge the gap between past and present stuttering therapy approaches. Specifically, the ideas and methods of Wendell Johnson and Dean Williams are compared to current approaches used in treating mental illness and communication disorders in which there is an emphasis on focusing on what is "right" with the individual and spending less time focusing on the "disorder". There is particular emphasis on tying Johnson's and Williams' overall philosophy to modern psychological approaches rooted in "Positive Psychology", to highlight how these early ideas in stuttering therapy may help us to discover the common factors that underlie the success of several different stuttering therapy approaches, independent of the specific techniques employed. It is proposed that future research on clinical efficacy in stuttering should use focused hypotheses techniques to investigate common factors that make therapy effective across individuals and therapy approaches. EDUCATIONAL OBJECTIVES The reader will be able to: (1) summarize the basic philosophy of the "Iowa" approach to stuttering as laid out by Wendell Johnson and Dean Williams; (2) describe current therapeutic techniques that incorporate "positive psychology"; (3) discuss possible common factors that influence therapy outcome that are independent of the therapeutic technique employed.
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Affiliation(s)
- Patricia M Zebrowski
- Department of Communication Sciences and Disorders, University of Iowa, Iowa City, IA 52242, USA.
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Owens JE, Menard M. The quantification of placebo effects within a general model of health care outcomes. J Altern Complement Med 2011; 17:817-21. [PMID: 21848415 DOI: 10.1089/acm.2010.0566] [Citation(s) in RCA: 12] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
OBJECTIVES The objective of this study was to test a model of placebo effects in the context of a general model of health care outcomes. DESIGN The design of this study was a multisite, double-blind, placebo-controlled crossover trial. SETTINGS The study was conducted at The University of Washington Hospital, Seattle, Washington, Cooper Hospital/University Medical Center, Camden, New Jersey, and at the Neurology Center of Fairfax, Fairfax, Virginia. SUBJECTS One hundred and seventeen (117) patients diagnosed with Multiple Sclerosis were enrolled in the study. INTERVENTION Subjects had daily exposure to a pulsing electromagnetic generator. OUTCOME MEASURES The outcome measures were the average score of three quality-of-life indices: the Modified Fatigue Impact Scale, the Medical Outcomes Study Pain Effects Scale, and the Spasticity Effects Scale. RESULTS Placebo responders scored higher in the personality trait of Absorption compared with nonresponders (p<0.01). Placebo responders were more confident that the sham device was active compared to placebo nonresponders (p<0.009). The two factors of confidence in the treatment and Absorption accurately identified 80% of placebo responders in a discriminant analysis (p<0.0004). CONCLUSIONS Placebo effects are best understood when integrated in a general model of health care outcomes.
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Affiliation(s)
- Justine E Owens
- Department of Medicine, Division of General Medicine, Geriatrics and Palliative Care, Health Sciences Center, University of Virginia, Charlottesville, VA, USA.
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Abstract
If placebos have been squeezed out of medicine to the point where their official place in in clinical trials designed to identify their own confounding effect, the placebo effect nevertheless thrives in psychotherapy. Not only does psychotherapy dispose of placebo effects that are less available to medicine as it becomes increasingly technological and preoccupied with body parts, but factors of the sort inhibiting the use of placebos in medicine have no equivalent in psychology. Medicine today is disturbed by the placebo effect in a way psychotherapy is not. Psychotherapy does not have to grapple with such a disconcerting paradox as successful sham surgery, and unlike those physicians who once pretended to treat the patient's body while actually attempting to treat the mind, the psychotherapist can treat the mind in all frankness. Perhaps it is because psychotherapy is less burdened by doubts about the placebo effect that it was able to come to its aid when it was orphaned by medicine. It is vain to expect something with so long a history as the placebo effect to disappear from the practices of healing.
