55 - Placebo, nocebo, caring, and healing in rheumatology

Abstract

Placebo and nocebo effects, once considered a nuisance in clinical research, are today considered an excellent model to understand how the psychosocial context around the patient and the therapy may affect the response to a treatment and the course of a disease. Today the complex psychosocial component involved in caring and healing as well as in the doctor–patient relationship can be investigated by using a biological and neuroscientific approach that uses modern tools to probe different brain functions. The main concept that has emerged today is that placebos modulate the same biochemical pathways that are modulated by drugs. Most of our knowledge about these mechanisms comes from the field of pain and represents a biomedical, psychological, and philosophical enterprise that is changing the way we approach and interpret medicine, psychology, and human biology. Several biochemical pathways and brain regions that are affected by placebos and nocebos have been identified; for example, the opioid and cannabinoid systems. In the same way as we know the mechanisms of drug action, we can now understand how the clinician–patient interaction may affect different biological functions. This represents an epochal transition, in which the distinction between biology and psychology is progressively getting thinner within the context of caring and healing.