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What techniques might be used to harness placebo effects in non-malignant pain? A literature review and survey to develop a taxonomy
  1. Felicity L Bishop1,
  2. Beverly Coghlan2,
  3. Adam WA Geraghty2,
  4. Hazel Everitt2,
  5. Paul Little2,
  6. Michelle M Holmes1,
  7. Dionysis Seretis1,
  8. George Lewith2
  1. 1 Department of Psychology, Faculty of Social Human and Mathematical Sciences, University of Southampton, Southampton, UK
  2. 2 Primary Care and Population Sciences, Aldermoor Health Centre, University of Southampton, Southampton, UK
  1. Correspondence to Dr Felicity L Bishop; F.L.Bishop{at}southampton.ac.uk

Abstract

Objectives Placebo effects can be clinically meaningful but are seldom fully exploited in clinical practice. This review aimed to facilitate translational research by producing a taxonomy of techniques that could augment placebo analgesia in clinical practice.

Design Literature review and survey.

Methods We systematically analysed methods which could plausibly be used to elicit placebo effects in 169 clinical and laboratory-based studies involving non-malignant pain, drawn from seven systematic reviews. In a validation exercise, we surveyed 33 leading placebo researchers (mean 12 years’ research experience, SD 9.8), who were asked to comment on and add to the draft taxonomy derived from the literature.

Results The final taxonomy defines 30 procedures that may contribute to placebo effects in clinical and experimental research, proposes 60 possible clinical applications and classifies procedures into five domains: the patient’s characteristics and belief (5 procedures and 11 clinical applications), the practitioner’s characteristics and beliefs (2 procedures and 4 clinical applications), the healthcare setting (8 procedures and 13 clinical applications), treatment characteristics (8 procedures and 14 clinical applications) and the patient–practitioner interaction (7 procedures and 18 clinical applications).

Conclusion The taxonomy provides a preliminary and novel tool with potential to guide translational research aiming to harness placebo effects for patient benefit in practice.

  • placebos
  • placebo effect
  • nocebo effect
  • translational research
  • review
  • classification

This is an Open Access article distributed in accordance with the terms of the Creative Commons Attribution (CC BY 4.0) license, which permits others to distribute, remix, adapt and build upon this work, for commercial use, provided the original work is properly cited. See: http://creativecommons.org/licenses/by/4.0/

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Footnotes

  • Contributors FLB designed and led the study, drafted the manuscript and is guarantor. FLB, GL, AWAG, HE and PL secured funding for the project. FLB designed the study with input and revisions from GL, BC, AWAG, HE and PL. BC led data collection and analysis with additional data collection and analysis by MH and DS. All authors contributed to data interpretation. FLB drafted the manuscript, and all authors revised it for important intellectual content. All authors had full access to all of the data in the study and can take responsibility for the integrity of the data and the accuracy of the data analysis.

  • Funding The project “Creating a Taxonomy to Harness the Placebo effect in UK primary care” was funded by the National Institute of Health Research (NIHR) School for Primary Care Research (SPCR) (project number 161). This paper presents independent research funded by the NIHR. Additional funding for BC was provided by Solent NHS Trust.

  • Disclaimer The views expressed are those of the author(s) and not necessarily those of the National Health Service (NHS), the NIHR or the Department of Health.

  • Competing interests None declared.

  • Provenance and peer review Not commissioned; externally peer reviewed.

  • Data sharing statement Data underpinning this paper are available on request from the corresponding author.

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