The experience of pain arises from both physiological and psychological factors, including one's beliefs and expectations Thus, placebo treatments that have no intrinsic pharmacological effects may produce analgesia by altering expectations However, controversy exists regarding whether placebos alter sensory pain transmission, pain affect, or simply produce compliance with the suggestions of investigators In two functional magnetic resonance imaging (fMRI) experiments, we found that placebo analgesia was related to decreased brain activity in pain-sensitive brain regions, including the thalamus, insula, and anterior cingulate cortex, and was associated with increased activity during anticipation of pain in the prefrontal cortex, providing evidence that placebos alter the experience of pain

/pdf/placebo-induced-changes-in-fmri-in-the-anticipation-and-4x9xg4ezpf.pdf

Placebo-induced changes in FMRI in the anticipation and experience of pain.

The Movement Disorder Society Task Force for Rating Scales for Parkinson's disease (PD) prepared a critique of the Hoehn and Yahr scale (HY). Strengths of the HY scale include its wide utilization and acceptance. Progressively higher stages correlate with neuroimaging studies of dopaminergic loss, and high correlations exist between the HY scale and some standardized scales of motor impairment, disability, and quality of life. Weaknesses include the scale's mixing of impairment and disability and its non-linearity. Because the HY scale is weighted heavily toward postural instability as the primary index of disease severity, it does not capture completely impairments or disability from other motor features of PD and gives no information on nonmotor problems. Direct clinimetric testing of the HY scale has been very limited, but the scale fulfills at least some criteria for reliability and validity, especially for the midranges of the scale (Stages 2-4). Although a "modified HY scale" that includes 0.5 increments has been adopted widely, no clinimetric data are available on this adaptation. The Task Force recommends that: (1) the HY scale be used in its original form for demographic presentation of patient groups; (2) when the HY scale is used for group description, medians and ranges should be reported and analysis of changes should use nonparametric methods; (3) in research settings, the HY scale is useful primarily for defining inclusion/exclusion criteria; (4) to retain simplicity, clinicians should "rate what you see" and therefore incorporate comorbidities when assigning a HY stage; and (5) because of the wide usage of the modified HY scale with 0.5 increments, this adaptation warrants clinimetric testing. Without such testing, however, the original five-point scales should be maintained.

/pdf/movement-disorder-society-task-force-report-on-the-hoehn-and-58mf2wq2ef.pdf

Movement Disorder Society Task Force report on the Hoehn and Yahr staging scale: status and recommendations.

Placebo

https://www.thelancet.com/pdfs/journals/lancet/PIIS0140-6736(09)61706-2.pdf

Biological, clinical, and ethical advances of placebo effects

The misinformation effect refers to the impairment in memory for the past that arises after exposure to misleading information. The phenomenon has been investigated for at least 30 years, as investigators have addressed a number of issues. These include the conditions under which people are especially susceptible to the negative impact of misinformation, and conversely when are they resistant. Warnings about the potential for misinformation sometimes work to inhibit its damaging effects, but only under limited circumstances. The misinformation effect has been observed in a variety of human and nonhuman species. And some groups of individuals are more susceptible than others. At a more theoretical level, investigators have explored the fate of the original memory traces after exposure to misinformation appears to have made them inaccessible. This review of the field ends with a brief discussion of the newer work involving misinformation that has explored the processes by which people come to believe falsely that they experienced rich complex events that never, in fact, occurred.

