1.07 - The Placebo & Nocebo Effects

Question 1

What is a Placebo?

Answer 1

An inert substance or therapy, which, when applied to the person, results in an improvement in the illness

Question 2

What are four possible explanations for the placebo effect?

Answer 2

Expectation / Conditioning
Natural course of the illness
Regression to the mean
Undetected active substance in “placebo”

Question 3

How does Placebo Analgesia appear to work?

Answer 3

Appears to occur through expectation (endogenous opioids), through conditioning and also through social learning

Question 4

What is some of the evidence for the Placebo Effect from Parkinson’s “treatment”?

Answer 4

Transplants of dopaminergic neurone into parkinson’s patients –> sham surgery was effective
Motor improvement seem to respond to expectancy
Increased dopamine release noted on PET

Question 5

What is a Nocebo?

Answer 5

An inert substance that when given to a patient will worsen their symptoms or condition

Question 6

How is it believed that the Nocebo effect occurs?

Answer 6

Through expectation and conditioning.

Question 7

What are some ethical consideration for the use of placebo?

Answer 7

If the placebo effects are useful in analgesia, shouldn’t we use them? Especially, since we might be avoiding potential side effects of the therapeutic drug.
Isn’t it unethical to do precedes, which are probably placebo precedes?
Isn’t it wrong to promise the patient that a procedure or therapy is active when it isn’t?