Placebo and Nocebo Effects

  • Maxie Blasini
  • Nicole Corsi
  • Luana CollocaEmail author


The placebo and nocebo phenomena are formed through a complex interplay of biological, psychological, and social factors that prevail in every clinical and healthcare setting. Different modulatory systems involving endogenous opioid, oxytocin, vasopressin, dopamine, and cannabinoid activity, as well as other neuropeptides regulating anxiety and stress-related behaviors, have been found to be key players in the development of placebo and nocebo effects. These events are primarily driven by the formation of positive or negative expectancies. Expectancies are shaped through various forms of learning, inclusive of social observation, instructional learning and verbal suggestions, as well as conditioning, and can also be influenced by individual factors related to personality traits and genetics. Clinical engagement of placebo effects has been shown to have effects in patients with irritable bowel syndrome, Parkinson’s, and depression. The palliative care setting is highly impacted by psychosocial distress, pain, depression, and nausea, aspects that can be strongly modulated through placebo effects and endogenous modulatory systems. Nonetheless, investigative limitations exist in this setting due to ethical considerations that must be taken during end-of-life care and the use of placebos. Despite these constraints, practical strategies can be taken to help enhance important contextual factors that when integrated to the therapeutic environment can significantly improve outcomes.


Palliative care Nausea Depression Pain End-of-life care Expectancy Conditioning 



This research was supported by the University of Maryland, Baltimore (LC), and the National Institute of Dental and Craniofacial Research (NIDCR, R01DE025946, LC).


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© Springer International Publishing AG, part of Springer Nature 2018

Authors and Affiliations

  1. 1.Doctor of Acupuncture and Chinese Medicine ProgramPacific College of Oriental MedicineSan DiegoUSA
  2. 2.Pain and Palliative Care Research Unit, Oncology DepartmentIRCCS – Mario Negri Institute for Pharmacological ResearchMilanItaly
  3. 3.Departments of Anesthesiology and Psychiatry, School of MedicineUniversity of MarylandBaltimoreUSA
  4. 4.Department of Pain Translational Symptom Science, School of NursingUniversity of MarylandBaltimoreUSA
  5. 5.Center to Advance Chronic Pain ResearchUniversity of MarylandBaltimoreUSA

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