How to Reduce Nocebo Effects in Pain: Translating Experimental Procedures to Clinical Interventions

Nocebo effects (i.e. negative outcomes that are not attributable to active treatment components) are established via learning through classical conditioning and have a substantial influence on the success of pain treatments. Therefore, interventions aimed at reducing nocebo effects by means of counterconditioning, could be a promising method for improving physical symptoms. Experimental studies on conditioning and counterconditioning have successfully reduced experimentally-induced nocebo effects on pain and itch. Clinical application of such procedures has yet to be researched. This talk focusses on the translation of experimental counterconditioning procedures/paradigms to the area of physical symptoms and clinical practice. Practical considerations (e.g., treatment duration, generalization beyond the experimental setting), as well as ethical dilemmas (e.g., the use of (non)deceptive conditioning methods) when setting up an intervention are discussed. Finally, results of a pilot study of a possible intervention in a randomized, controlled trial for fibromyalgia patients are described. With this lecture, we provide insights into the potential of counterconditioning to reduce nocebo effects for pain and provide recommendations for applying such methods in clinical research.