What Is the Role of the Placebo Effect for Pain Relief in Neurorehabilitation?

Gianluca Castelnuovo, Emanuele Maria Giusti, Gian Mauro Manzoni, Donatella Saviola, Samantha Gabrielli, Marco Lacerenza, Giada Pietrabissa, Roberto Cattivelli, Chiara Anna Maria Spatola, Alessandro Rossi, Giorgia Varallo, Margherita Novelli, Valentina Villa, Francesca Luzzati, Andrea Cottini, Carlo Lai, Eleonora Volpato, Cesare Cavalera, Francesco Pagnini, Valentina TesioLorys Castelli, Mario Tavola, Riccardo Torta, Marco Arreghini, Loredana Zanini, Amelia Brunani, Ionathan Seitanidis, Giuseppe Ventura, Paolo Capodaglio, Guido Edoardo D'Aniello, Federica Scarpina, Andrea Brioschi, Matteo Bigoni, Lorenzo Priano, Alessandro Mauro, Giuseppe Riva, Daniele Di Lernia, Claudia Repetto, Camillo Regalia, Enrico Molinari, Paolo Notaro, Stefano Paolucci, Giorgio Sandrini, Susan Simpson, Brenda Kay Wiederhold, Santino Gaudio, Jeffrey B Jackson, Stefano Tamburin, Fabrizio Benedetti

Research output: Contribution to journalArticle

Abstract

Background: It is increasingly acknowledged that the outcomes of medical treatments are influenced by the context of the clinical encounter through the mechanisms of the placebo effect. The phenomenon of placebo analgesia might be exploited to maximize the efficacy of neurorehabilitation treatments. Since its intensity varies across neurological disorders, the Italian Consensus Conference on Pain in Neurorehabilitation (ICCP) summarized the studies on this field to provide guidance on its use.Methods: A review of the existing reviews and meta-analyses was performed to assess the magnitude of the placebo effect in disorders that may undergo neurorehabilitation treatment. The search was performed on Pubmed using placebo, pain, and the names of neurological disorders as keywords. Methodological quality was assessed using a pre-existing checklist. Data about the magnitude of the placebo effect were extracted from the included reviews and were commented in a narrative form.Results: 11 articles were included in this review. Placebo treatments showed weak effects in central neuropathic pain (pain reduction from 0.44 to 0.66 on a 0-10 scale) and moderate effects in postherpetic neuralgia (1.16), in diabetic peripheral neuropathy (1.45), and in pain associated to HIV (1.82). Moderate effects were also found on pain due to fibromyalgia and migraine; only weak short-term effects were found in complex regional pain syndrome. Confounding variables might have influenced these results.Clinical implications: These estimates should be interpreted with caution, but underscore that the placebo effect can be exploited in neurorehabilitation programs. It is not necessary to conceal its use from the patient. Knowledge of placebo mechanisms can be used to shape the doctor-patient relationship, to reduce the use of analgesic drugs and to train the patient to become an active agent of the therapy.
Original languageItalian
JournalFrontiers in Neurology
Volume9
DOIs
Publication statusPublished - 2018

Cite this

Castelnuovo, G., Giusti, E. M., Manzoni, G. M., Saviola, D., Gabrielli, S., Lacerenza, M., ... Benedetti, F. (2018). What Is the Role of the Placebo Effect for Pain Relief in Neurorehabilitation? Frontiers in Neurology, 9. https://doi.org/10.3389/fneur.2018.00310

