Prior Therapeutic Experiences, Not Expectation Ratings, Predict Placebo Effects: An Experimental Study in Chronic Pain and Healthy Participants.

INTRODUCTION: Many clinical trials fail because of placebo responses. Prior therapeutic experiences and patients' expectations may affect the capacity to respond to placebos in chronic disorders. OBJECTIVE: The scope of this study in 763 chronic orofacial pain and healthy study participants was to compare the magnitude and prevalence of placebo effects and determine the putative role of prior therapeutic experiences vs. expectations. METHODS: We tested placebo propensity in a laboratory setting by using 2 distinct levels of individually tailored painful stimulations (high pain and low pain) to reinforce expectations and provide a hypoalgesic experience (conditioning phase). Afterwards, both levels of pain were surreptitiously set at a moderate pain level to test for placebo effects (testing phase). Pain and expectation ratings were assessed as primary outcomes using visual analog scales. RESULTS: In both chronic pain and healthy participants, placebo effects were similar in magnitude, with the larger prevalence of responders in the healthy participants. Although chronic pain participants reported higher pain relief expectations, expectations did not account for the occurrence of placebo effects. Rather, prior experience via conditioning strength mediated placebo effects in both pain and healthy participants. CONCLUSIONS: These findings indicate that participants with chronic pain conditions display robust placebo effects that are not mediated by expectations but are instead directly linked to prior therapeutic experiences. This confirms the importance of assessing the therapeutic history while raising questions about the utility of expectation ratings. Future research is needed to enhance prediction of responses to placebos, which will ultimately improve clinical trial designs.

Determining the influence of Gaussian blurring on inversion effects with talking faces.

Perception of visual speech and the influence of visual speech on auditory speech perception is affected by the orientation of a talker's face, but the nature of the visual information underlying this effect has yet to be established. Here, we examine the contributions of visually coarse (configural) and fine (featural) facial movement information to inversion effects in the perception of visual and audiovisual speech. We describe two experiments in which we disrupted perception of fine facial detail by decreasing spatial frequency (blurring) and disrupted perception of coarse configural information by facial inversion. For normal, unblurred talking faces, facial inversion had no influence on visual speech identification or on the effects of congruent or incongruent visual speech movements on perception of auditory speech. However, for blurred faces, facial inversion reduced identification of unimodal visual speech and effects of visual speech on perception of congruent and incongruent auditory speech. These effects were more pronounced for words whose appearance may be defined by fine featural detail. Implications for the nature of inversion effects in visual and audiovisual speech are discussed.