Comprehensive review

Pain and placebo in pediatrics: A comprehensive review of laboratory and clinical findings

Simmons, Kanesha^a,1; Ortiz, Robin^a,1; Kossowsky, Joe^b,c; Krummenacher, Peter^c,d; Grillon, Christian^a; Pine, Daniel^a; Colloca, Luana^a,e,f,*

Author Information

^aNational Institute of Mental Health (NIMH), Bethesda, MD, USA

^bDepartment of Anesthesiology Perioperative and Pain Medicine, Boston Children’s Hospital, Harvard Medical School, Boston, MA, USA

^cDepartment of Psychology, Clinical Psychology and Psychotherapy, University of Basel, Basel, Switzerland

^dCollegium Helveticum, University of Zurich and ETH Zurich, Zurich, Switzerland

^eClinical Center, Department of Bioethics, National Institutes of Health, Bethesda, MD, USA

^fNational Center for Complementary and Alternative Medicine (NCCAM), Bethesda, MD, USA

^*Corresponding author at: Clinical Center, National Institutes of Health, 10 Center Dr, 10/1C154, Bethesda, MD 20892-1156, USA. Tel.: +1 (301) 435 8715; fax: +1 (301) 496 0760.

E-mail: [email protected]

¹The first 2 authors contributed equally to this article, and both should be considered first author.

Submitted March 22, 2014; revised August 24, 2014; accepted August 26, 2014.

Pain 155(11):p 2229-2235, November 2014. | DOI: 10.1016/j.pain.2014.08.036

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Abstract

Are developing children more prone than older children and adults to form placebo analgesic effects? We address this issue providing a comprehensive analysis of both nociception and pain modulation in pediatrics.

Pain modulation by placebo mechanisms is one of the most robust and best-studied phenomena, yet almost all research investigating the mechanisms and implications of the placebo analgesia are based on adult research. After highlighting crucial aspects that need to be considered in studying pain modulation in children, this comprehensive review examines studies related to pain modulation with an emphasis on factors such as age, neural development and pain measures. We critically discuss psychological mechanisms underlying placebo effects, including (1) verbally induced expectations, (2) conditioning and learning mechanisms, and (3) child–parent–physician interactions. Taken together, research suggests that placebo mechanisms can affect therapeutic outcomes and potentially be exploited clinically to improve clinical outcomes in pediatric population. Recommendations for further investigating the mechanistic bases and harnessing placebo effects for supportive therapeutic applications are given.