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Background: With evidence for large nocebo effects in pain, guidelines for nocebo-minimizing strategies regarding side effect disclosure are emerging. While the ethical implications and effectiveness of such strategies have been the subject of investigations, the perspective of healthcare users are missing despite the stakes for patient autonomy., Methods: In an online survey, 2766 adults (≥18 years) from a general population sample in Europe and North America responded to questions related to nocebo familiarity, nocebo beliefs and attitudes towards side effect disclosure., Results: Only 474 (17%) were familiar with nocebo terminology, while 1379 (50%) were familiar with the concept of nocebo side effects. Belief in nocebo side effects was not well-established; 738 (31%) agreed that side effect information could increase side effect occurrence. Nocebo belief was associated with more negative attitudes towards side effect disclosure and 1962 (73%) indicated that positive framing was an acceptable way of disclosing side effect information. In general, the majority of participants (65-76%) held positive attitudes towards the disclosure of all potential side effects and 2309 (84%) favoured patient autonomy over nonmaleficence. Although the general patterns were similar in the European and North American sample, the latter showed stronger nocebo belief and stronger positive attitudes towards side effect disclosure., Conclusions: The study found a consistent, moderate association between nocebo belief and attitudes towards nondisclosure, alongside positive attitudes towards the use of framing. Together with the discovered discrepancy between nocebo familiarity and nocebo belief, these findings have implications for the implementation of nocebo education and risk framing strategies., Significance Statement: This is the first large-scale, general population-based study to contribute to the scientific discussion about nocebo side effects from the perspective of healthcare users. The findings have implications for the discussion on how to handle the medical and ethical problem of nocebo side effects in clinical practice., (© 2024 The Author(s). European Journal of Pain published by John Wiley & Sons Ltd on behalf of European Pain Federation ‐ EFIC ®.)

Background: Complementary and Integrative Health Approaches (CIHA), including but not limited to, natural products and Mind and Body Practices (MBPs), are promising non-pharmacological adjuvants to the arsenal of pain management therapeutics. We aim to establish possible relationships between use of CIHA and the capacity of descending pain modulatory system in the form of occurrence and magnitude of placebo effects in a laboratory setting., Methods: This cross-sectional study investigated the relationship between self-reported use of CIHA, pain disability, and experimentally induced placebo hypoalgesia in chronic pain participants suffering from Temporomandibular Disorders (TMD). In the 361 enrolled TMD participants, placebo hypoalgesia was measured using a well-established paradigm with verbal suggestions and conditioning cues paired with distinct heat painful stimulations. Pain disability was measured with the Graded Chronic Pain Scale, and use of CIHA were recorded with a checklist as part of the medical history., Results: Use of physically oriented MBPs (e.g., yoga and massage) was associated with reduced placebo effects (F 1,2110.44  = 23.15, p < 0.001, Cohen's d = 0.171). Further, linear regressions indicated that greater number of physically oriented MBPs predicted smaller placebo effects (β = -0.17, p = 0.002), and less likelihood of being a placebo responder (OR = 0.70, p = 0.004). Use of psychologically oriented MBPs and natural product were not associated with placebo effects magnitude and responsiveness., Conclusions: Our findings suggest that use of physically oriented CIHA was associated with experimental placebo effects possibly through an optimized capability to recognize distinct somatosensorial stimulations. Future research is needed to understand the mechanisms underlying placebo-induced pain modulation in CIHA users., Significance: Chronic pain participants who use physically oriented mind-body practices, such as yoga and massage, demonstrated attenuated experimentally induced placebo hypoalgesia in comparison with those who do not use them. This finding disentangled the relationship between use of complementary and integrative approaches and placebo effects, providing the potential therapeutic perspective of endogenous pain modulation in chronic pain management., (© 2023 European Pain Federation - EFIC ®.)

Background: Temporomandibular disorders (TMD) symptoms develop into chronic pain for some patients, but the reasons for this are unclear. Psychosocial factors and chronic overlapping pain conditions are believed to contribute to the development of pain-related disability. We examined the role of jaw function, negative and positive psychological factors and chronic overlapping pain conditions (COPCs) on pain-related disability whilst controlling for demographic variables., Methods: We collected demographics, medical and psychosocial history and the Graded Chronic Pain Scale, a measure of pain intensity and pain interference from 400 participants with chronic TMD. Structural equation modelling was used to assess a model of COPCs and the latent variables of psychological unease (pain catastrophizing, somatic symptoms and negative affect), positive valence factors (optimism and positive affect), jaw function (chewing, opening and expression limitation) and pain-related disability (pain intensity and pain interference) whilst controlling for demographic variables., Results: We achieved good fit of a parsimonious model (root-mean-square error of approximation = 0.063 [90% CI] [0.051-0.075]), comparative fit index = 0.942, standard root-mean-square residual = 0.067. Jaw function was the strongest latent variable predictor, followed by psychological unease and COPCs suggesting resources focused on improving joint function, psychosocial support and management of COPCs will improve pain-related disability in TMDs., Conclusions: These findings not only increase the body of knowledge related to TMD clinical phenotypes but also, have a translational impact in further supporting the potential value of targeting physical therapy such as jaw exercise along with psychological interventions as multidisciplinary nonpharmacological therapeutic solutions., (© 2022 European Pain Federation - EFIC ®.)

Background: Recently, it has been shown that live, face-to-face social observation induces marked placebo analgesia. Despite the phenomenal growth of video sharing platforms, the potential analgesic effects of video-based social observation are largely unknown. This study compared video-based and live social observation induced placebo analgesia and whether there was a similar relationship between analgesic responses and empathy traits for both conditions., Methods: Here, we compared placebo analgesia in four groups: social observation through a video (SOV group), social observation in person (SOP group), verbal suggestion alone (VS group) and a natural history group (NH group). The SOV and SOP groups underwent a placebo treatment and painful stimuli following respectively a video-based and live observation of a demonstrator showing analgesic effects when the painful stimuli were paired to a green light but not a red light. The VS group received painful stimuli after they had been verbally instructed to expect less pain after the green light. The NH group received painful stimuli, but was told nothing about the meaning of the lights. Individual pain reports and empathy traits were measured., Results: We found that video-based observation induced substantial placebo analgesic responses that were of similar magnitude to live observation. Notably, the analgesic scores were strongly correlated with empathetic concern in the live observation group but not in the video replay group., Conclusions: These findings add evidence that placebo analgesia can be induced by social observation and that empathy interacts with these effects in a context-dependent manner., (© 2013 European Pain Federation - EFIC®)

In this study we address the problem of the repeatability of autonomic responses in the experimental setting. In healthy volunteers, we measured the heart rate (HR) response to pain anticipation and to pain elicited with galvanic stimulation. After evaluation of pain threshold (T), all subjects underwent the same experimental protocol, whereby a painful stimulus at 1.5T was delivered on the forehead following a warning, while the ECG was continuously recorded. The procedure was repeated three times across a three-week period. The parameters recorded included pain threshold, pain rating, HR response to pain anticipation and HR response to pain. We found a high correlation among the three sessions for all parameters, indicating that, as occurs for pain threshold and pain rating, individual differences in autonomic responses can be reliably reproduced as well, even though significant habituation develops.