This paper reviews some recent advances in our understanding of the effects of sham or dummy interventions on pain and other symptoms in osteoarthritis (OA), and outlines two new approaches to the investigation of placebo and nocebo effects. We argue that the placebo effect provides us with a valuable way of investigating the nature of conditions like OA. For example, by examining which symptoms, biochemical markers or imaging features do or do not respond to placebo, we might learn more about the relationships between pathology and symptoms in OA. Placebo and nocebo effects are positive or negative outcomes resulting from the human interactions and contexts in which healthcare consultations take place. Subtle changes in behaviours and the environments in which consultations take place can have major effects on pain and other symptoms being experienced by people with OA. Nocebo effects are particularly powerful, leading to many health-care professionals (HCPs) causing unintended harm to their clients. Based on our own research, we conclude that beneficial outcomes are most likely to occur when both the (HCP) and the client feel safe and relaxed, and when the experiences of the client are validated by the (HCP). These findings have important implications for clinical practice. We believe that research in this field needs to be 'trans-disciplinary', escaping from the constraints of the purely biomedical, deterministic, positivist paradigm of most medical research. We provide the example of our own work which combines performance studies and scholarship, with psychology and medicine.

译文

:本文回顾了我们对假手术或假人干预对骨关节炎(OA)疼痛和其他症状的影响的理解的最新进展,并概述了研究安慰剂和Nocebo效应的两种新方法。我们认为,安慰剂效应为我们提供了一种研究OA等病症性质的宝贵方法。例如,通过检查哪些症状,生化标志物或影像学特征对安慰剂有反应或没有反应,我们可能会了解有关OA中病理与症状之间关系的更多信息。安慰剂和Nocebo的影响是正面的或负面的结果,是由于进行医疗咨询时的人际互动和环境而产生的。行为和进行咨询的环境的细微变化可能会对OA患者所经历的疼痛和其他症状产生重大影响。 Nocebo效应特别强大,导致许多医疗保健专业人员(HCP)对他们的客户造成意想不到的伤害。根据我们自己的研究,我们得出结论,当(HCP)和客户都感到安全和放松,并且(HCP)验证了客户的经验时,最有可能产生有益的结果。这些发现对临床实践具有重要意义。我们认为,该领域的研究需要是“跨学科的”,摆脱了大多数医学研究的纯生物医学,确定性,实证主义范式的约束。我们提供了自己的工作实例,将表演研究和奖学金与心理学和医学相结合。

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