What Is the Role of the Placebo Effect for Pain Relief in Neurorehabilitation? / Castelnuovo, Gianluca; Giusti, Emanuele Maria; Manzoni, Gian Mauro; Saviola, Donatella; Gabrielli, Samantha; Lacerenza, Marco; Pietrabissa, Giada; Cattivelli, Roberto; Spatola, Chiara Anna Maria; Rossi, Alessandro; Varallo, Giorgia; Novelli, Margherita; Villa, Valentina; Luzzati, Francesca; Cottini, Andrea; Lai, Carlo; Volpato, Eleonora; Cavalera, Cesare; Pagnini, Francesco; Tesio, Valentina; Castelli, Lorys; Tavola, Mario; Torta, Riccardo; Arreghini, Marco; Zanini, Loredana; Brunani, Amelia; Seitanidis, Ionathan; Ventura, Giuseppe; Capodaglio, Paolo; D'Aniello, Guido Edoardo; Scarpina, Federica; Brioschi, Andrea; Bigoni, Matteo; Priano, Lorenzo; Mauro, Alessandro; Riva, Giuseppe; Di Lernia, Daniele; Repetto, Claudia; Regalia, Camillo; Molinari, Enrico; Notaro, Paolo; Paolucci, Stefano; Sandrini, Giorgio; Simpson, Susan; Wiederhold, Brenda Kay; Gaudio, Santino; Jackson, Jeffrey B; Tamburin, Stefano; Benedetti, Fabrizio.

In: Frontiers in Neurology, Vol. 9, 2018.

Research output: Contribution to journalArticle

Castelnuovo, G, Giusti, EM, Manzoni, GM, Saviola, D, Gabrielli, S, Lacerenza, M, Pietrabissa, G, Cattivelli, R, Spatola, CAM, Rossi, A, Varallo, G, Novelli, M, Villa, V, Luzzati, F, Cottini, A, Lai, C, Volpato, E, Cavalera, C, Pagnini, F, Tesio, V, Castelli, L, Tavola, M, Torta, R, Arreghini, M, Zanini, L, Brunani, A, Seitanidis, I, Ventura, G, Capodaglio, P, D'Aniello, GE, Scarpina, F, Brioschi, A, Bigoni, M, Priano, L, Mauro, A, Riva, G, Di Lernia, D, Repetto, C, Regalia, C, Molinari, E, Notaro, P, Paolucci, S, Sandrini, G, Simpson, S, Wiederhold, BK, Gaudio, S, Jackson, JB, Tamburin, S & Benedetti, F 2018, 'What Is the Role of the Placebo Effect for Pain Relief in Neurorehabilitation?', Frontiers in Neurology, vol. 9. https://doi.org/10.3389/fneur.2018.00310
Castelnuovo, Gianluca ; Giusti, Emanuele Maria ; Manzoni, Gian Mauro ; Saviola, Donatella ; Gabrielli, Samantha ; Lacerenza, Marco ; Pietrabissa, Giada ; Cattivelli, Roberto ; Spatola, Chiara Anna Maria ; Rossi, Alessandro ; Varallo, Giorgia ; Novelli, Margherita ; Villa, Valentina ; Luzzati, Francesca ; Cottini, Andrea ; Lai, Carlo ; Volpato, Eleonora ; Cavalera, Cesare ; Pagnini, Francesco ; Tesio, Valentina ; Castelli, Lorys ; Tavola, Mario ; Torta, Riccardo ; Arreghini, Marco ; Zanini, Loredana ; Brunani, Amelia ; Seitanidis, Ionathan ; Ventura, Giuseppe ; Capodaglio, Paolo ; D'Aniello, Guido Edoardo ; Scarpina, Federica ; Brioschi, Andrea ; Bigoni, Matteo ; Priano, Lorenzo ; Mauro, Alessandro ; Riva, Giuseppe ; Di Lernia, Daniele ; Repetto, Claudia ; Regalia, Camillo ; Molinari, Enrico ; Notaro, Paolo ; Paolucci, Stefano ; Sandrini, Giorgio ; Simpson, Susan ; Wiederhold, Brenda Kay ; Gaudio, Santino ; Jackson, Jeffrey B ; Tamburin, Stefano ; Benedetti, Fabrizio. / What Is the Role of the Placebo Effect for Pain Relief in Neurorehabilitation?. In: Frontiers in Neurology. 2018 ; Vol. 9.
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title = "What Is the Role of the Placebo Effect for Pain Relief in Neurorehabilitation?",
