Hohenschurz-Schmidt David, Thomson Oliver P, Rossettini Giacomo, Miciak Maxi, Newell Dave, Roberts Lisa, Vase Lene, Draper-Rodi Jerry
Pain Research, Dept. Surgery & Cancer, Faculty of Medicine, Imperial College, Chelsea & Westminster Hospital Campus, 369 Fulham Road London, London, SW10 9NH, UK.
Research Centre, University College of Osteopathy, 275 Borough High Street, London, SE1 1JE, UK.
Musculoskelet Sci Pract. 2022 Dec;62:102677. doi: 10.1016/j.msksp.2022.102677. Epub 2022 Oct 21.
While the placebo effect is increasingly recognised as a contributor to treatment effects in clinical practice, the nocebo and other undesirable effects are less well explored and likely underestimated. In the chiropractic, osteopathy and physiotherapy professions, some aspects of historical models of care may arguably increase the risk of nocebo effects.
In this masterclass article, clinicians, researchers, and educators are invited to reflect on such possibilities, in an attempt to stimulate research and raise awareness for the mitigation of such undesirable effects.
This masterclass briefly introduces the nocebo effect and its underlying mechanisms. It then traces the historical development of chiropractic, osteopathy, and physiotherapy, arguing that there was and continues to be an excessive focus on the patient's body. Next, aspects of clinical practice, including communication, the therapeutic relationship, clinical rituals, and the wider social and economic context of practice are examined for their potential to generate nocebo and other undesirable effects. To aid reflection, a model to reflect on clinical practice and individual professions through the 'prism' of nocebo and other undesirable effects is introduced and illustrated. Finally, steps are proposed for how researchers, educators, and practitioners can maximise positive and minimise negative clinical context.
虽然安慰剂效应在临床实践中作为治疗效果的一个促成因素越来越受到认可，但反安慰剂效应和其他不良影响的研究较少，可能被低估了。在整脊疗法、骨疗法和物理治疗专业中，一些传统护理模式的方面可能会增加反安慰剂效应的风险。
在这篇大师班文章中，邀请临床医生、研究人员和教育工作者思考这些可能性，以刺激研究并提高对减轻此类不良影响的认识。
本大师班简要介绍了反安慰剂效应及其潜在机制。然后追溯了整脊疗法、骨疗法和物理治疗的历史发展，认为过去和现在都过度关注患者的身体。接下来，研究了临床实践的各个方面，包括沟通、治疗关系、临床仪式以及更广泛的社会和经济实践背景，以探讨它们产生反安慰剂效应和其他不良影响的可能性。为了帮助思考，引入并说明了一个通过反安慰剂效应和其他不良影响的“棱镜”来反思临床实践和各个专业的模型。最后，提出了研究人员、教育工作者和从业者如何最大化积极的临床情境并最小化消极临床情境的步骤。
