Placebo Effect
Placebos
Acupuncture Therapy
Double-Blind Method
Cardiovascular Physiological Processes
Clinical Trials as Topic
Hypnosis
Acupuncture
Randomized Controlled Trials as Topic
Controlled Clinical Trials as Topic
Pain
Treatment Outcome
Irritable Bowel Syndrome
Research Design
Cross-Over Studies
Pain Measurement
Single-Blind Method
Placebo medication use in patient care: a survey of medical interns. (1/414)
The use of placebo medication, long recognized by clinicians, often has serious practical implications, such as patient deception. Past evidence has suggested that resident physicians tend to misuse placebo medication. Interns from two consecutive years of a residency program were surveyed anonymously to assess their knowledge and use of placebos. Of the 74 interns surveyed, 44 (59%) were familiar with placebo use in patient care. Fifty percent of these interns familiar with placebo use had learned about placebos from another physician. All interns who had learned about placebos during their internships had learned from another physician, whereas interns who had gained their knowledge of placebos as medical students were as likely to have learned from the medical literature as they were to have learned from a physician (P = 0.027). Interns aware of placebo use were more likely to consider placebo administration for suspected, factitious pain (P = 0.022). The present study uncovered no relationship between interns' estimations of placebo efficacy and the utility they attributed to placebos in assessing a complaint of pain. This suggests that conceptual inconsistencies underlie their use of placebos. Interns often learn of placebos as medical students and are influenced by physician-mentors. Placebo use in patient care is an area of attention for medical educators. (+info)Somatotopic activation of opioid systems by target-directed expectations of analgesia. (2/414)
We induced specific expectations of analgesia on four different parts of the body to understand how endogenous opioid systems are activated by expectancies. The left hand, right hand, left foot, and right foot were simultaneously stimulated by means of a subcutaneous injection of capsaicin, which produces a painful burning sensation. Specific expectations of analgesia were induced by applying a placebo cream on one of these body parts and by telling the subjects that it was a powerful local anesthetic. In such a way, expectancy of the anesthetic effect was directed only toward the part on which the placebo cream was applied. We found that a placebo analgesic response occurred only on the treated part, whereas no variation in pain sensitivity was found on the untreated parts. If the same experiment was performed after an intravenous infusion of the opioid antagonist naloxone, this highly spatial-specific placebo response was totally abolished, indicating that it was completely mediated by endogenous opioid systems. These findings show that a spatially directed expectation of pain reduction is capable of inducing a specific effect only on the part of the body which is the target of the expectation. Most important, this specific effect is mediated by endogenous opioids, indicating that placebo-activated opioids do not act on the entire body but only on the part where expectancy is directed. This suggests that a highly organized and somatotopic network of endogenous opioids links expectation, attention, and body schema. (+info)Placebo effect in the treatment of duodenal ulcer. (3/414)
AIMS: To assess whether frequency of placebo administration is associated with duodenal ulcer healing. METHODS: A systematic literature review of randomized clinical trials was undertaken. 79 of 80 trials that met the inclusion criteria. The pooled 4 week placebo healing rate of all duodenal ulcer trials that employed a four times a day regimen was compared with the rate obtained from trials with a twice a day regimen. RESULTS: The pooled 4 week healing rate of the 51 trials with a four times a day regimen was 44. 2% (805 of 1821 patients) compared with 36.2% (545 of 1504 patients) in the 28 trials with a twice a day regimen (difference, 8.0% [equal effects model]; 95% confidence interval, 4.6% to 11.3%). Depending on the statistical analysis, the rate difference ranged from 6.0% (multivariable random effects model) to 8.0% (equal effects model). A number of sensitivity analyses showed comparable differences between the two regimens. Most of these sensitivity analyses were not significant, probably because a number of trials were excluded resulting in a loss of power. CONCLUSIONS: We found a relation between frequency of placebo administration and healing of duodenal ulcer. We realize that the comparison was based on nonrandomized data. However, we speculate that the difference between regimens was induced by the difference in frequency of placebo administration. A better knowledge of various placebo effects is required in order to make clinically relevant assessments of treatment effects derived from placebo-controlled trials. (+info)Pain relief with intracameral mepivacaine during phacoemulsification. (4/414)
