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The Underestimated Significance of Conditioning in Placebo Hypoalgesia and Nocebo Hyperalgesia

Placebo and nocebo effects are intriguing phenomena in pain perception with important implications for clinical research and practice because they can alleviate or increase pain. According to current theoretical accounts, these effects can be shaped by verbal suggestions, social observational learni...

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Autores principales: Bräscher, Anne-Kathrin, Witthöft, Michael, Becker, Susanne
Formato: Online Artículo Texto
Lenguaje:English
Publicado: Hindawi 2018
Materias:
Acceso en línea:https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5833150/
https://www.ncbi.nlm.nih.gov/pubmed/29670678
http://dx.doi.org/10.1155/2018/6841985
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author Bräscher, Anne-Kathrin
Witthöft, Michael
Becker, Susanne
author_facet Bräscher, Anne-Kathrin
Witthöft, Michael
Becker, Susanne
author_sort Bräscher, Anne-Kathrin
collection PubMed
description Placebo and nocebo effects are intriguing phenomena in pain perception with important implications for clinical research and practice because they can alleviate or increase pain. According to current theoretical accounts, these effects can be shaped by verbal suggestions, social observational learning, and classical conditioning and are necessarily mediated by explicit expectation. In this review, we focus on the contribution of conditioning in the induction of placebo hypoalgesia and nocebo hyperalgesia and present accumulating evidence that conditioning independent from explicit expectation can cause these effects. Especially studies using subliminal stimulus presentation and implicit conditioning (i.e., without contingency awareness) that bypass the development of explicit expectation suggest that conditioning without explicit expectation can lead to placebo and nocebo effects in pain perception. Because only few studies have investigated clinical samples, the picture seems less clear when it comes to patient populations with chronic pain. However, conditioning appears to be a promising means to optimize treatment. In order to get a better insight into the mechanisms of placebo and nocebo effects in pain and the possible benefits of conditioning compared to explicit expectation, future studies should carefully distinguish both methods of induction.
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spelling pubmed-58331502018-04-18 The Underestimated Significance of Conditioning in Placebo Hypoalgesia and Nocebo Hyperalgesia Bräscher, Anne-Kathrin Witthöft, Michael Becker, Susanne Pain Res Manag Review Article Placebo and nocebo effects are intriguing phenomena in pain perception with important implications for clinical research and practice because they can alleviate or increase pain. According to current theoretical accounts, these effects can be shaped by verbal suggestions, social observational learning, and classical conditioning and are necessarily mediated by explicit expectation. In this review, we focus on the contribution of conditioning in the induction of placebo hypoalgesia and nocebo hyperalgesia and present accumulating evidence that conditioning independent from explicit expectation can cause these effects. Especially studies using subliminal stimulus presentation and implicit conditioning (i.e., without contingency awareness) that bypass the development of explicit expectation suggest that conditioning without explicit expectation can lead to placebo and nocebo effects in pain perception. Because only few studies have investigated clinical samples, the picture seems less clear when it comes to patient populations with chronic pain. However, conditioning appears to be a promising means to optimize treatment. In order to get a better insight into the mechanisms of placebo and nocebo effects in pain and the possible benefits of conditioning compared to explicit expectation, future studies should carefully distinguish both methods of induction. Hindawi 2018-01-28 /pmc/articles/PMC5833150/ /pubmed/29670678 http://dx.doi.org/10.1155/2018/6841985 Text en Copyright © 2018 Anne-Kathrin Bräscher et al. http://creativecommons.org/licenses/by/4.0/ This is an open access article distributed under the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited.
spellingShingle Review Article
Bräscher, Anne-Kathrin
Witthöft, Michael
Becker, Susanne
The Underestimated Significance of Conditioning in Placebo Hypoalgesia and Nocebo Hyperalgesia
title The Underestimated Significance of Conditioning in Placebo Hypoalgesia and Nocebo Hyperalgesia
title_full The Underestimated Significance of Conditioning in Placebo Hypoalgesia and Nocebo Hyperalgesia
title_fullStr The Underestimated Significance of Conditioning in Placebo Hypoalgesia and Nocebo Hyperalgesia
title_full_unstemmed The Underestimated Significance of Conditioning in Placebo Hypoalgesia and Nocebo Hyperalgesia
title_short The Underestimated Significance of Conditioning in Placebo Hypoalgesia and Nocebo Hyperalgesia
title_sort underestimated significance of conditioning in placebo hypoalgesia and nocebo hyperalgesia
topic Review Article
url https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5833150/
https://www.ncbi.nlm.nih.gov/pubmed/29670678
http://dx.doi.org/10.1155/2018/6841985
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