Implications of placebo and nocebo effects for clinical practice: Expert consensus
Open accessAbstract
BACKGROUND: Placebo and nocebo effects occur in clinical or laboratory medical contexts after administration of an inert treatment or as part of active treatments and are due to psychobiological mechanisms such as expectancies of the patient. Placebo and nocebo studies have evolved from predominantly methodological research into a far-reaching interdisciplinary field that is unravelling the neurobiological, behavioural and clinical underpinnings of these phenomena in a broad variety of medical conditions. As a consequence, there is an increasing demand from health professionals to develop expert recommendations about evidence-based and ethical use of placebo and nocebo effects for clinical practice. METHODS: A survey and interdisciplinary expert meeting by invitation was organized as part of the 1st Society for Interdisciplinary Placebo Studies (SIPS) conference in 2017. Twenty-nine internationally recognized placebo researchers participated. RESULTS: There was consensus that maximizing placebo effects and minimizing nocebo effects should lead to better treatment outcomes with fewer side effects. Experts particularly agreed on the importance of informing patients about placebo and nocebo effects and training health professionals in patient-clinician communication to maximize placebo and minimize nocebo effects. CONCLUSIONS: The current paper forms a first step towards developing evidence-based and ethical recommendations about the implications of placebo and nocebo research for medical practice, based on the current state of evidence and the consensus of experts. Future research might focus on how to implement these recommendations, including how to optimize conditions for educating patients about placebo and nocebo effects and providing training for the implementation in clinical practice.
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The current literature may have not adequately considered the role of individual components of mindfulness and of placebo effects.
“When examining the effectiveness of mindfulness, the current literature may have not adequately considered the role of its individual components and of placebo effects, i.e., beneficial effects of (inert) interventions due to mechanisms such as patients' expectations (Evers et al., 2018).”
From Mindfulness Effects on Anxiety: Disentangling the Role of Decentering and Treatment Expectations (2024) · cites this paper as Evers et al., 2018
The Discussion describes placebo effects associated with inert substances and active treatments, including effects mediated by patients’ expectations. It does not assess mindfulness, its individual components, or whether the mindfulness literature has adequately considered placebo effects. (LLM, conf=0.86)
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Self-citation
- Authors
- Evers, A. W. M., Colloca, L., Blease, C., Annoni, M., Atlas, L. Y., Benedetti, F., Bingel, U., Büchel, C., Carvalho, C., Colagiuri, B., Crum, A. J., Enck, P., Gaab, J., Geers, A. L., Howick, J., Jensen, K. B., Kirsch, I., Meissner, K., Napadow, V., Peerdeman, K. J., Raz, A., Rief, W., Vase, L., Wager, T. D., Wampold, B. E., Weimer, K., Wiech, K., Kaptchuk, T. J., Klinger, R., & Kelley, J. M.
- Affiliations
- Leiden University (NL)
- University of Maryland, Baltimore (US)
- Beth Israel Deaconess Medical Center (US)
- Institute of Biomedical Technologies (IT)
- National Institutes of Health (US)
- University of Turin (IT)
- Essen University Hospital (DE)
- University Medical Center Hamburg-Eppendorf (DE)
- The University of Sydney (AU)
- Stanford University (US)
- Universitätsklinikum Tübingen (DE)
- University of Basel (CH)
- University of Toledo (US)
- University of Oxford (GB)
- Karolinska Institutet (SE)
- Coburg University of Applied Sciences (DE)
- Athinoula A. Martinos Center for Biomedical Imaging (US)
- McGill University (CA)
- Philipps University of Marburg (DE)
- Aarhus University (DK)
- University of Colorado Boulder (US)
- University of Wisconsin–Madison (US)
- University Hospital Ulm (DE)
- ORCID
- Evers, Andrea W.M.
- Colloca, Luana
- Blease, Charlotte
- Annoni, Marco
- Atlas, Lauren Y.
- Benedetti, Fabrizio
- Bingel, Ulrike
- Büchel, Christian
- Colagiuri, Ben
- Crum, Alia J.
- Enck, Paul
- Gaab, Jens
- Geers, Andrew L.
- Howick, Jeremy
- Jensen, Karin B.
- Kirsch, Irving
- Meissner, Karin
- Napadow, Vitaly
- Peerdeman, Kaya J.
- Raz, Amir
- Rief, Winfried
- Vase, Lene
- Wager, Tor D.
- Wampold, Bruce E.
- Weimer, Katja
- Wiech, Katja
- Kaptchuk, Ted J.
- Klinger, Regine
- Kelley, John M.
- Venue
- Psychotherapy and Psychosomatics
- Publisher
- S. Karger AG
- Published
- 2018
- Volume
- 87
- Issue
- 4
- Pages
- 204-210
- ISSN
- 0033-3190 (ISSN-L)
- 1423-0348
- PMC
- PMC6191882
- OpenAlex
- W2807782653
- Cited by
- 562
- References
- 44
- Citations by year
- 2026: 52 · 2025: 88 · 2024: 73 · 2023: 81 · 2022: 73 · 2021: 70 · 2020: 60 · 2019: 53 · 2018: 12
- FWCI
- 29.04
- Type
- journal article
- Language
- en
- Open access
- hybrid
- doi.org
- Licence
- Locations
- Psychotherapy and Psychosomatics (publishedVersion, cc-by-nc-nd)
- Europe PMC (PubMed Central) (publishedVersion)
- PubMed Central (publishedVersion)
- PubMed (publishedVersion)
- edoc (University of Basel) (acceptedVersion, other-oa)
- Leiden Repository (Leiden University) (submittedVersion)
- KTH Publication Database DiVA (KTH Royal Institute of Technology) (submittedVersion, other-oa)
- Portuguese National Funding Agency for Science, Research and Technology (RCAAP Project by FCT) (submittedVersion, cc-by-nc)
- Radboud Repository (Radboud University) (submittedVersion)
- Radboud Repository (Radboud University) (submittedVersion, other-oa)
- Data Archiving and Networked Services (DANS) (submittedVersion, other-oa)
- edoc (University of Basel)
- Funders
- National Institute for Health and Care Research (SPCR-045)
- Irish Research Council (CLNE/2017/226)
- Nederlandse Organisatie voor Wetenschappelijk Onderzoek (453-16-004)
- National Institutes of Health (OT2OD023867, R61-AT009306)
- National Institute of Dental and Craniofacial Research (R01DE025946)
- National Center for Complementary and Integrative Health (R61AT009306)
- FP7 Ideas: European Research Council (617700)
- Topics
- Life Sciences › Neuroscience › Cognitive Neuroscience › Pain Management and Placebo Effect
- Social Sciences › Psychology › Clinical Psychology › Psychotherapy Techniques and Applications
- Health Sciences › Health Professions › General Health Professions › Patient-Provider Communication in Healthcare
- Keywords
- placebo effect, nocebo effect, patient expectations, patient-clinician communication, informed consent, health professions education, expert consensus recommendations
- MeSH terms
- Humans, Physician-Patient Relations, Placebo Effect, Consensus, Evidence-Based Practice, Drug-Related Side Effects and Adverse Reactions, Nocebo Effect
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