/pdf/planting-misinformation-in-the-human-mind-a-30-year-3m1pwi44ea.pdf

Planting misinformation in the human mind: A 30-year investigation of the malleability of memory

Placebo analgesia was produced by conditioning trials wherein heat induced experimental pain was surreptitiously reduced in order to test psychological factors of expectancy and desire for pain reduction as possible mediators of placebo analgesia. The magnitudes of placebo effects were assessed after these conditioning trials and during trials wherein stimulus intensities were reestablished to original baseline levels. In addition, analyses were made of the influence of these psychological factors on concurrently assessed pain and remembered pain intensities. Statistically reliable placebo effects on sensory and affective measures of pain were graded according to the extent of surreptitious lowering of stimulus strength during the manipulation trials, consistent with conditioning. However, all of these effects were strongly associated with expectancy but not desire for relief. These results show that although conditioning may be sufficient for placebo analgesia, it is likely to be mediated by expectancy. The results further demonstrated that placebo effects based on remembered pain were 3 to 4 times greater than those based on concurrently assessed placebo effects, primarily because baseline pain was remembered as being much more intense than it actually was. However, similar to concurrent placebo effects, remembered placebo effects were strongly associated with expected pain levels that occurred just after conditioning. Taken together, these results suggest that magnitudes of placebo effect are dependent on multiple factors, including conditioning, expectancy, and whether analgesia is assessed concurrently or retrospectively.

An analysis of factors that contribute to the magnitude of placebo analgesia in an experimental paradigm

The effectiveness of virtual reality distraction for pain reduction: a systematic review.

A comprehensive, methodologically informed review of studies of the effectiveness of hypnosis for reducing procedure-related pain in children and adolescents is provided. To be included in the review, studies were required to use a between-subjects or mixed model design in which hypnosis was compared with a control condition or an alternative intervention in reducing the procedure-related pain of patients younger than age 19. An exhaustive search identified 13 studies satisfying these criteria. Hypnosis was consistently found to be more effective than control conditions in alleviating discomfort associated with bone marrow aspirations, lumbar punctures, voiding cystourethograms, the Nuss procedure, and post-surgical pain. Furthermore, hypnosis was as at least as effective as distraction. Three hypnotic interventions met criteria as a possibly efficacious empirically supported therapy for reducing post-surgical or lumbar puncture pain. Several other hypnotic interventions would have achieved the status of a possibly efficacious therapy had studies used a treatment manual.

The effectiveness of hypnosis for reducing procedure-related pain in children and adolescents: a comprehensive methodological review.

Virtual reality uses computer technology to immerse the individual in a multisensory, 3-dimensional environment. This meta-analysis is the first to quantify the effect of virtual reality distraction on pain. To be included in the meta-analysis, studies were required to use a between-subjects or mixe

The effectiveness of virtual reality distraction for reducing pain: A meta-analysis.

Immediate and persisting effects of misleading questions and hypnosis on memory reports were assessed. After listening to a story, 52 highly suggestible students and 59 low and medium suggestible students were asked misleading or neutral questions in or out of hypnosis. All participants were then asked neutral questions without hypnosis. Both hypnosis and misleading questions significantly increased memory errors, and misleading questions produced significantly more errors than did hypnosis. The 2 effects were additive, so that misleading questions in hypnosis produced the greatest number of errors. There were no significant interactions with level of hypnotic suggestibility. Implications of these findings for the per se exclusion of posthypnotic testimony are discussed. Hypnosis has received considerable attention in recent years as a method of enhancing eyewitness memory reports. Although some studies have suggested that hypnosis may have a small effect on improving memory accuracy, the effect is unreliable and has been linked to factors that are not specific to hypnosis (Erdelyi, 1994). Most of the studies in this area indicate that hypnotic procedures do not increase the accuracy of memory. Instead, it results in increased error rates and enhanced confidence in the accuracy of both true and false retrieved details (for reviews, see Erdelyi, 1994; Kebbell & Wagstaff, 1998; Orne, Whitehouse, Dinges, & Orne, 1996). The negative effects of hypnosis on posthypnotic memory re

Leonard S. Milling

Papers

An analysis of factors that contribute to the magnitude of placebo analgesia in an experimental paradigm

The effectiveness of virtual reality distraction for pain reduction: a systematic review.

The effectiveness of hypnosis for reducing procedure-related pain in children and adolescents: a comprehensive methodological review.

The effectiveness of virtual reality distraction for reducing pain: A meta-analysis.

Immediate and persisting effects of misleading questions and hypnosis on memory reports.