AIM: To assess the efficacy and safety of an intraoperative intracameral injection of mepivacaine, administered when patients experienced pain during the course of cataract surgery under topical anaesthesia. METHODS: This is a prospective placebo controlled double masked randomised clinical trial. 50 eyes were included; 25 receiving the active compound and 25 receiving placebo. Mepivacaine (2%, 0.4 ml) or placebo was administered intraoperatively under the iris of the patients who experienced pain during the course of phacoemulsification in spite of previous topical anaesthesia. Efficacy was evaluated by the patients themselves using a five point subjective pain rating scale, the Keele verbal pain chart. Safety was measured by assessing intraocular inflammation (clinical evaluation and laser flare meter), intraocular pressure, and endothelial cell count. RESULTS: The pain rating score significantly diminished after intracameral injection in the mepivacaine group (mean 3.0 (95% CI 2.6-3.4) v 0.8 (0.3-1.3), p<10(-4))) while remaining unchanged in the placebo group (2.9 (2.6-3.2) v 2.9 (2.5-3. 3)), the mean reduction in pain score being significantly different between the two groups (p<10(-4)). There was no indication of increased postoperative ocular inflammation, intraocular pressure change, or endothelial cell loss. CONCLUSIONS: These results suggest that it may not be necessary to systematically add intracameral anaesthesia with topical anaesthesia for cataract surgery. An intraoperative intracameral injection, performed only in patients who happen to suffer during surgery, is safe and effective. (+info)The physician healer: ancient magic or modern science? (5/414)
The therapeutic role of general practitioners (GPs) is one that, over the years, has slowly diminished with the growing fashion for evidence-based medicine. However, it is clear that the art of healing and the strength of the doctor-patient relationship play a vital role in improving the well-being of patients. This is exemplified by the placebo effect, where the attitude of the doctor can make an appreciable difference to the psychological response of the patient who feels the need to be understood and listened to empathically. By maximizing the role of the physician healer, there is considerable scope for bridging the gap left by the impersonality of medical science, while at the same time increasing the GP's effectiveness. (+info)Effects of acupuncture on radial artery hemodynamics: controlled trials in sensitized and naive subjects. (6/414)
Palpation of the radial pulses is an important technique in traditional Chinese medicine. Two double-blind randomized trials of the effects of real and sham acupuncture on radial artery hemodynamics were conducted in 19 patients regularly exposed to acupuncture (sensitized subjects) and in 8 healthy subjects devoid of previous exposure (naive subjects), respectively. Radial artery diameter and pulse waveform were measured with a high-resolution echotracking system and aplanation tonometry, respectively, before and during a 20-min acupuncture period. In sensitized patients, arterial diameter significantly increased during real acupuncture, compared with the sham group (+7.5 +/- 2.8 vs. -2.9 +/- 2.7%, respectively; P < 0.01). By contrast, in naive subjects, arterial diameter did not change during real or sham acupuncture. In both populations, no significant difference was observed between real and sham acupuncture, concerning the time course of blood pressure, radial artery distensibility, and pressure waveform. Our results demonstrate that real acupuncture is associated with an objective vasodilatation of the radial artery in patients regularly exposed to acupuncture, but not in naive subjects. (+info)Unconventional dentistry: Part V. Professional issues, concerns and uses. (7/414)
This is the last in a series of 5 articles providing a contemporary overview and introduction to unconventional dentistry (UD) and its correlation to unconventional medicine (UM). UD and UM both present important concerns for health care professionals and for the general public. Professional concerns include risks to the practitioner and the patient. UD is of special concern because of the potential harm of invasive dental procedures. Nonetheless, because some UD practices may be of benefit to the patient, decision-making issues and guidelines for UD practice are suggested. (+info)Is the placebo powerless? An analysis of clinical trials comparing placebo with no treatment. (8/414)
