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Pharm 4001 > Lecture 6- Placebos > Flashcards

Lecture 6- Placebos Flashcards

1
Q

Placebo

A
  • control treatment with similar appearance, but without its specific activity
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2
Q

Two arm trial

A
  • placebo group (placebo effect) + treatment group (specific effect)
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3
Q

Three-arm trial

A

placebo group (placebo effect) + treatment group (specific effect) + untreated group (natural history)

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4
Q

The placebo paradox

A

placebo in RCTs

  • nuisance factor
  • noise in system
  • obsures “real” treatment effects
  • non-specific

placebo in clinical practice

  • useful therapeutic tool
  • good clinical practice involves factors other than specific treatments
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5
Q

contribution of placebo in clinical trials

A
  • 8 different conditions, placebo has dramatic effect
  • ex: phobias: placebo> active
  • acute pain —> placebo doesn’t do much
  • chronic pain —> placebo has more of an effect
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6
Q

pain is multidimensional

A
  • emotion and cognition can have a +/- effect on pain
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7
Q

Influence of doctor-patient relationship on placebo

A
  • group not informed before surgery
  • 2nd group informed of pain expectations, positive
  • acute phase: control group reported a much higher level of pain than the informed special care group
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8
Q

Contextual factors influencing placebo (hidden/open manner)

A
  • different analgesics given to patients
  • drugs given in a hidden manner (computer delivery pump given to patient at unknown times) or open (via nurse)
  • if there was a nurse present —> reported much less pain than if they were completely unaware
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9
Q

Pharmacological conditioning of placebo

A
  • morphine to chronic pain patient —> analgesia
  • sugar pill —> no response
  • during study, was the acquisition phase: patient given sugar pill + morphine = to induce unconditioned response
  • evocation: just give sugar pill, patients reported feeling analgesia
  • can pharmacologically condition patients into thinking they are getting a pain-relieving drug
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10
Q

Opioid conditioning and expectation placebo involves _____

A

Opioid conditioning and expectation placebo involves endogenous opioids

  • subjects underwent ischemic pain
  • condition people with morphine on day 2, 3
  • 4th day: tell them you are giving them morphine, but actually saline —-> still get pain response
  • day 4: giving naloxone (opioid antagonist)—> no placebo reported by patient
  • if you do this conditioning and give expectations, there is endogenous opioids triggered in the body that help with analgesia
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11
Q

Non-opioid conditioning and expectation ____

A

Non-opioid conditioning and expectation DOES NOT involve endogenous opioids

  • condition individual with something thats not an opioid —> placebo effect involves the endogenous
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12
Q

How is non-opioid conditioning placebo mediated?

A
  • by CB1 cannabinoid receptors
  • placebo involves the endocannabinoid ss
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13
Q

conditioning with opioid –> placebo effect involves

A

endogenous opioids

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14
Q

conditioning with non-opioid, placebo effect involves

A
  • placebo effect involves endocannabinoids
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15
Q

Effect of branding on headache pain reporting

A
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16
Q

Placebo affecting neurochemistry

A
  • Placebo activates endogenous opioid system
  • looked at regions of brain involved in pain transmission
  • gave them mu opioid receptor tracer
  • induced pain
  • gave placebo
  • found that even though the patient was taking placebo, endogenous opioids were being released in areas associated with pain
  • also asked subjects “how much pain are you feeling”
  • reported pain correlated with the mu opioids being released in the brain
17
Q

Placebo activates ___ circuits

A

Placebo activates dopaminergic circuits

  • also involved in placebo
  • activated in subjects who received placebo
  • amount of pain reported correlates with amount of dopamine released in the brain of these individuals
18
Q

Does placebo occur in animals?

A
  • measure the time it takes for animal to withdraw its paw
  • group 4: pharmacologically conditioned with morphine in first few days, later given saline
  • group 5: given naloxone on final day
  • group 6: conditioned with non-opioid (ASA)
  • placebo effect occurring in group 4
  • endogenous opioid system occurring in animals as well
  • naloxone + non opioid —> no placebo effect
19
Q

Morphine-induced placebo effect

A
20
Q

Aspirin-induced placebo effect

A

*

21
Q

Nocebo effect

A
  • expectations or information stating that procedure will be more painful leads to increased pain response
  • fear
  • nervousness
  • negative emotions
  • involves cholecystokinin release
  • proglumide = CCK antagonist

hidden situation: P administered —> doesn’t do anything (doesn’t cause pain)

open situation: syringe full of saline “this is gonna hurt” —> reported pain (nocebo)

given increasing doses of CCK antagonist —> able to block nocebo

CCK involved in expectation/ nocebo effect

22
Q

psychological induction of pain

A
  • normal subjects
  • placed electrodes on head
  • old electrical current was going to be passed through their heads (no current was actuallygiven)
  • patients describe headache
  • focusing on pain can itself cause pain
23
Q

what can block the nocebo response

A
  • proglumide
  • proglumide = CCK antagonist
24
Q

Summary

A
  • placebo has an influence on how physicians should treat patients
  • can have positive effects
  • complement treatment strategies
  • placebo contributes to clinical trial outcomes
  • placebo/nocebo has cle

Pharm 4001 (9 decks)

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