abstract = "Background: It is increasingly acknowledged that the outcomes of medical treatments are influenced by the context of the clinical encounter through the mechanisms of the placebo effect. The phenomenon of placebo analgesia might be exploited to maximize the efficacy of neurorehabilitation treatments. Since its intensity varies across neurological disorders, the Italian Consensus Conference on Pain in Neurorehabilitation (ICCP) summarized the studies on this field to provide guidance on its use.Methods: A review of the existing reviews and meta-analyses was performed to assess the magnitude of the placebo effect in disorders that may undergo neurorehabilitation treatment. The search was performed on Pubmed using placebo, pain, and the names of neurological disorders as keywords. Methodological quality was assessed using a pre-existing checklist. Data about the magnitude of the placebo effect were extracted from the included reviews and were commented in a narrative form.Results: 11 articles were included in this review. Placebo treatments showed weak effects in central neuropathic pain (pain reduction from 0.44 to 0.66 on a 0-10 scale) and moderate effects in postherpetic neuralgia (1.16), in diabetic peripheral neuropathy (1.45), and in pain associated to HIV (1.82). Moderate effects were also found on pain due to fibromyalgia and migraine; only weak short-term effects were found in complex regional pain syndrome. Confounding variables might have influenced these results.Clinical implications: These estimates should be interpreted with caution, but underscore that the placebo effect can be exploited in neurorehabilitation programs. It is not necessary to conceal its use from the patient. Knowledge of placebo mechanisms can be used to shape the doctor-patient relationship, to reduce the use of analgesic drugs and to train the patient to become an active agent of the therapy.",
author = "Gianluca Castelnuovo and Giusti, {Emanuele Maria} and Manzoni, {Gian Mauro} and Donatella Saviola and Samantha Gabrielli and Marco Lacerenza and Giada Pietrabissa and Roberto Cattivelli and Spatola, {Chiara Anna Maria} and Alessandro Rossi and Giorgia Varallo and Margherita Novelli and Valentina Villa and Francesca Luzzati and Andrea Cottini and Carlo Lai and Eleonora Volpato and Cesare Cavalera and Francesco Pagnini and Valentina Tesio and Lorys Castelli and Mario Tavola and Riccardo Torta and Marco Arreghini and Loredana Zanini and Amelia Brunani and Ionathan Seitanidis and Giuseppe Ventura and Paolo Capodaglio and D'Aniello, {Guido Edoardo} and Federica Scarpina and Andrea Brioschi and Matteo Bigoni and Lorenzo Priano and Alessandro Mauro and Giuseppe Riva and {Di Lernia}, Daniele and Claudia Repetto and Camillo Regalia and Enrico Molinari and Paolo Notaro and Stefano Paolucci and Giorgio Sandrini and Susan Simpson and Wiederhold, {Brenda Kay} and Santino Gaudio and Jackson, {Jeffrey B} and Stefano Tamburin and Fabrizio Benedetti",
year = "2018",
doi = "10.3389/fneur.2018.00310",
language = "Italian",
volume = "9",
journal = "Frontiers in Neurology",
issn = "1664-2295",
publisher = "Frontiers Research Foundation",

