Key result
Placebo and nocebo effects have reliable effects on heart rate variability (reducing and increasing low-frequency HRV, respectively), but not on heart rate or blood pressure.
Why the study?
Studies have reported inconsistent findings on how cardiac activity is modulated following placebo/nocebo effects, and no systematic review had provided a clear picture of cardiac placebo responses.
Do placebo analgesia and nocebo hyperalgesia affect cardiac activity as measured by blood pressure, heart rate, and heart rate variability?
Systematic Review
Do placebo analgesia and nocebo hyperalgesia affect cardiac activity as measured by blood pressure, heart rate, and heart rate variability?
Placebo and nocebo effects reliably modulate heart rate variability, specifically low-frequency HRV, but do not consistently affect heart rate or blood pressure.
Placebo/nocebo effects warrant control in HRV assessments during pain trials; confirms selective autonomic modulation without HR or BP changes.
Background: Placebo/nocebo effects involve the autonomic nervous system, including cardiac activity, but studies have reported inconsistent findings on how cardiac activity is modulated following a placebo/nocebo effect. However, no systematic review has been conducted to provide a clear picture of cardiac placebo responses. Objective: The main goal of the present study is to review the effects of placebo analgesia and nocebo hyperalgesia on cardiac activity as measured by blood pressure, heart rate, and heart rate variability. Methods: Using several Boolean keyword combinations, the PubMed, EMBASE, PsycINFO, Cochrane Review Library, and ISI Web of Knowledge databases were searched until January 5, 2020, to find studies that analyzed blood pressure, heart rate or heart rate variability indexes following a placebo analgesic/nocebo hyperalgesic effect. Results: Nineteen studies were found, with some reporting more than one index of cardiac activity; eight studies were on blood pressure, 14 studies on heart rate, and six on heart rate variability. No reliable association between placebo/nocebo effects and blood pressure or heart rate was found. However, placebo effects reduced, and nocebo effects increased low frequency heart rate variability, and heart rate variability significantly predicted placebo effects in two studies. Conclusion: Placebo/nocebo effects can have reliable effects on heart rate variability, but not on heart rate and blood pressure.
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Daniali et al. (2020) conducted a systematic review in Pain. Placebo analgesia and nocebo hyperalgesia vs. Control or comparison group/condition was evaluated on Cardiac activity (blood pressure, heart rate, and heart rate variability). Placebo and nocebo effects have reliable effects on heart rate variability (reducing and increasing low-frequency HRV, respectively), but not on heart rate or blood pressure.
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