%0 Journal Article
%T An Emerging Dimension in Psychosomatic Research: The Nocebo Phenomenon in the Management of Chronic Pain
%A A. Ciaramella
%A M. Paroli
%A P. Poli
%J ISRN Neuroscience
%D 2013
%R 10.1155/2013/574526
%X Introduction. The nocebo effect consists in delivering verbal suggestions of negative outcomes so that the subject expects clinical worsening. Several studies indicate that negative verbal suggestions may result in the amplification of pain. Amplification style is one of the most important dimensions in psychosomatic research. Methods. One group of pain therapy unit patients was evaluated at baseline and again after 6 months from the beginning of the pain treatment. Results. Only 43% of 86 chronic pain patients respond positively to the expectation of sham pain. This group shows at baseline higher pain intensity (t value: 2.72, ) and lower cold pain threshold (t value: 2.18, ) than the group of subjects with any response to sham pain stimulus. Somatoform dimensions influence positively the strength of nocebo response in those predisposed to it. Conclusion. Our study shows that the power of the nocebo phenomenon seems to be a dimension belonging to the investigation in psychosomatic. In contrast to what one might expect, the presence of the nocebo phenomenon affects positively pain relief and the outcome of pain treatment. In a clinical setting, and the meaning of nocebo response does not seem to be different from placebo response. 1. Introduction The nocebo effect consists in delivering verbal suggestions of negative outcomes so that the subject expects clinical worsening [1]. Several studies indicate that negative verbal suggestions may result in the amplification of pain [2, 3] and in the alteration of somatosensory perception [4]. In order to try to disentangle the effects of positive and negative cues on pain processing, several authors used brain imaging [5¨C7]. Expectation of pain increase has been found to enhance the activation of the thalamus, insula, prefrontal cortex, and anterior cingulate cortex [6], but it is not known how this variation may influence pain processing in clinical pain [8]. Previous studies suggest that nocebo effects, sometimes termed ˇ°negative placebo effects,ˇ± contribute appreciably to a variety of medical symptoms [9, 10] adverse events in clinical trials and medical care [11¨C14], and public health ˇ°mass psychogenic illnessˇ± outbreaks [15]. While the majority of studies on placebo and nocebo effects show consistent results with patient expectations and the main psychological mechanisms, they seem to be the related factors of subconscious conditioning and conscious expectations [8].Kennedy introduced the concept of ˇ°nocebo reactionˇ± in 1961, a few years after Beecher published his landmark paper on the placebo effect.
%U http://www.hindawi.com/journals/isrn.neuroscience/2013/574526/