What Is the Role of the Placebo Effect for Pain Relief in Neurorehabilitation? Clinical Implications From the Italian Consensus Conference on Pain in Neurorehabilitation

Gianluca Castelnuovo, Giada Pietrabissa, Roberto Cattivelli, Eleonora Volpato, Cesare Massimo Cavalera, Francesco Pagnini, Giuseppe Riva, Daniele Di Lernia, Claudia Repetto, Camillo Regalia, Enrico Molinari, Emanuele Maria Giusti, Gian Mauro Manzoni, Alessandro Rossi, Margherita Novelli, Andrea Pietro Cottini, Carlo Lai, Lorys Castelli, Guido Edoardo D'Aniello, Federica ScarpinaAndrea Mauro Brioschi, Stefano Paolucci, Brenda Kay Wiederhold, Fabrizio Benedetti, Donatella Saviola, Samantha Gabrielli, Marco Lacerenza, Giorgia Varallo, Valentina Villa, Francesca Luzzati, Andrea Cottini, Valentina Tesio, Mario Tavola, Riccardo Torta, Marco Arreghini, Loredana Zanini, Amelia Brunani, Ionathan Seitanidis, Giuseppe Ventura, Paolo Capodaglio, Andrea Brioschi, Matteo Bigoni, Lorenzo Priano, Alessandro Mauro, Paolo Notaro, Giorgio Sandrini, Susan Simpson, Santino Gaudio, Jeffrey B. Jackson, Stefano Tamburin, Michela Agostini, Enrico Alfonsi, Anna Maria Aloisi, Elena Alvisi, Irene Aprile, Michela Armando, Micol Avenali, Eva Azicnuda, Francesco Barale, Michelangelo Bartolo, Roberto Bergamaschi, Mariangela Berlangieri, Vanna Berlincioni, Laura Berliocchi, Eliana Berra, Giulia Berto, Silvia Bonadiman, Sara Bonazza, Federica Bressi, Annalisa Brugnera, Stefano Brunelli, Maria Gabriella Buzzi, Carlo Cacciatori, Andrea Calvo, Cristina Cantarella, Augusto Caraceni, Roberto Carone, Elena Carraro, Roberto Casale, Paola Castellazzi, Adele Castino, Rosanna Cerbo, Adriano Chiò, Cristina Ciotti, Carlo Cisari, Daniele Coraci, Elena Dalla Toffola, Giovanni Defazio, Roberto De Icco, Ubaldo Del Carro, Andrea Dell'Isola, Antonio De Tanti, Mariagrazia D'Ippolito, Elisa Fazzi, Adriano Ferrari, Sergio Ferrari, Francesco Ferraro, Fabio Formaglio, Rita Formisano, Simone Franzoni, Francesca Gajofatto, Marialuisa Gandolfi, Barbara Gardella, Pierangelo Geppetti, Alessandro Giammò, Raffaele Gimigliano, Elena Greco, Valentina Ieraci, Marco Invernizzi, Marco Jacopetti, Silvia La Cesa, Davide Lobba, Francesca Magrinelli, Silvia Mandrini, Umberto Manera, Paolo Marchettini, Enrico Marchioni, Sara Mariotto, Andrea Martinuzzi, Marella Masciullo, Susanna Mezzarobba, Danilo Miotti, Angela Modenese, Marco Molinari, Salvatore Monaco, Giovanni Morone, Rossella Nappi, Stefano Negrini, Andrea Pace, Emanuela Pagliano, Valerio Palmerini, Costanza Pazzaglia, Cristiano Pecchioli, Alessandro Picelli, Carlo Adolfo Porro, Daniele Porru, Marcello Romano, Laura Roncari, Riccardo Rosa, Marsilio Saccavini, Paola Sacerdote, Angelo Schenone, Vittorio Schweiger, Giorgio Scivoletto, Nicola Smania, Claudio Solaro, Vincenza Spallone, Isabella Springhetti, Cristina Tassorelli, Michele Tinazzi, Rossella Togni, Monica Torre, Marco Traballesi, Marco Tramontano, Andrea Truini, Valeria Tugnoli, Andrea Turolla, Gabriella Vallies, Elisabetta Verzini, Mario Vottero, Paolo Zerbinati

Research output: Contribution to journalArticlepeer-review

18 Citations (Scopus)

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 languageEnglish
Pages (from-to)N/A-N/A
JournalFrontiers in Neurology
Volume9
DOIs
Publication statusPublished - 2018

Keywords

  • Clinical psychology
  • Consensus conference
  • Health psychology
  • Neurorehabilitation
  • Pain
  • Placebo
  • Placebo effect

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