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Pain treatment and resolution - Research Paper Example

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“I Will Harm” An exploration of psychological dimensions in clinical adverse events Anyone having studied health care, or the details of pharmaceutical research will be familiar with that complication of clinical research, the placebo effect. The confounding influence of what might be termed 'psycho-medical' factors; obscuring whether a drug or treatment truly yields the desired result…
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Pain treatment and resolution
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Download file to see previous pages Yet thinking one’s self well – or sick can be more important than earlier clinicians realized. (Enck et al. 2008) Placebo effects have received considerable publicity in recent decades, and the technological march that permits advances in brain imaging, and the tools thereof, have dramatically increased our comprehension of the associated neurobiology. But researchers have now begun the investigation of the phenomenon that is the opposite of the beneficial placebo. These, are the nocebo effects – adverse effects, including worsening of medical status or increased negative severity of symptoms due simply to the expectation or suggestion involving some inert treatment – is a somewhat more obscure area of study in the field of neuroscience. Among these effects are findings of anticipatory anxiety that can heighten pain, through Cholecystokinin activation, among the activity of other neurotransmitters. (Colloca et al. 2007) A growing body of research has demonstrated that while the mind has the power to convince the body to heal, a dark cousin of the same phenomenon swings the other way, as well. Taken from a Latin word 'I will harm', rather than placebo's 'To appease'. Medication-caused adverse effects are seen as a common reason for low compliance in medical practice and during clinical studies. These events can be disturbingly common in patients receiving only placebo. Headache/migraine studies appear prone to this mistaken pathology, (Mitsikostas et al. 2011) with trial participants dropping out over effects of a drug that is not a drug. The emergence of adverse effects in placebo-only groups can simplify anomalies in the assessment of clinical monitors that must report, and define adverse events. A study by Rief et el. found that 4% to 26% of patients in the control groups of large, pharmaceutical trials of statin drugs discontinued placebo use because of the perception of adverse effects that seemed real to the patient. (Rief et al. 2006) Several studies suggest that the effects of the nocebo, which can be termed “negative placebo effects,” form a significant contribution to a wide range of medical symptoms and adverse effects. Clinical trials and medical care are both influenced by these effects; in which an adverse event can be seemingly derived from an agent with no pharmacological activity. These nocebo effects can be invoked through the generation of negative expectancy to a phony treatment, subjective pain rankings increased by a significant factor on nocebo sites of the arm in comparison with control sites. fMRI investigations confirmed a variety of brain regions involved in an hyperalgesic nocebo effect. Functional Magnetic Resonance Imaging can be used to measure, and map out these brain regions specifically, and these fMRI studies have demonstrated brain activity corresponding to an increased pain reaction. Signaling increases can be found in the bilateral dorsal ACC, insula, superior temporal gyrus; left frontal and parietal operculum, medial frontal gyrus, orbital prefrontal cortex, superior parietal lobule and hippocampus; right claustrum / putamen, lateral prefrontal gyrus and middle temporal gyrus. In addition, changes in the basal ganglia have been observed. (Jian et al. 2008) (Benedetti, 2011) Which raises questions concerning the nature of pain ...Download file to see next pages Read More
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