1. Open- and closed-label placebo and nocebo suggestions about a sham transdermal patch
- Author
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Henriët van Middendorp, Andrea W M Evers, Stefanie H Meeuwis, Dieuwke S. Veldhuijzen, and A.P.M. Lavrijsen
- Subjects
medicine.medical_specialty ,Side effect ,Nocebo ,Transdermal patch ,GLM = general linear model ,Transdermal Patch ,Placebo ,03 medical and health sciences ,PA = positive affect ,0302 clinical medicine ,Primary outcome ,AN(C)OVA = analysis of (co)variance ,Internal medicine ,SS-10 = Sensitive Scale-10 ,PANAS = Positive and Negative Affect Schedule ,medicine ,Humans ,Cover story ,itch ,Nocebo Effect ,Suggestion ,Applied Psychology ,Transdermal ,nocebo effects ,business.industry ,Pruritus ,NRS = Numeric Rating Scale ,open-label placebo ,Original Articles ,Placebo Effect ,VS = verbal suggestion ,030227 psychiatry ,Psychiatry and Mental health ,STAI-S-s = Spielberger State Trait Anxiety Inventory, State anxiety short scale ,ComputingMethodologies_DOCUMENTANDTEXTPROCESSING ,business ,030217 neurology & neurosurgery ,placebo effects ,expectations - Abstract
Supplemental digital content is available in the text., Objective Placebo effects may occur when it is known that an inert substance is given (i.e., open-label placebo). It is not yet clear whether these effects are similar to concealed (i.e., closed-label) placebo effects for itch or whether nocebo effects can be induced under open-label conditions. Methods Healthy volunteers (n = 112) were randomized to an open-label (I) or closed-label (II) positive suggestions group, or an open-label (III) or closed-label (IV) negative suggestions group. Participants were told, as cover story, that a transdermal caffeine patch would be applied that positively influences cognitive abilities and, as a side effect, positively or negatively (depending on group allocation) influences itch. Participants in the open-label groups were given a rationale explaining placebo and nocebo effect mechanisms. Itch (the primary outcome) was induced at baseline and postsuggestions by histamine iontophoresis. Results Analyses of variance revealed significantly lower itch in the positive compared with the negative suggestions groups for both open- and closed-label contexts (all, p ≤ .008, Cohen d ≥ 0.47). Self-rated skin response was less severe after positive versus negative suggestions (all, p ≤ .017, Cohen d ≥ 0.33), but no effects on physical skin response were found (all, p ≥ .23, Cohen d ≤ 0.30). Conclusions Itch can be reduced by positive compared with negative suggestions under both open- and closed-label conditions. These findings indicate that open-label suggestions may potentially be a tool to use placebo effects for self-reported outcomes in clinical practice, for example, by explaining the role of expectancy in treatment. It needs to be investigated further under which circumstances an open-label rationale may impact placebo and nocebo effects. Trial Registration: www.trialregister.nl; NTR7174
- Published
- 2020