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Abstract
BACKGROUND Risperidone is the first new generation antipsychotic drug made available in the market in its generic form. OBJECTIVES To examine the clinical effects of oral risperidone for people with schizophrenia and schizophrenia-like psychoses in comparison with placebo. SEARCH STRATEGY We searched the Cochrane Schizophrenia Group's Register (February 2008), references of all included studies, and contacted industry and authors of included studies for relevant studies and data. SELECTION CRITERIA Randomised clinical trials comparing oral risperidone with placebo treatments for people with schizophrenia and/or schizophrenia-like psychoses. DATA COLLECTION AND ANALYSIS Two reviewers independently inspected citations and/or abstracts, ordered papers, re-inspected and assessed the quality of results and extracted data. For dichotomous data, we calculated the relative risk (RR), the 95% confidence interval (CI) and, where appropriate, the number needed to treat (NNT), on an intention-to-treat basis. For continuous data, we calculated weighted mean differences (WMD). MAIN RESULTS One study (n=599) compared risperidone against placebo but the attrition rate was 60% over a period of six weeks rendering most of the efficacy and global improvement data unusable. The attrition rate was higher for placebo compared with risperidone (n=1363, 10 RCTs, RR 0.70 CI 0.57 to 0.86, NNT 13 CI 9 to 29) and less participants left the trial in the risperidone arm due to lack of efficacy (n=888, 5 RCTs, RR 0.38 CI 0.20 to 0.73, NNT 7 CI 5 to 15). Risperidone was no better than placebo on the CGI global score (n=397, 3 RCTs, RR 0.80 CI 0.55 to 1.15) but significantly more number of participants in risperidone arm had more than 20% reduction in their BPRS/PANSS score (n=856, 7 RCTs, RR 0.43 CI 0.32 to 0.58, NNT 7 CI 6 to 10). Data became considerably more homogeneous (and positive) when the one study independent of industry funding was removed (I(2) 75% to 55%). Despite poor reporting, it is clear that around 24% of all participants receiving either risperidone or placebo developed some form of extrapyramidal effects (n=723, 5 RCTs, RR 1.40 CI 0.93 to 2.10). Three people on risperidone had prolonged QTc (n=198, 1 RCT, RR 7.5 CI 0.4 to 144), more on risperidone gained weight (n=303, 2 RCTs, RR 5.14 CI 1.79 to 14.73, NNH 10 CI 3 to 51) and had a raised prolactin (n=323, 2 RCTs, RR 12.54 CI 5.11 to 30.79, NNH 3 CI 2 to 5). Fewer in the risperidone arm needed an additional psychotropic during the trial period (n=186, 1 RCT, RR 0.62 CI 0.45 to 0.85, NNT 10 CI 7 to 28). AUTHORS' CONCLUSIONS Risperidone appears to have a marginal benefit in terms of clinical improvement compared with placebo in the first few weeks of treatment but data are limited, poorly reported and probably biased in favour of risperidone. The margin of improvement chosen by the researchers as their outcome may not be clinically meaningful. Even after so much use of this drug, we feel that further independent trials can be justified.
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Rattehalli RD, Jayaram MB, Smith M. Risperidone versus placebo for schizophrenia. THE COCHRANE DATABASE OF SYSTEMATIC REVIEWS 2010. [DOI: 10.1002/14651858.cd006918.pub2] [Citation(s) in RCA: 12] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/12/2022]
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Abstract
The reader may be eager to examine in which diseases ozonetherapy can be proficiently used and she/he will be amazed by the versatility of this complementary approach (Table 9 1). The fact that the medical applications are numerous exposes the ozonetherapist to medical derision because superficial observers or sarcastic sceptics consider ozonetherapy as the modern panacea. This seems so because ozone, like oxygen, is a molecule able to act simultaneously on several blood components with different functions but, as we shall discuss, ozonetherapy is not a panacea. The ozone messengers ROS and LOPs can act either locally or systemically in practically all cells of an organism. In contrast to the dogma that “ozone is always toxic”, three decades of clinical experience, although mostly acquired in private clinics in millions of patients, have shown that ozone can act as a disinfectant, an oxygen donor, an immunomodulator, a paradoxical inducer of antioxidant enzymes, a metabolic enhancer, an inducer of endothelial nitric oxide synthase and possibly an activator of stem cells with consequent neovascularization and tissue reconstruction.
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Affiliation(s)
- Velio Bocci
- Department of Physiology, University of Siena, via A. Moro 2, 53100 Siena, Italy
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Sturmberg JP. EBM: a narrow and obsessive methodology that fails to meet the knowledge needs of a complex adaptive clinical world: a commentary on Djulbegovic, B., Guyatt, G. H. & Ashcroft, R. E. (2009) Cancer Control, 16, 158-168. J Eval Clin Pract 2009; 15:917-23. [PMID: 20367684 DOI: 10.1111/j.1365-2753.2009.01321.x] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
Affiliation(s)
- Joachim P Sturmberg
- Monash University, Melbourne, Vic. and Associate Professor of General Practice, The Newcastle University, Newcastle, NSW, Australia
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Ommen O, Wirtz M, Janssen C, Neumann M, Driller E, Ernstmann N, Loeffert S, Pfaff H. Psychometric evaluation of an instrument to assess patient-reported ‘psychosocial care by physicians’: a structural equation modeling approach. Int J Qual Health Care 2009; 21:190-7. [DOI: 10.1093/intqhc/mzp010] [Citation(s) in RCA: 21] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/12/2022] Open
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Engler RJM, With CM, Gregory PJ, Jellin JM. Complementary and alternative medicine for the allergist-immunologist: where do I start? J Allergy Clin Immunol 2009; 123:309-16. [PMID: 19203654 DOI: 10.1016/j.jaci.2009.01.001] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/06/2008] [Revised: 12/24/2008] [Accepted: 01/05/2009] [Indexed: 12/01/2022]
Abstract
Complementary and alternative medicine (CAM) therapies present a growing information management challenge for physicians because nearly 40% of their patients may be using and another 50% may be considering use of CAM as part of their healthcare regimen. The National Health Statistics Reports for 2007 described the most commonly used nonvitamin, nonmineral therapy as natural products (eg, herbals at 17.7%). More than 5% of children under the age of 18 years used CAM for allergic conditions including asthma. The amount and quality of information available and concerns about liability risk represent a challenge for most physicians. This review focuses on considerations for approaching a CAM-related consultation, incorporating legal and logistic factors affecting how such an encounter should be approached. A 10-step process is presented that addresses different components of CAM consultations and what should be documented. Access to timely, high-quality information regarding product specific efficacy and safety data, as found in the Natural Medicines Comprehensive Database, is needed to support CAM consultation efficiently. Understanding of serious adverse events associated with CAM is limited; an international need exists for improved safety surveillance and information sharing. Allergy-immunology, as a specialty with expertise in adverse drug reaction evaluation and management, has a unique opportunity to support enhanced CAM-related adverse events evaluations, reporting, and research.
