By many reasons it is important we increased our definition and understanding of placebo and nocebo as a biopsychosocial-cultural process at both nomothetic and ideographic levels!
On of the reasons is that placebo can be a problem when the psychological (actually Limbic, see more below*) effects override/hide the biological effects given there is assumed more than understood. Why, the Limbic placebo effect, when expression of biological dysfunctions (as well as Limbic add-ons), it fools as to believe that health is being returning and stop going on with biopsychosocial-cultural examinations. This may also be a problem when there is cultural overriding biological dysfunctions.
What about nocebo, can equal happens? Yes, of course, defined as the biopsychosocial-cultural opposite. Limbic/psychological and cultural nocebo not only can fool us to examine wrong systems but also by itself prevent recovery while doing resistance against the placebo work.
Interplay between placebo and nocebo? Yes, of course while extremely huge amount of reactions occurs (also at different time behaviors scales making it even more complex) we need to assume a net effect of all those interacting systems behaviors.
But, the above is not possible to get even a slightest idea of?
Perhaps, but as I argue elsewhere here, we can focus on basics already quite well recognized as potential placebo promotors as expectations, qualitative encounters in constructive contexts, knowledge and its practice co-operation with patients (met with patient group education is we done for 30 years based on “patient as an educated, reasonable competent resource and coworker in own rehab”), but also using psychophysiological knowledge to measure, explain and intervene (integrated biofeedback), follow and outcome those parameters that are useful and enabled to measure giving a platform to move on!
More, if “only” a psychological, precognitive (Limbic spatial with not further biological “connections” occurs giving symptoms relieve – which is mostly very much to extremely welcomed – it can prevent further investigations and interventional processes! We do have clinical experiences from patients, but as we, in those cases, could measure autonomic nervous systems behaviors in lab as well in real world, we had a strategy to deal with this without disappointing those patients. But without data, we would not realize it!
This is why sometimes psychological interventions can fool us, without clinicians really realize it. But, often, we can assume that “real biological world dysfunctions “hit back” in spite of psychological camouflaged placebo after a while, when they (the dysfunctions) have been more destructive developed masked by a symptoms placebo without real causal influence!
This is also a huge risk with pharmacological treatments, especially bad example is hypertension – the entrance for more severe dysfunctions! When pills camouflage biological dysfunctions, often life style related (which should be changed and pills only when life threatened, see e.g. www.skillsbeforepills.com), symptom expressions are silenced while dysfunctional development goes on!
Perhaps can more extensive work – knowledge based and practically clinically focused (individually!) – on placebo and nocebo also increase our understanding how to deal with limited, extreme complex life style related diseases and mental problems – at large!
Appreciate comments on the above – which is (perhaps too fast written and) only a draft to be more worked on!
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