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Inicio Medicina Clínica (English Edition) Placebo effect and therapeutic context: A challenge in clinical research
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Vol. 149. Issue 1.
Pages 26-31 (July 2017)
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Vol. 149. Issue 1.
Pages 26-31 (July 2017)
Review
Placebo effect and therapeutic context: A challenge in clinical research
Efecto placebo y contexto terapéutico: un reto en investigación clínica
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11
Antoni Morrala,
Corresponding author
, Gerard Urrutiab, Xavier Bonfillb
a Facultat de Ciències de la Salut Blanquerna, Universitat Ramon Llull, Barcelona, Spain
b Centro Cochrane Iberoamericano, Institut d’Investigació Biomèdica, Hospital de la Santa Creu i Sant Pau, Universitat Autònoma de Barcelona, Barcelona, Spain
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Abstract

When we apply a physical or pharmacological treatment, there are many things that may explain the clinical improvement experienced by a patient. The drugs or physical agents applied are important, but we must also add other elements in the context of the patient–therapist relationship. Scientific evidence has proven that the placebo effect exists. This is a true biopsychosocial phenomenon produced by the context in which an intervention is carried out. Biases aside, placebo and nocebo responses are changes in patients’ symptoms, due to their participation at the therapeutic meeting, with its rituals, symbols and interactions. This multitude of signals inherent, in any intervention, is perceived and interpreted by patients and can create positive or negative expectations.

Keywords:
Placebo effect
Nocebo effect
Therapeutic context
Resumen

Cuando administramos un tratamiento físico o farmacológico, existen muchas variables que pueden explicar la mejoría clínica que experimenta un paciente. El principio activo del fármaco o el agente físico aplicado son importantes, pero también hay que sumarle otros elementos presentes en el contexto de la relación paciente-terapeuta. La evidencia científica ha demostrado que el efecto placebo existe. Se trata de un auténtico fenómeno biopsicosocial producido por el contexto en el cual se lleva a cabo una intervención. Sesgos al margen, las respuestas placebo y nocebo son cambios en los síntomas de los pacientes atribuibles a su participación en el encuentro terapéutico, con sus rituales, símbolos e interacciones. Esta multitud de señales inherentes a toda intervención son percibidas e interpretadas por los pacientes, generando expectativas positivas o negativas.

Palabras clave:
Efecto placebo
Efecto nocebo
Contexto terapéutico

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