BACKGROUND: Placebo treatments have been reported to help patients with many diseases, but the quality of the evidence supporting this finding has not been rigorously evaluated. METHODS: We conducted a systematic review of clinical trials in which patients were randomly assigned to either placebo or no treatment. A placebo could be pharmacologic (e.g., a tablet), physical (e.g., a manipulation), or psychological (e.g., a conversation). RESULTS: We identified 130 trials that met our inclusion criteria. After the exclusion of 16 trials without relevant data on outcomes, there were 32 with binary outcomes (involving 3795 patients, with a median of 51 patients per trial) and 82 with continuous outcomes (involving 4730 patients, with a median of 27 patients per trial). As compared with no treatment, placebo had no significant effect on binary outcomes (pooled relative risk of an unwanted outcome with placebo, 0.95; 95 percent confidence interval, 0.88 to 1.02), regardless of whether these outcomes were subjective or objective. For the trials with continuous outcomes, placebo had a beneficial effect (pooled standardized mean difference in the value for an unwanted outcome between the placebo and untreated groups, -0.28; 95 percent confidence interval, -0.38 to -0.19), but the effect decreased with increasing sample size, indicating a possible bias related to the effects of small trials. The pooled standardized mean difference was significant for the trials with subjective outcomes (-0.36; 95 percent confidence interval, -0.47 to -0.25) but not for those with objective outcomes. In 27 trials involving the treatment of pain, placebo had a beneficial effect (-0.27; 95 percent confidence interval, -0.40 to -0.15). This corresponded to a reduction in the intensity of pain of 6.5 mm on a 100-mm visual-analogue scale. CONCLUSIONS: We found little evidence in general that placebos had powerful clinical effects. Although placebos had no significant effects on objective or binary outcomes, they had possible small benefits in studies with continuous subjective outcomes and for the treatment of pain. Outside the setting of clinical trials, there is no justification for the use of placebos. (+info)The placebo effect is a psychological or psychophysiological phenomenon in which a person's symptoms improve following a treatment but this improvement is not attributable to the properties of the treatment itself. Instead, it is believed to be due to the mind's belief in the effectiveness of the treatment, often influenced by positive expectations and the ritualistic aspects of the therapy itself.
Placebos are often used in clinical trials as a control group to compare against the actual treatment. The placebo effect can make it challenging to determine whether an observed improvement is truly due to the treatment or other factors.
"Mental healing" is not a term that is widely used in modern medicine or psychiatry. However, it generally refers to the process of addressing and resolving psychological issues or emotional distress through non-pharmacological means, such as talk therapy, psychotherapy, or mindfulness practices.
In a broader sense, mental healing can also refer to the improvement of one's mental and emotional well-being through various holistic approaches, including self-care, stress management techniques, social support, and spiritual practices. These methods aim to help individuals develop coping skills, build resilience, and improve their overall quality of life.
It is important to note that while these approaches can be helpful in managing mental health symptoms, they should not replace evidence-based treatments for mental health conditions, such as medication or therapy with a licensed mental health professional.
A placebo is a substance or treatment that has no inherent therapeutic effect. It is often used in clinical trials as a control against which the effects of a new drug or therapy can be compared. Placebos are typically made to resemble the active treatment, such as a sugar pill for a medication trial, so that participants cannot tell the difference between what they are receiving and the actual treatment.
The placebo effect refers to the phenomenon where patients experience real improvements in their symptoms or conditions even when given a placebo. This may be due to psychological factors such as belief in the effectiveness of the treatment, suggestion, or conditioning. The placebo effect is often used as a comparison group in clinical trials to help determine if the active treatment has a greater effect than no treatment at all.
In a medical context, "suggestion" often refers to the act of proposing or recommending a treatment or course of action to a patient. It can also refer to the use of verbal or nonverbal communication to influence a person's perceptions, attitudes, or behaviors related to their health.
However, it is important to note that "suggestion" does not have a specific medical definition and its meaning may vary depending on the context in which it is used. In some cases, it may be used interchangeably with terms such as "recommendation," "counseling," or "persuasion."
In contrast, there is a psychological concept called "the power of suggestion" that refers to the phenomenon where an individual's thoughts, feelings, or behaviors can be influenced by expectations or suggestions from others. While this concept is not unique to medicine, it can have important implications for medical practice, particularly in areas such as hypnosis, placebo effects, and patient-provider communication.
