Nocebo effects in practice: methotrexate myths and misconceptions

AbstractThe formation and persistence of negative pain-related expectations by classical conditioning remain incompletely understood. We elucidated behavioural and neural correlates involved in the acquisition and extinction of negative expectations towards different threats across sensory modalities. In two complementary functional magnetic resonance imaging studies in healthy humans, differential conditioning paradigms combined interoceptive visceral pain with somatic pain (study 1) and aversive tone (study 2) as exteroceptive threats. Conditioned responses to interoceptive threat predictors were enhanced in both studies, consistently involving the insula and cingulate cortex. Interoceptive threats had a greater impact on extinction efficacy, resulting in disruption of ongoing extinction (study 1), and selective resurgence of interoceptive CS-US associations after complete extinction (study 2). In the face of multiple threats, we preferentially learn, store, and remember interoceptive danger signals. As key mediators of nocebo effects, conditioned responses may be particularly relevant to clinical conditions involving disturbed interoception and chronic visceral pain.

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“Consensus on Placebo and Nocebo Effects Connects Science with Practice:” Reply to “Questioning the Consensus on Placebo and Nocebo Effects”

Psychotherapy and Psychosomatics ◽

10.1159/000514435 ◽

2021 ◽

Vol 90 (3) ◽

pp. 213-214

Author(s):

Andrea W.M. Evers ◽

Luana Colloca ◽

Charlotte Blease ◽

Jens Gaab ◽

Karin B. Jensen ◽

...

Keyword(s):

Nocebo Effects

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Unreal Nocebo Effects

Journal of Christian Nursing ◽

10.1097/01.cnj.0000326268.71246.95 ◽

2008 ◽

Vol 25 (3) ◽

pp. 136-137

Author(s):

&NA;

Keyword(s):

Nocebo Effects

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Placebo and nocebo effects in youth: subjective thermal discomfort can be modulated by a conditioning paradigm utilizing mental states of low and high self-efficacy

British Journal of Pain ◽

10.1177/20494637211020042 ◽

2021 ◽

pp. 204946372110200

Author(s):

Ella Weik ◽

Regula Neuenschwander ◽

Karin Jensen ◽

Tim F Oberlander ◽

Christine Tipper

Keyword(s):

Placebo Effect ◽

Self Efficacy ◽

Group Analysis ◽

Structured Interview ◽

Thermal Stimulus ◽

Nocebo Effect ◽

Conditioning Paradigm ◽

Significant Difference ◽

Nocebo Effects ◽

Subjective Discomfort

Introduction: Conditioning is a key mechanism of placebo and nocebo effects in adults, but little is known about these effects in youth. This study investigated whether personalized verbal cues evoking a sense of high or low self-efficacy can induce conditioned placebo and nocebo effects on subjective discomfort of noxious heat in youth. Methods: In a structured interview, 26 adolescents (13–18 years) described personal situations in which they experienced a sense of high, low or neutral self-efficacy. Participants were then asked to recall these memories during a conditioning paradigm, in which a high thermal stimulus applied to the forearm was repeatedly paired with a low self-efficacy cue and a low thermal stimulus with a high self-efficacy cue. In a testing phase, high, low and neutral self-efficacy cues were paired with the same moderate temperature. We hypothesized that conditioned high and low self-efficacy cues would induce conditioned placebo and nocebo responses to moderate temperatures. Results: Moderate temperatures were rated as more uncomfortable when paired with the conditioned low compared with the neutral self-efficacy cue (nocebo effect). While in the whole-group analysis, there was no significant difference between ratings of moderate thermal stimuli paired with high compared with neutral self-efficacy cues (placebo effect), a sub-group of participants with a greater range of emotional valence between high and neutral self-efficacy cues revealed a significant placebo effect. The strength of the nocebo effect was associated with higher anxiety and lower hope. Conclusion: Conditioned associations using internal self-efficacy states can change subjective discomfort of thermal sensations.

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