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Affiliation(s)
- Renata J M Engler
- Vaccine Healthcare Centers Network, Allergy-Immunology Department, Walter Reed Army Medical Center, Washington, DC, USA
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Abstract
This paper considers how the full range of human experience may catalyze a placebo response. The placebo effect has been characterized as something to control in clinical research, something to cultivate in clinical practice and something present in all healing encounters. We examine domains in which the term 'placebo' is used in discourse: clinical research, clinical practice, media representations of treatment efficacy and lay interpretations of placebo--an underresearched topic. We briefly review major theoretical frameworks proposed to explain the placebo effect: classical conditioning, expectancy, the therapeutic relationship and sociocultural 'meaning.' As a corrective to what we see as an overemphasis on conscious cognitive approaches to understanding placebo, we reorient the discussion to argue that direct embodied experience may take precedence over meaning-making in the healing encounter. As an example, we examine the neurobiology of rehearsing or visualizing wellness as a mode of directly (performatively) producing an outcome often dismissed as a 'placebo response.' Given body/mind/emotional resonance, we suggest that the placebo response is an evolutionarily adaptive trait and part of healing mechanisms operating across many levels--from genetic and cellular to social and cultural.
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Köteles F, Bárdos G. Expectations of side effects evoked by perceptual characteristics of curatives and their psychological background. ACTA ACUST UNITED AC 2009. [DOI: 10.1556/mental.10.2009.1.3] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/19/2022]
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Haga SB, Warner LR, O'Daniel J. The potential of a placebo/nocebo effect in pharmacogenetics. Public Health Genomics 2009; 12:158-62. [PMID: 19204418 DOI: 10.1159/000189628] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/19/2022] Open
Abstract
Pharmacogenetic testing holds great promise to improve health outcomes and reduce adverse drug responses through enhanced selection of therapeutic agents. Since drug responses can be manipulated by verbal suggestions, it is of particular interest to understand the potential impact of pharmacogenetic test results on drug response. Placebo and nocebo-like effects may be possible due to the suggestive nature of pharmacogenetic information that a drug will or will not likely lead to improved health outcomes. For example, pharmacogenetic testing could provide further reassurance to patients that a given drug will be effective and/or cause minimal side effects. However, pharmacogenetic information could adversely affect drug response through negative expectations that a drug will be less than optimally effective or cause an adverse response, known as a nocebo-like effect. Therefore, a patient's perceived value of testing, their understanding of the test results, and the manner in which they are communicated may influence therapeutic outcome. As such, physicians should consider the potential effect of pharmacogenetic test results on therapeutic outcome when communicating results to patients. Studies are needed to investigate the impact of pharmacogenetic information of therapeutic outcome.
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Affiliation(s)
- S B Haga
- Duke University, Institute for Genome Sciences and Policy, Durham, NC 27708, USA.