Acupuncture therapy is a form of traditional Chinese medicine that involves the insertion of thin needles into specific points on the body to stimulate the flow of energy (Qi), balance the vital force (Chi), and promote healing. It is based on the concept of meridians, or pathways, through which this energy flows. Acupuncture therapy is used to treat a variety of conditions, including pain, stress, anxiety, insomnia, digestive disorders, and reproductive health issues. According to Western medicine, acupuncture may work by stimulating the nervous system, increasing blood flow, and releasing natural pain-relieving chemicals called endorphins. It is generally considered safe when performed by a qualified practitioner using sterile needles.
The double-blind method is a study design commonly used in research, including clinical trials, to minimize bias and ensure the objectivity of results. In this approach, both the participants and the researchers are unaware of which group the participants are assigned to, whether it be the experimental group or the control group. This means that neither the participants nor the researchers know who is receiving a particular treatment or placebo, thus reducing the potential for bias in the evaluation of outcomes. The assignment of participants to groups is typically done by a third party not involved in the study, and the codes are only revealed after all data have been collected and analyzed.
Cardiovascular physiological processes refer to the functioning and mechanisms of the heart and blood vessels to maintain adequate circulation of blood, oxygen, and nutrients throughout the body. This includes:
1. Heart rate and rhythm: The heart's ability to contract and relax regularly to pump blood.
2. Cardiac output: The amount of blood pumped by the heart in one minute, calculated as stroke volume (amount of blood pumped per beat) multiplied by heart rate.
3. Blood pressure: The force exerted by circulating blood on the walls of the blood vessels, determined by cardiac output and systemic vascular resistance.
4. Vascular tone: The degree of constriction or dilation of blood vessels, regulated by the autonomic nervous system and various hormones to maintain blood pressure and blood flow.
5. Blood flow distribution: The regulation of blood flow to different organs based on their metabolic demands, influenced by local autoregulation and neural and humoral factors.
6. Electrolyte and fluid balance: The maintenance of proper electrolyte concentrations and fluid volume in the blood and tissues, essential for cardiovascular function and overall homeostasis.
7. Cardiac and vascular response to stress: The adaptive changes in heart rate, contractility, vascular tone, and blood flow during exercise or other physiological stressors.
8. Hemostasis and thrombosis: The processes that maintain the integrity of the cardiovascular system by preventing excessive bleeding (hemostasis) while minimizing the risk of pathological clot formation (thrombosis).
Clinical trials are research studies that involve human participants and are designed to evaluate the safety and efficacy of new medical treatments, drugs, devices, or behavioral interventions. The purpose of clinical trials is to determine whether a new intervention is safe, effective, and beneficial for patients, as well as to compare it with currently available treatments. Clinical trials follow a series of phases, each with specific goals and criteria, before a new intervention can be approved by regulatory authorities for widespread use.
Clinical trials are conducted according to a protocol, which is a detailed plan that outlines the study's objectives, design, methodology, statistical analysis, and ethical considerations. The protocol is developed and reviewed by a team of medical experts, statisticians, and ethicists, and it must be approved by an institutional review board (IRB) before the trial can begin.
Participation in clinical trials is voluntary, and participants must provide informed consent before enrolling in the study. Informed consent involves providing potential participants with detailed information about the study's purpose, procedures, risks, benefits, and alternatives, as well as their rights as research subjects. Participants can withdraw from the study at any time without penalty or loss of benefits to which they are entitled.
Clinical trials are essential for advancing medical knowledge and improving patient care. They help researchers identify new treatments, diagnostic tools, and prevention strategies that can benefit patients and improve public health. However, clinical trials also pose potential risks to participants, including adverse effects from experimental interventions, time commitment, and inconvenience. Therefore, it is important for researchers to carefully design and conduct clinical trials to minimize risks and ensure that the benefits outweigh the risks.
Hypnosis is a state of highly focused attention or concentration, often associated with relaxation, and heightened suggestibility. In a clinical context, hypnosis is often used as a tool in hypnotherapy, to help individuals explore unconscious thoughts, feelings, and behaviors, or to make positive changes to their thoughts, behavior, and physical well-being. It's important to note that hypnosis is not a state of unconsciousness or sleep, but rather a state of altered consciousness characterized by increased suggestibility and focused attention.
