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Nocebo and lessebo effects.

Tiago A Mestre1

  • 1University of Ottawa Brain and Mind Research Institute, Ottawa, ON, Canada; The Ottawa Hospital Research Institute, Ottawa, ON, Canada; Division of Neurology, Department of Medicine, The Ottawa Hospital, Ottawa, ON, Canada.

International Review of Neurobiology
|June 22, 2020
PubMed
Summary
This summary is machine-generated.

The nocebo effect (harm from placebo expectation) and lessebo effect (reduced benefit from uncertainty) impact clinical trials. Understanding these detrimental placebo responses is crucial for improving patient care and research.

Keywords:
Alzheimer's diseaseEpilepsyExpectationHeadacheLesseboNoceboPainParkinson's diseasePlacebo

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Area of Science:

  • Neuroscience
  • Clinical Psychology
  • Pharmacology

Background:

  • The placebo effect is well-known, but detrimental effects like the nocebo and lessebo effects are less understood.
  • The nocebo effect involves expecting harm from a placebo, leading to adverse events.
  • The lessebo effect is a newer concept where therapeutic benefit is reduced due to uncertainty about receiving a placebo.

Purpose of the Study:

  • To define and explore the nocebo and lessebo effects in neurological diseases.
  • To review the existing literature on nocebo responses in various neurological conditions.
  • To discuss the neurobiological mechanisms and potential mitigation strategies for these effects.

Main Methods:

  • Literature review and meta-analyses of randomized controlled trials in neurological diseases.
  • Examination of neurobiological mechanisms, including functional neuroimaging and neurotransmitter involvement.
  • Analysis of factors influencing nocebo response variability.

Main Results:

  • Nocebo responses were evaluated across numerous neurological conditions, showing significant variability.
  • Factors like study design, participant characteristics, and disease type influence nocebo responses, with inconsistent findings.
  • Neurobiological understanding is limited, but functional neuroimaging and neurotransmitters (dopamine, opioids) are implicated.

Conclusions:

  • Nocebo and lessebo effects significantly impact clinical research and practice.
  • Developing strategies to mitigate these detrimental placebo responses is essential.
  • Improved informed consent, study designs, and patient-physician communication are key to addressing these effects.