Abstract
The therapeutic response to a drug treatment is a mixture of direct pharmacological action and placebo effect. Therefore, harnessing the positive aspects of the placebo effect and reducing the negative ones could potentially benefit the patient. This article is aimed at providing an overview for clinicians of the importance of contextual psychosocial variables in determining treatment response, and the specific focus is on determinants of the placebo response. A better understanding of the physiological, psychological, and social mechanisms of placebo may aid in predicting which contexts have the greatest potential for inducing positive treatment responses. We examine the evidence for the role of psychological traits, including optimism, pessimism, and the effect of patient expectations on therapeutic outcome. We discuss the importance of the patient-practitioner relationship and how this can be used to enhance the placebo effect, and we consider the ethical challenges of using placebos in clinical practice.
Highlights
The therapeutic response to a drug treatment is a mixture of direct pharmacological action and placebo effect
The clinical relevance of placebo Evidence from clinical studies emphasizes the relevance of contextual psychosocial variables, including physicianpatient interactions, for treatment outcome [1]
Placebo analgesia has been regarded as a nuisance phenomenon in clinical trials
Summary
Placebo analgesia is a robust psychological and neurophysiological phenomenon that appears to be dependent largely on expectation. Further research is needed to better understand how the contextual factors that cause placebo response might have an impact on specific symptoms such as pain. By providing positive and comprehensible information to the patient, fostering empathic patient-practitioner relationships, or using cognitivebehavioral intervention where necessary, placebo mechanisms could be potentially enhanced without the need for deception. This article is part of the series Evolving understanding of the biology of pain and its application to patient care, edited by Daniel Clauw and Anthony Jones. Other articles in this series can be found at http://arthritis-research.com/series/pain. Competing interests The authors declare that they have no competing interests
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