It's also worth noting that the definition of hypnosis can vary between different fields and perspectives. Some definitions emphasize the role of suggestion in shaping experience during hypnosis, while others focus on the importance of expectancy and belief. Additionally, there is ongoing debate about the precise mechanisms underlying hypnotic phenomena, with some researchers emphasizing social and psychological factors, while others highlight neurological and physiological changes associated with hypnosis.
Analgesia is defined as the absence or relief of pain in a patient, achieved through various medical means. It is derived from the Greek word "an-" meaning without and "algein" meaning to feel pain. Analgesics are medications that are used to reduce pain without causing loss of consciousness, and they work by blocking the transmission of pain signals to the brain.
Examples of analgesics include over-the-counter medications such as acetaminophen (Tylenol) and nonsteroidal anti-inflammatory drugs (NSAIDs) like ibuprofen (Advil, Motrin) and naproxen (Aleve). Prescription opioid painkillers, such as oxycodone (OxyContin, Percocet) and hydrocodone (Vicodin), are also used for pain relief but carry a higher risk of addiction and abuse.
Analgesia can also be achieved through non-pharmacological means, such as through nerve blocks, spinal cord stimulation, acupuncture, and other complementary therapies. The choice of analgesic therapy depends on the type and severity of pain, as well as the patient's medical history and individual needs.
Acupuncture is a form of traditional Chinese medicine that involves the insertion of thin needles into specific points on the body to stimulate the body's natural healing processes. According to traditional Chinese medicine theory, energy (known as "qi" or "chi") flows through the body along pathways called meridians. Acupuncture is believed to help restore the flow of qi and improve the balance of the body's energy.
In modern medical practice, acupuncture is often used to treat pain, including chronic pain, muscle stiffness, and headaches. It is also sometimes used to treat conditions such as nausea and vomiting, insomnia, and addiction. The precise mechanism by which acupuncture works is not fully understood, but it is thought to involve the release of natural pain-relieving chemicals called endorphins, as well as other physiological changes in the body. Acupuncture is generally considered safe when performed by a qualified practitioner, and side effects are typically mild and temporary.
A randomized controlled trial (RCT) is a type of clinical study in which participants are randomly assigned to receive either the experimental intervention or the control condition, which may be a standard of care, placebo, or no treatment. The goal of an RCT is to minimize bias and ensure that the results are due to the intervention being tested rather than other factors. This design allows for a comparison between the two groups to determine if there is a significant difference in outcomes. RCTs are often considered the gold standard for evaluating the safety and efficacy of medical interventions, as they provide a high level of evidence for causal relationships between the intervention and health outcomes.
Controlled clinical trials are a type of medical research study that compare the effects of one or more interventions (e.g., drugs, treatments, or procedures) to a standard of care or placebo in a group of participants who have a specific medical condition. These studies are designed to determine whether an intervention is safe and effective, and they typically involve randomly assigning participants to receive either the experimental intervention or the control.
In a controlled clinical trial, the researchers carefully control and monitor all aspects of the study to minimize bias and ensure that the results are as reliable and valid as possible. This may include using standardized measures to assess outcomes, blinding participants and researchers to treatment assignments, and analyzing data using statistical methods.
Controlled clinical trials are an important part of the process for developing and approving new medical treatments and interventions. They provide valuable information about the safety and efficacy of these interventions, and help to ensure that they are safe and effective for use in clinical practice.
Pain is an unpleasant sensory and emotional experience associated with actual or potential tissue damage, or described in terms of such damage. It is a complex phenomenon that can result from various stimuli, such as thermal, mechanical, or chemical irritation, and it can be acute or chronic. The perception of pain involves the activation of specialized nerve cells called nociceptors, which transmit signals to the brain via the spinal cord. These signals are then processed in different regions of the brain, leading to the conscious experience of pain. It's important to note that pain is a highly individual and subjective experience, and its perception can vary widely among individuals.
Treatment outcome is a term used to describe the result or effect of medical treatment on a patient's health status. It can be measured in various ways, such as through symptoms improvement, disease remission, reduced disability, improved quality of life, or survival rates. The treatment outcome helps healthcare providers evaluate the effectiveness of a particular treatment plan and make informed decisions about future care. It is also used in clinical research to compare the efficacy of different treatments and improve patient care.
