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Table 2 Key points on placebo, nocebo and context-related effects

From: Context matters: the psychoneurobiological determinants of placebo, nocebo and context-related effects in physiotherapy

Take-home message
• Placebo and nocebo effects are psychoneurobiological phenomena respectively produced by a positive and a negative healthcare context around the treatment;
• The healthcare context is composed by contextual factors such as the feature of: the physiotherapist; the patient; the patient-physiotherapist relationship; the treatment; and the healthcare setting.
• The psychological determinants of placebo and nocebo effects include: expectation; learning (classical conditioning and observational learning); reinforced expectations; mindset; and personality traits.
• The neurophysiological mechanisms of placebo and nocebo effects involve different systems (the endogenous opioid, the endocannabinoid, and the dopaminergic) and brain regions (dorsolateral prefrontal cortex, the rostral anterior cingulate cortex, the periaqueductal gray, and the dorsal horn of spine).
• From a clinical perspective, the manipulation of the healthcare context with the best evidence-based therapy represents an opportunity to trigger placebo effects and to avoid nocebo effects respecting the ethical and deontological code of conduct.
• From a managerial perspective, stakeholders, organizations and governments should encourage the assessment of the healthcare context aimed to improve the quality of physiotherapy services.
• From an educational perspective, placebo and nocebo effects are professional topics that should be integrated in the university program of health and medical professions.
• From a research perspective, the control of placebo, nocebo and context-related effects offers to the scientific community the chance to better measure the impact of physiotherapy on different outcomes and in different conditions through primary studies.