Klinger

Regine Klinger
Head psychologist of the section Pain Medicine and Pain Psychology, Department of Anesthesiology, Center for Anesthesiology and Intensive Care Medicine, University Medical Hospital Hamburg-Eppendorf (UKE), Germany.

Deliberate application of placebo effects: Use of placebo effects in clinical practice by modulating expectancies

Clinical work must be a comprehensible process—random positive results are a pleasant benefit but are not usable and therefore not helpful for clinical practice. Accordingly, patient care relies on reliable and predictable results. Research on placebo effects offers a variety of possibilities to use placebo effects in ethical acceptable ways. One key finding of previous research is that the pharmacological effect of pain medication can be enhanced by the additive effect of analgesic placebo effect.

The application of placebo effects in clinical settings does not mean that pain medication should be substituted with placebos. It rather stands for increasing the effectiveness of pain medication by amplifying their inherent placebo component. Every effective pain medication has a pharmacological active component and a psychological (placebo) component.

In clinical practice, it is possible to boost an analgesic therapy by supporting it with the placebo component. The principles are to modulate expectancies by a targeted use of verbal instructions, cues, associations, and social learning models in the healing context of pain treatment. Accordingly, the open application of medication is an ethically way of using placebo effects in a clinical context. In this approach, physicians and other providers of pain treatment draw patients’ attention to the positive aspects of analgesics or other treatments. They give supporting information about the medication, take care of the patients, and try to establish a positive patient–clinician atmosphere.

On the basis of current studies with patients the potential of using placebo effects in pain therapy will be presented.

 

Biosketch

Regine is the head psychologist of the section „Pain Medicine and Pain Psychology“, 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 nonpharmacological pain interventions in a more systematic manner than what naturally occurs in clinical settings. Her current projects focus on placebo effects in acute pain therapy, e.g. postoperative knee pain, postoperative pain after sectio caeseare.