About this Research Topic
Placebo effects affect all medical subspecialties and are relevant contributions to all medical treatment successes and/or failures, irrespective of the type of intervention (drug, surgery, psychotherapy, and instrumental and manual therapies); they are, however studied specifically well in psychiatry and neurology, e.g. with a focus on depression, pain, and motor functions, and less well investigated in others, e.g. in children and the elderly. While the underlying psychological mechanisms (learning procedures, expectancies) are known, their neurobiology is less well established and varies substantially between clinical conditions, symptoms, and bodily organs looked at.
Moderators and mediators of the placebo effect are subject to many studies and meta-analyses, and it has been shown that they include not only age and sex of patients and volunteers, but also their cultural background, previous disease and symptom history and effective and ineffective treatments in the past, genetic contributions as well as the social setting and environment in which treatment takes place, e.g. the family (called "placebo by proxy"). Different from placebo controls in drug trails, effective blinding is difficult to achieve, e.g. in psychotherapy and thus, hampers validity of many trials and conclusions in the past.
Like placebo effects and placebo responses, as they occur in clinical trials, negative responses (called nocebo effects) to medication and/or placebo application are a challenge in medicine, both in medical routine and in randomized controlled trials (RCTs). For the latter, increasing rates of placebo and nocebo responses have been noted, e.g. in psychiatry, and call for the development of novel trial designs that minimize placebo and nocebo responses, while for clinical routine, increased inclusion and "harnessing" of the placebo effect and avoidance of nocebo effects is favored, but requires validation. Open-label placebo applications have been tested in a few conditions but their integration in clinical routine awaits validation.
All placebo applications inherent is an ethical element that calls into attention that patients seek help rather than desire to participate in RCT or in experiments; this is specifically relevant with non-minor diseases and complaints, and for patients with limited ability to understand the concept why placebo research is conducted in medicine at all. Deceptive placebo research has limitations not only when applied to patients, but also in healthy volunteers. Whether open-label placebo is a way out of this dilemma is questionable, given the limited data basis for comparison with effective treatment modalities available.
We are welcoming to contribute both data paper and review articles to all aspects of the placebo/nocebo response and placebo/nocebo effects in medicine, however with a focus of psychiatry, neurobiology, and psychology.
Keywords: Placebo, nocebo, expectations, conditioning
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