Dynamics and significance of placebo response in primary dysmenorrhea
Abstract
A total of 55 patients with primary dysmenorrhea who had shown a favorable response to a preliminary treatment cycle with placebo were admitted to a double-blind study on placebo versus antiprostaglandin agents (naproxen and pirprofen). To evaluate the placebo effect and its duration, the treatment was given for 4 successive cycles. Whereas the antiprostaglandin agents were effective in most of the patients (in 80% of the pirprofen group and 85.7% of the naproxen group) and this efficacy was maintained throughout the study, a favorable response to placebo was observed in 84% in the first cycle, 29% in the second, 16% in the third and 10% in the fourth. The incidence of side effects was similar in the placebo and the active treatment groups (35.4% vs. 37.5%). It is postulated that a placebo effect in dysmenorrhea is due to a central analgesic mechanism mediated by endorphin release or possibly to psychological dynamics (mental or conditioning theories). However, this effect loses efficacy with time possibly due to a decreased susceptibility to the opioid action of the central nervous circuits responsible for menstrual pain perception or to deconditioning mechanisms.
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A mere placebo effect seems unlikely given the relatively prolonged treatment period.
“Nevertheless, a mere placebo effect, typically lasting no longer than a few weeks (64), seems unlikely, given the relatively prolonged treatment period.”
From A stepped-care approach to symptomatic endometriosis management: A participatory research initiative (2018) · cites this paper as [64]
The placebo effect is short-lived in this clinical condition.
“Alternatively, if the antalgic properties of a drug are to be shown, what better than a placebo-controlled study, given that the placebo-effect is short-lived in this clinical condition (Fedele et al., 1989).”
From “Waiting for Godot”: a commonsense approach to the medical treatment of endometriosis (2011) · cites this paper as Fedele et al., 1989
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“Alternatively, if the antalgic properties of a drug are to be shown, what better than a placebo-controlled study, given that the placebo-effect is short-lived in this clinical condition (Fedele et al., 1989).”
BackgroundSelf-citationVercellini, P., Aimi, G., Busacca, M., Apolone, G., Uglietti, A., & Crosignani, P. G. (2003) · Fertility and Sterility · doi:10.1016/s0015-0282(03)00613-7 · Cited by 137 · see citing works
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Self-citationA stepped-care approach to symptomatic endometriosis management: A participatory research initiative
Vercellini, P., Donati, A., Ottolini, F., Frassineti, A., Fiorini, J., Nebuloni, V., Frattaruolo, M. P., Roberto, A., Mosconi, P., & Somigliana, E. (2018) · Fertility and Sterility · doi:10.1016/j.fertnstert.2018.01.037 · Cited by 64 · see citing works
LING, F. W. (1999) · Obstetrics & Gynecology · doi:10.1097/00006250-199901000-00012 · Cited by 223 · see citing works
- Authors
- Fedele, L., Marchini, M., Acaia, B., Garagiola, U., & Tiengo, M.
- Affiliations
- University of Milan (IT)
- Corresponding author
- Fedele, Luigi
- Venue
- Pain
- Published
- 1989-01
- Volume
- 36
- Issue
- 1
- Pages
- 43-47
- ISSN
- 0304-3959 (ISSN-L)
- OpenAlex
- W2037266595
- Cited by
- 66
- References
- 20
- Citations by year
- 2026: 1 · 2025: 1 · 2024: 1 · 2023: 2 · 2021: 1 · 2018: 4 · 2016: 1 · 2015: 1 · 2013: 1 · 2012: 1
- FWCI
- 0.90
- Type
- journal article
- Language
- en
- Open access
- closed
- Locations
- Pain (publishedVersion)
- PubMed (publishedVersion)
- Topics
- Life Sciences › Neuroscience › Cognitive Neuroscience › Pain Management and Placebo Effect
- Health Sciences › Medicine › Public Health, Environmental and Occupational Health › Menstrual Health and Disorders
- Health Sciences › Medicine › Physiology › Pain Mechanisms and Treatments
- Keywords
- placebo response, primary dysmenorrhea, naproxen, pirprofen, endorphin release, central analgesia, dysmenorrhea, deconditioning, adverse effects
- MeSH terms
- Adult, Double-Blind Method, Dysmenorrhea, Female, Humans, Naproxen, Phenylpropionates, Placebos
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