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Kravitz RL, Duan N, Niedzinski EJ, Hay MC, Subramanian SK, Weisner TS. What ever happened to N-of-1 trials? Insiders' perspectives and a look to the future. Milbank Q 2009; 86:533-55. [PMID: 19120979 DOI: 10.1111/j.1468-0009.2008.00533.x] [Citation(s) in RCA: 68] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022] Open
Abstract
CONTEXT When feasible, randomized, blinded single-patient (n-of-1) trials are uniquely capable of establishing the best treatment in an individual patient. Despite early enthusiasm, by the turn of the twenty-first century, few academic centers were conducting n-of-1 trials on a regular basis. METHODS The authors reviewed the literature and conducted in-depth telephone interviews with leaders in the n-of-1 trial movement. FINDINGS N-of-1 trials can improve care by increasing therapeutic precision. However, they have not been widely adopted, in part because physicians do not sufficiently value the reduction in uncertainty they yield weighed against the inconvenience they impose. Limited evidence suggests that patients may be receptive to n-of-1 trials once they understand the benefits. CONCLUSIONS N-of-1 trials offer a unique opportunity to individualize clinical care and enrich clinical research. While ongoing changes in drug discovery, manufacture, and marketing may ultimately spur pharmaceutical makers and health care payers to support n-of-1 trials, at present the most promising resuscitation strategy is stripping n-of-1 trials to their essentials and marketing them directly to patients. In order to optimize statistical inference from these trials, empirical Bayes methods can be used to combine individual patient data with aggregate data from comparable patients.
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Abstract
This review discusses physical activity counseling in primary care, including evidence-based perspectives on optimizing the risk-benefit ratio for the majority of patients who are not physically fit.
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Affiliation(s)
- Lisa Terre
- Department of Psychology, University of Missouri-Kansas City,
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Abstract
In a study testing whether the relationship between exercise and health is moderated by one's mind-set, 84 female room attendants working in seven different hotels were measured on physiological health variables affected by exercise. Those in the informed condition were told that the work they do (cleaning hotel rooms) is good exercise and satisfies the Surgeon General's recommendations for an active lifestyle. Examples of how their work was exercise were provided. Subjects in the control group were not given this information. Although actual behavior did not change, 4 weeks after the intervention, the informed group perceived themselves to be getting significantly more exercise than before. As a result, compared with the control group, they showed a decrease in weight, blood pressure, body fat, waist-to-hip ratio, and body mass index. These results support the hypothesis that exercise affects health in part or in whole via the placebo effect.
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Affiliation(s)
- Alia J Crum
- Department of Psychology, Harvard University, 1330 William James Hall, 33 Kirkland St., Cambridge, MA 02138, USA.
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Abstract
The placebo is much more than a control medicine in a clinical trial. The placebo response is the largest component of any allergy treatment and consists of two components: nonspecific effects (eg, natural recovery) and a "true placebo effect" that is the psychological therapeutic effect of the treatment. Belief in the beneficial nature of the treatment is a key component of the true placebo effect, and can be enhanced by factors such as interaction with the physician and the sensory impact of the treatment. Negative beliefs can generate a nocebo effect that may explain some psychogenic illnesses; this is the basis of much research in psychoneuroimmunology. An understanding of the placebo and nocebo effects is important for general allergy practice, and harnessing the power of the true placebo effect is a major challenge to modern medicine.
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Affiliation(s)
- Ron Eccles
- Common Cold Centre, Cardiff School of Biosciences, Cardiff University, Cardiff CF10 3US, UK.
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Geers AL, Kosbab K, Helfer SG, Weiland PE, Wellman JA. Further evidence for individual differences in placebo responding: an interactionist perspective. J Psychosom Res 2007; 62:563-70. [PMID: 17467411 DOI: 10.1016/j.jpsychores.2006.12.005] [Citation(s) in RCA: 71] [Impact Index Per Article: 4.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/24/2005] [Indexed: 11/23/2022]
Abstract
OBJECTIVE A prior investigation found that individuals low in optimism are more likely to follow a negative placebo (nocebo) expectation. The present study tested the hypothesis that individuals high in optimism are more likely to follow a positive placebo expectation. METHODS Individuals (N=56) varying in their level of optimism were randomly assigned to one of three conditions. In the first condition, participants were given the expectation that a placebo sleep treatment would improve their sleep quality (placebo expectation condition). In the second condition, participants engaged in the same sleep treatment activity but were not given the positive placebo expectation (treatment control condition). Finally, a third group did not receive the positive placebo expectation and also did not engage in the placebo sleep treatment (no-placebo control condition). RESULTS Optimism was positively associated with better sleep quality in the placebo expectation condition (r=.48, P<.05). Optimism scores were not associated with better sleep quality in either the treatment control condition (r=-.17, P=.46) or the no-placebo control condition (r=-.24, P=.35). CONCLUSION Dispositional optimism relates to placebo responding. This relationship, however, is not manifested in a simple increase or decrease in all types of placebo responding. Rather, it appears that, as optimism increases, response to the positive placebo expectation increases, whereas response to nocebo expectation decreases. It is recommended that future research on personality and placebo effects consider the interaction between situational and dispositional variables.
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Affiliation(s)
- Andrew L Geers
- Department of Psychology, University of Toledo, Toledo, OH 43606-3390, USA.
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Adams M. Deception in Psoriasis Study Involving Greater than Minimal Risk. J Empir Res Hum Res Ethics 2007; 2:87-8. [DOI: 10.1525/jer.2007.2.1.87a] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
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