Starts:

Tuesday, September 20th
4:30pm-6:00pm EDT

Category:

Topical Workshop

Tracks:

Placebo

Room

716 A

Nocebo Effects in Pain: From Mechanisms to Therapeutic Treatments in Clinical Practice

Nocebo effects plays a critical role in pain management, influencing patients’ experience of pain and distress, post-operative pain, treatment satisfaction, adherence to treatment, therapeutic effectiveness, and the incidence of complications and adverse treatment effects. Placebo researchers have played an important role in the development of our understanding of how nocebo can influence pain and treatment outcomes, providing systematic evidence for the specific characteristics of nocebo mechanisms and strategies to alter these effects. This workshop will showcase the most recent advances in this area, highlighting specific strategies that have been empirically demonstrated to inhibit nocebo effects and optimize treatment effects. First, Dr. Luana Colloca will talk about neurobiological and psychological mechanisms of nocebo effects and how communication strategies play a role in altering nocebo effects. Next, Dr Ben Colagiuri will describe a series of novel studies providing evidence for two promising behavioral strategies for inhibiting nocebo hyperalgesia; a communication strategy that involves positively framing verbal information and a learning strategy involving pre-exposure to the target treatment context. Finally, Dr Andrea Evers will present the potential of counterconditioning to reduce nocebo effects for pain and will provide recommendations for applying such methods in clinical research and care.

Presentations

Time
4:30pm EDT6:00pm EDT

Explaining the Mechanisms of Nocebo Effects

Tracks: Placebo
Categories: Topical Workshop
Presented By: Prof. Luana Colloca

The descending modulatory system orchestrates the effects of pricing on nocebo hyperalgesia. Anticipation of upcoming high painful stimulation makes healthy study participants perceive non-painful and low-painful stimulations as painful and high-painful stimulations, respectively. Verbally-induced nocebo effects are as strong as those induced through actual exposure to high pain.2 Moreover, receiving a placebo after a simulation of an effective analgesic treatment as compared to receiving the same placebo intervention after a treatment perceived as ineffective produce 49.3% versus 9.7% pain reductions. Anticipation of a given side effect and negative prior experience, bad interactions between clinicians and patients and the general psychosocial context surrounding the patient, can create clinically relevant nocebo effects. This talk will illustrate how verbal communication and contextual cues associated with any treatment, and other aspects of the physician-patient interactions, are important elements to prevent unwanted nocebo effects. Strategies of framing information, optimal doctor-patient interactions, and effective managing of symptoms represent promising ways for lessening clinical nocebo effects.

4:30pm EDT6:00pm EDT

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

Tracks: Placebo
Categories: Topical Workshop
Presented By: Prof. Andrea W. Evers

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.

4:30pm EDT6:00pm EDT

Identifying Novel Behavioural Strategies to Inhibit Nocebo Hyperalgesia

Tracks: Placebo
Categories: Topical Workshop

Nocebo hyperalgesia is a pervasive phenomenon that significantly adds the global burden of pain. Many experimental and clinical studies demonstrate that verbal information and conditioning combine to produce negative expectancies that trigger nocebo hyperalgesia. Yet, there have been very few attempts to use this knowledge to identify behavioural strategies to inhibit nocebo hyperalgesia. In this talk, Ben Colaguiri will describe a series of novel studies providing evidence for two promising behavioural strategies for inhibiting nocebo hyperalgesia. The first is a communication strategy that involves positively framing verbal information (‘positive attribute framing’) in order to reduce the maladaptive expectancies that drive nocebo hyperalgesia. The second is a learning strategy involving pre-exposure to the target treatment context (‘laten inhibition’) that can undermine the formation of conditioned nocebo hyperalgesia. A critical feature of both strategies is that there is no deception involved, meaning that these techniques can be implemented ethically in clinical practice. Identifying effective behavioural techniques to inhibit nocebo hyperalgesia will pave the way for translational research to prevent the burden it causes.

Presenters

Professor Ben Colagiuri

Professor
University of Sydney

Prof. Luana Colloca

MPower Distinguished Professor
University of Maryland, School of Nursing

Prof. Andrea W. Evers

Professor
Leiden University