Placebo/Nocebo: a two-side coin in the clinician’s hand

The last decade has witnessed an upsurge in placebo and nocebo research, which has provided scientific ground for a phenomenon once believed to be only patient mystification, or at best a variable to control in clinical trials. Neurochemical, pharmacological and neuroimaging studies are elucidating the mechanisms by which the activation of identifiable neural pathways produce symptom changes following treatments devoid of specific activity. Placebo analgesia and nocebo hyperalgesia are among the best studied models, and awareness of the possible clinical application of research knowledge can lead to the optimization of the context surrounding the patient, in order to maximize the placebo component and minimize the nocebo component present in any treatment.