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J Neurotrauma. 2018 Jun 1;35(11):1205-1212. doi: 10.1089/neu.2017.5506. Epub 2018 Apr 5.

Placebo Effects in Traumatic Brain Injury.

Author information

1
1 Department of Physical Medicine and Rehabilitation, Harvard Medical School, Spaulding Rehabilitation Hospital , Charlestown, Massachusetts.
2
2 MassGeneral Hospital for Children Sport Concussion Program , Boston, Massachusetts.
3
3 Red Sox Foundation and Massachusetts General Hospital Home Base Program , Boston, Massachusetts.
4
4 Program in Placebo Studies and Therapeutic Encounter, Harvard Medical School, Beth Israel Deaconess Medical Center , Boston, Massachusetts.

Abstract

In recent years, several randomized controlled trials evaluating pharmaceutical treatments for traumatic brain injury (TBI) have failed to demonstrate efficacy over placebo, with both active and placebo arms improving at comparable rates. These findings could be viewed in opposing ways, suggesting on the one hand failure of the tested outcome, but on the other, representing evidence of robust placebo effects in TBI. In this article, we examine several of the primary psychological processes driving placebo effects (verbal suggestion, cognitive re-framing, interpersonal interactions, conditioning, therapeutic alliance, anxiety reduction) as well as placebo neurobiology (top-down cortical regulation, reward system activation, dopaminergic and serotonergic neurotransmission). We then extrapolate from the literature to explore whether something inherent in TBI makes it particularly responsive to placebos. Viewed as such here, placebos may indeed represent a powerful and effective treatment for a variety of post-TBI complaints.

KEYWORDS:

TBI; dopamine; placebo effects; reward system; verbal suggestion

PMID:
29343158
PMCID:
PMC6016098
DOI:
10.1089/neu.2017.5506
[Indexed for MEDLINE]
Free PMC Article

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