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TY - JOUR

T1 - What Is the Role of the Placebo Effect for Pain Relief in Neurorehabilitation?

AU - Castelnuovo, Gianluca

AU - Giusti, Emanuele Maria

AU - Manzoni, Gian Mauro

AU - Saviola, Donatella

AU - Gabrielli, Samantha

AU - Lacerenza, Marco

AU - Pietrabissa, Giada

AU - Cattivelli, Roberto

AU - Spatola, Chiara Anna Maria

AU - Rossi, Alessandro

AU - Varallo, Giorgia

AU - Novelli, Margherita

AU - Villa, Valentina

AU - Luzzati, Francesca

AU - Cottini, Andrea

AU - Lai, Carlo

AU - Volpato, Eleonora

AU - Cavalera, Cesare

AU - Pagnini, Francesco

AU - Tesio, Valentina

AU - Castelli, Lorys

AU - Tavola, Mario

AU - Torta, Riccardo

AU - Arreghini, Marco

AU - Zanini, Loredana

AU - Brunani, Amelia

AU - Seitanidis, Ionathan

AU - Ventura, Giuseppe

AU - Capodaglio, Paolo

AU - D'Aniello, Guido Edoardo

AU - Scarpina, Federica

AU - Brioschi, Andrea

AU - Bigoni, Matteo

AU - Priano, Lorenzo

AU - Mauro, Alessandro

AU - Riva, Giuseppe

AU - Di Lernia, Daniele

AU - Repetto, Claudia

AU - Regalia, Camillo

AU - Molinari, Enrico

AU - Notaro, Paolo

AU - Paolucci, Stefano

AU - Sandrini, Giorgio

AU - Simpson, Susan

AU - Wiederhold, Brenda Kay

AU - Gaudio, Santino

AU - Jackson, Jeffrey B

AU - Tamburin, Stefano

AU - Benedetti, Fabrizio

PY - 2018

Y1 - 2018

N2 - Background: It is increasingly acknowledged that the outcomes of medical treatments are influenced by the context of the clinical encounter through the mechanisms of the placebo effect. The phenomenon of placebo analgesia might be exploited to maximize the efficacy of neurorehabilitation treatments. Since its intensity varies across neurological disorders, the Italian Consensus Conference on Pain in Neurorehabilitation (ICCP) summarized the studies on this field to provide guidance on its use.Methods: A review of the existing reviews and meta-analyses was performed to assess the magnitude of the placebo effect in disorders that may undergo neurorehabilitation treatment. The search was performed on Pubmed using placebo, pain, and the names of neurological disorders as keywords. Methodological quality was assessed using a pre-existing checklist. Data about the magnitude of the placebo effect were extracted from the included reviews and were commented in a narrative form.Results: 11 articles were included in this review. Placebo treatments showed weak effects in central neuropathic pain (pain reduction from 0.44 to 0.66 on a 0-10 scale) and moderate effects in postherpetic neuralgia (1.16), in diabetic peripheral neuropathy (1.45), and in pain associated to HIV (1.82). Moderate effects were also found on pain due to fibromyalgia and migraine; only weak short-term effects were found in complex regional pain syndrome. Confounding variables might have influenced these results.Clinical implications: These estimates should be interpreted with caution, but underscore that the placebo effect can be exploited in neurorehabilitation programs. It is not necessary to conceal its use from the patient. Knowledge of placebo mechanisms can be used to shape the doctor-patient relationship, to reduce the use of analgesic drugs and to train the patient to become an active agent of the therapy.

AB - Background: It is increasingly acknowledged that the outcomes of medical treatments are influenced by the context of the clinical encounter through the mechanisms of the placebo effect. The phenomenon of placebo analgesia might be exploited to maximize the efficacy of neurorehabilitation treatments. Since its intensity varies across neurological disorders, the Italian Consensus Conference on Pain in Neurorehabilitation (ICCP) summarized the studies on this field to provide guidance on its use.Methods: A review of the existing reviews and meta-analyses was performed to assess the magnitude of the placebo effect in disorders that may undergo neurorehabilitation treatment. The search was performed on Pubmed using placebo, pain, and the names of neurological disorders as keywords. Methodological quality was assessed using a pre-existing checklist. Data about the magnitude of the placebo effect were extracted from the included reviews and were commented in a narrative form.Results: 11 articles were included in this review. Placebo treatments showed weak effects in central neuropathic pain (pain reduction from 0.44 to 0.66 on a 0-10 scale) and moderate effects in postherpetic neuralgia (1.16), in diabetic peripheral neuropathy (1.45), and in pain associated to HIV (1.82). Moderate effects were also found on pain due to fibromyalgia and migraine; only weak short-term effects were found in complex regional pain syndrome. Confounding variables might have influenced these results.Clinical implications: These estimates should be interpreted with caution, but underscore that the placebo effect can be exploited in neurorehabilitation programs. It is not necessary to conceal its use from the patient. Knowledge of placebo mechanisms can be used to shape the doctor-patient relationship, to reduce the use of analgesic drugs and to train the patient to become an active agent of the therapy.

U2 - 10.3389/fneur.2018.00310

DO - 10.3389/fneur.2018.00310

M3 - Articolo

VL - 9

JO - Frontiers in Neurology

JF - Frontiers in Neurology

SN - 1664-2295

ER -