Cesare Cavalera

What Is the Role of the Placebo Effect for Pain Relief in Neurorehabilitation? Clinical Implications From the Italian Consensus Conference on Pain in Neurorehabilitation

Background It is increasingly acknowledged that the outcomes of medical treatments are influenced by the context of the clinical encounter through the mechanisms of the placebo effect. The phenomenon of placebo analgesia might be exploited to maximize the efficacy of neurorehabilitation treatments. Since its intensity varies across neurological disorders, the Italian Consensus Conference on Pain in Neurorehabilitation (ICCP) summarized the studies on this field to provide guidance on its use. Methods A review of the existing reviews and meta-analyses was performed to assess the magnitude of the placebo effect in disorders that may undergo neurorehabilitation treatment. The search was performed on Pubmed using placebo, pain, and the names of neurological disorders as keywords. Methodological quality was assessed using a pre-existing checklist. Data about the magnitude of the placebo effect were extracted from the included reviews and were commented in a narrative form. Results 11 articles were included in this review. Placebo treatments showed weak effects in central neuropathic pain (pain reduction from 0.44 to 0.66 on a 0–10 scale) and moderate effects in postherpetic neuralgia (1.16), in diabetic peripheral neuropathy (1.45), and in pain associated to HIV (1.82). Moderate effects were also found on pain due to fibromyalgia and migraine; only weak short-term effects were found in complex regional pain syndrome. Confounding variables might have influenced these results. Clinical implications These estimates should be interpreted with caution, but underscore that the placebo effect can be exploited in neurorehabilitation programs. It is not necessary to conceal its use from the patient. Knowledge of placebo mechanisms can be used to shape the doctor–patient relationship, to reduce the use of analgesic drugs and to train the patient to become an active agent of the therapy.

Negative social emotions and cognition: Shame, guilt and working memory impairments

Negative emotions can have an impact on a variety of cognitive domains, including Working Memory (WM). The present work investigated whether shame and guilt modulate WM performance in a dual-task test both in a non-clinical and a clinical population. In Experiment 1, 76 non-clinical participants performed a dual-task before and after being randomly assigned to shame, guilt or neutral inductions elicited by the writing of autobiographical past experiences. Shame and guilt elicitations were related to impaired WM performances. In Experiment 2, 65 clinical inpatients with eating disorders were assigned to the same procedure. The negative relationship of self-conscious emotions and WM was confirmed. Taken together these results suggest that shame and guilt are related to impairments of WM in both clinical and non-clinical participants.