Klinischer Nutzen und praktische Implikationen des analgetischen Placeboeffekts

Abstract

Current knowledge about the analgesic placebo effect supports its potential for clinical applications. The underlying mechanisms as well as the effectiveness of placebo interventions in the field of pain has been demonstrated in many experimental studies as well as in meta-analyses. While a systematic, broader implementation of placebos in clinical practice requires further research, particularly in clinical populations, it is already now feasible to integrate placebo effects as an additive component in active pain therapy without exceeding ethical limits. This can successfully increase the clinical potential of analgesic treatment. There is evidence for the assumption that analgesic effects consists of two components, i. e., the pharmacological analgesic effect and the psychological effect (placebo effect). This psychological add-on effect should not be withheld from patients undergoing pain therapy. The AWMF S3-guidelines of the German Interdisciplinary Association for Pain Therapy DIVS “Treatment of acute perioperative and posttraumatic pain” for the first time included the recommendation of using the additional placebo effect for clinical application. This exemplifies an innovative perspective and opens up new clinical options for the administration of painkillers. A responsible handling requires that therapists have a comprehensive knowledge of placebo analgesia, including the role of the endogenous opioid system and the underlying mechanisms of placebo effects, i. e., classical conditioning and expectancy theory. This knowledge enables the clinical application of placebo effects by specific delivery of information, control of expectations and consideration of prior experiences and former associations with analgesics which may have to be revised or strengthened. This article describes these principles and proposes some clinical applications of placebo analgesia within ethical limits.