Irritable Bowel Syndrome (IBS) is a functional gastrointestinal disorder characterized by recurrent abdominal pain, bloating, and altered bowel habits in the absence of any structural or biochemical abnormalities. The symptoms can vary from person to person, ranging from mild to severe.
The exact cause of IBS is not known, but it's thought to involve a combination of factors such as muscle contractions in the intestine, abnormalities in the nervous system, inflammation in the intestines, severe infection, or changes in bacteria in the gut.
It's important to note that while IBS can cause great discomfort and distress, it does not lead to serious complications such as changes in bowel tissue or increased risk of colorectal cancer. However, it can significantly affect a person's quality of life and daily activities.
A research design in medical or healthcare research is a systematic plan that guides the execution and reporting of research to address a specific research question or objective. It outlines the overall strategy for collecting, analyzing, and interpreting data to draw valid conclusions. The design includes details about the type of study (e.g., experimental, observational), sampling methods, data collection techniques, data analysis approaches, and any potential sources of bias or confounding that need to be controlled for. A well-defined research design helps ensure that the results are reliable, generalizable, and relevant to the research question, ultimately contributing to evidence-based practice in medicine and healthcare.
A cross-over study is a type of experimental design in which participants receive two or more interventions in a specific order. After a washout period, each participant receives the opposite intervention(s). The primary advantage of this design is that it controls for individual variability by allowing each participant to act as their own control.
In medical research, cross-over studies are often used to compare the efficacy or safety of two treatments. For example, a researcher might conduct a cross-over study to compare the effectiveness of two different medications for treating high blood pressure. Half of the participants would be randomly assigned to receive one medication first and then switch to the other medication after a washout period. The other half of the participants would receive the opposite order of treatments.
Cross-over studies can provide valuable insights into the relative merits of different interventions, but they also have some limitations. For example, they may not be suitable for studying conditions that are chronic or irreversible, as it may not be possible to completely reverse the effects of the first intervention before administering the second one. Additionally, carryover effects from the first intervention can confound the results if they persist into the second treatment period.
Overall, cross-over studies are a useful tool in medical research when used appropriately and with careful consideration of their limitations.
Pain measurement, in a medical context, refers to the quantification or evaluation of the intensity and/or unpleasantness of a patient's subjective pain experience. This is typically accomplished through the use of standardized self-report measures such as numerical rating scales (NRS), visual analog scales (VAS), or categorical scales (mild, moderate, severe). In some cases, physiological measures like heart rate, blood pressure, and facial expressions may also be used to supplement self-reported pain ratings. The goal of pain measurement is to help healthcare providers better understand the nature and severity of a patient's pain in order to develop an effective treatment plan.
A single-blind method in medical research is a study design where the participants are unaware of the group or intervention they have been assigned to, but the researchers conducting the study know which participant belongs to which group. This is done to prevent bias from the participants' expectations or knowledge of their assignment, while still allowing the researchers to control the study conditions and collect data.
In a single-blind trial, the participants do not know whether they are receiving the active treatment or a placebo (a sham treatment that looks like the real thing but has no therapeutic effect), whereas the researcher knows which participant is receiving which intervention. This design helps to ensure that the participants' responses and outcomes are not influenced by their knowledge of the treatment assignment, while still allowing the researchers to assess the effectiveness or safety of the intervention being studied.
Single-blind methods are commonly used in clinical trials and other medical research studies where it is important to minimize bias and control for confounding variables that could affect the study results.
Pain management is a branch of medicine that focuses on the diagnosis and treatment of pain and improvement in the quality of life of patients with chronic pain. The goal of pain management is to reduce pain levels, improve physical functioning, and help patients cope mentally and emotionally with their pain. This may involve the use of medications, interventional procedures, physical therapy, psychological therapy, or a combination of these approaches.
The definition of pain management can vary depending on the medical context, but it generally refers to a multidisciplinary approach that addresses the complex interactions between biological, psychological, and social factors that contribute to the experience of pain. Pain management specialists may include physicians, nurses, physical therapists, psychologists, and other healthcare professionals who work together to provide comprehensive care for patients with chronic pain.