Optimizing Placebo and Minimizing Nocebo to Reduce Pain, Catastrophizing, and Opioid Use: A Review of the Science and an Evidence-Informed Clinical Toolkit

International Review of Neurobiology
Beth D Darnall, Luana Colloca

Abstract

Pain, a noxious psychosensory experience, motivates escape behavior to assure protection and survival. Psychological factors alter the experience and trajectory of pain, as well as behavior and treatment response. In the context of pain, the placebo effect (expectation for pain relief) releases endogenous opioids and facilitates analgesia from exogenously administered opioids. Nocebo hyperalgesia (expectation for persistent or worsening pain) opposes endogenous opioid analgesia and patient engagement in prescription opioid tapering. Reductions in nocebo hyperalgesia and pain catastrophizing may enhance descending modulation of pain, mediate adaptive structural brain changes and promote patient engagement in opioid tapering. Interventions that minimize nocebo and optimize placebo may adaptively shape the central nervous system toward pain relief and potentially opioid reduction. Here we provide a critical description of catastrophizing and its impact on pain, placebo and nocebo effects. We also consider the importance of minimizing nocebo and optimizing placebo effects during prescription opioid tapering, and offer a clinical toolkit of resources to accomplish these goals clinically.

Citations

May 19, 2020·Annals of Behavioral Medicine : a Publication of the Society of Behavioral Medicine·Janelle E LetzenClaudia M Campbell
Mar 30, 2021·Pain Medicine : the Official Journal of the American Academy of Pain Medicine·Mary JanevicJohn D Piette
Apr 17, 2021·Pain Medicine : the Official Journal of the American Academy of Pain Medicine·David A Fishbain
May 18, 2021·The American Journal of Clinical Hypnosis·Enrica L SantarcangeloLaura Sebastiani
Aug 15, 2021·Journal of General Internal Medicine·Aram MardianBeth D Darnall
Aug 26, 2021·Physiotherapy Theory and Practice·Roger Pack
Sep 18, 2021·Chiropractic & Manual Therapies·Alice KongstedLise Hestbæk
Nov 11, 2021·Science Translational Medicine·Nicole Mercer LindsayGrégory Scherrer

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