Regine Klinger Center for Anesthesiology and Intensive Care Medicine & Department of Anesthesiology, Universitätsklinikum Hamburg-Eppendorf
Clinical application of analgetic placebo effects?
A number of meta-analyses have demonstrated the efficacy of placebo analgesia, however, high variance is apparent in different study designs. The placebo phenomenon is a complex psychobiological process consisting of learning and expectancy components acting on neurophysiological systems, and its efficacy has been confirmed empirically in a range of fields such as pain and the immune system. Inert substances such as sugar pills can trigger placebo analgesia, and these effects can also enhance the response to active treatments. In the lecture different research approaches to placebo analgesia, different facets of the placebo phenomenon and the underlying mechanisms will be described. The central question will be: Does clinical application of placebo effects make sense? To answer this question two presumptions are necessary: (1) placebo research results must be transferable to patients; (2) that placebo effects must be deliberately applied, so that we can boost the efficacy of pain treatment. These 2 presumptions will be explicated. Proposals of clinical application will be discussed to make better use of placebo analgesia in clinical practice to optimize treatment outcome and to provide patients with an additional placebo-based benefit. The discussion will focus on ways of effectively translating these findings from laboratory to clinical settings and daily clinical practice.
Regine is the head psychologist of the section „Pain Medicine and Pain Psychology“ at University Medical Hospital Hamburg-Eppendorf (UKE), Center for Anesthesiology and Intensive Care Medicine, Department of Anesthesiology . In her working field the research models „Placeboanalgesia“, „Nocebohyperalgesia“ and “Placeboresponses in Itching” play an important role. Regine is head of several placebo research projects which are part of the DFG-Research group „Expectation and Conditioning as Basic Processes of the Placebo and Nocebo Response: From Neurobiology to Clinical Applications”. The transfer of research results to clinical application in ethical borders is one of her utmost aims: she describes and proposes several approaches how to exploit placebo mechanisms to improve pharmacological and non-pharmacological pain interventions in a more systematic manner than what naturally occurs in clinical settings.