Dipartimento di Neuroscienze, Università degli Studi di Torino e

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Dipartimento di Neuroscienze, Universit degli Studi di Torino e Istituto Nazionale di Neuroscienze (INN), Torino. www.personalweb.unito.it / fabrizio.benedetti www.ist-nazionale-neuroscienze.unito.it. Placebo. Improvement. Spontaneous remission. Unidentified co-interventions. Biases. - PowerPoint PPT Presentation

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  • Dipartimento di Neuroscienze, Universit degli Studi di TorinoeIstituto Nazionale di Neuroscienze (INN), Torinowww.personalweb.unito.it / fabrizio.benedettiwww.ist-nazionale-neuroscienze.unito.it

  • PlaceboImprovementSpontaneousremissionRegression tothe meanBiasesDetectionambiguityUnidentifiedco-interventionsPsychosocial-psychobiologicalfactorsPavlovianconditioningExpectationRewardmechanismsAnxietymechanisms PLACEBO RESPONSEIMPROVEMENT IN THE PLACEBO GROUP

  • Placebo effect = Context effectMedical treatmentDummy treatment

  • COGNITION Expectation Belief Trust HopeConditioned stimulusUnconditioned stimulus (e.g. drug)Conditioned responseEffectUnconsciousConscious

  • Therapeutic effectsNegative effectsBenedetti (2008) Ann Rev Pharmacol Toxicol 48: 33-60

  • IFN-g, IL-2 5-HT1B-1D 5-HT re-uptake D2-D3 CCK-A/B m-opioid b-adrenergic immuno sumatriptan anti anti CCK narcotic b-blockersuppressive depressant parkinsonian antagonistPsychosocial contextD r u g s e x p e c t a t i o na n d / o r c o n d i t i o n i n gAnalgesia andcardiovascularsystemHyperalgesiaParkinsonDepressionHormonalresponsesImmuneresponsesAnalgesia andrespiratorycentersBenedetti (2008) Annu Rev Pharmacol Toxicol 48: 33-60??

  • Benedetti et al. (1995) Lancet 346: 1231

  • hidden drugBenedetti et al. (1995) Lancet 346: 1231

  • 0Pain reductionBUPRENORPHINETRAMADOLKETOROLACMETAMIZOLopenopenopenopenhiddenhiddenhiddenhidden-1-2-3Open injectionHidden injectioncomputerPharmacodynamic effectPsychological effectBenedetti et al (1995) Lancet 346: 1231Amanzio et al. (2001) Pain 90:205-15Colloca et al (2004) Lancet Neurol. 3: 679-684

  • TRIAL Met#2 (Colloca and Benedetti, Nature Rev Neurosci 6: 545-552, 2005)

    Is metamizol (300 mg) effective in post-thymectomy pain?

    Open metamizol injection group (N=10)

    Hidden metamizol injection group (N=10)Informed consent You will receive metamizol but you dont know whenDouble blind

  • Pain intensity (NRS)01234560246810Pain intensity (NRS)0246810Open injection of metamizolHidden injection of metamizolhours

  • www.personalweb.unito.it / fabrizio.benedettiwww.ist-nazionale-neuroscienze.unito.itNEUROFISIOLOGIA

    Antonella PolloLuana CollocaSergio VighettiPSICOLOGIA

    Martina AmanzioClaudia ArduinoElisa CarlinoNEUROLOGIA

    Leonardo LopianoInnocenzo RaineroGiovanni AsteggianoCHIRURGIA

    Giuliano MaggiCaterina CasadioAnna ArslanianNEUROCHIRURGIA

    Michele LanotteAntonio MelcarneDipartimento di Neuroscienze, Universit degli Studi di TorinoeIstituto Nazionale di Neuroscienze (INN), Torino

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