***TASK*** the task is to summarize an input biomedical literature in six sentences 
    ***INPUT*** the input is a biomedical literature 
    ***OUTPUT*** the output is the summary of an input biomedical literature in six sentences 
    ***DOCUMENTATION*** 
    ***EXAMPLES*** 
    Input: Nocebo hyperalgesia has received sparse experimental attention compared to placebo analgesia . The aim of the present study was to investigate if personality traits and fear of pain could predict experimental nocebo hyperalgesia . One hundred and eleven healthy volunteers ( 76 females ) participated in an experimental study in which personality traits and fear of pain were measured prior to induction of thermal heat pain . Personality traits were measured by the Big-Five Inventory-10 . Fear of pain was measured by the Fear of Pain Question naire III . Heat pain was induced by a PC-controlled thermode . Pain  was measured by a computerized visual analog scale .  Stress levels during the experiment were measured by numerical rating scales . The participants were r and omized to a Nocebo group or to a no-treatment Natural History group . The results revealed that pain and stress levels were significantly higher in the Nocebo group after nocebo treatment . Mediation analysis showed that higher levels of the Fear of Pain Question naire III factor “ fear of medical pain ” significantly increased stress levels after nocebo treatment and that higher stress levels were associated with increased nocebo hyperalgesic responses . There were no significant associations between any of the personality factors and the nocebo hyperalgesic effect . The results from the present study suggest that dispositional fear of pain might be a useful predictor for nocebo hyperalgesia and emotional states concomitant with expectations of increased pain . Furthermore , measurement of traits that are specific to pain experience is probably better suited for prediction of nocebo hyperalgesic responses compared to broad measures of personality & NA ; The aim of this study was to examine how men and women observe experimentally induced pain in male and female participants and to specifically determine the accuracy of observed pain ratings , the possible interactions between the sex of the viewer and the sex of the individual being observed , and the influence of gender role expectations on observed pain ratings . The sample comprised 29 participants ( 15 females ) . They each completed a battery of psychological question naires and viewed a presentation of 10 r and omly ordered video clips . Each presentation consisted of 10 video clips , lasting 30 s , of a participant ( five males and five females ) in the cold pressor task . The participants viewing the videos were asked to provide several ratings , including observed pain intensity and gender role related characteristics of the individual in the video . In terms of sex of the video participant , results indicated that viewers rated male videos as having less pain than female videos although the effect was small . Regarding sex of the viewer , results indicated that for both male and female videos , female viewers rated observed pain intensity significantly higher than did male viewers . In terms of accuracy , results indicated that on average , female video participants ' pain was underestimated by 14 points , while male videos participants ' pain was underestimated by 22 points ( on a 0–100‐point scale ) . Pain intensity ratings and pain tolerance from the participants in the videos did not differ significantly with respect to sex , though women had shorter tolerance times and higher pain ratings than men . Hierarchical regression analyses indicated that expectations of gender related ‘ endurance of pain ’ significantly predicted ratings of both male and female videos . When endurance expectations were controlled , sex of the viewer no longer significantly predicted observed pain ratings . The ‘ willingness to report pain ’ variable was not a significant predictor of observed pain ratings . Our results show that women are perceived to have more pain than men , that there was a tendency by both sexes to underestimate pain in others , but men showed even greater underestimation , and that gender role expectations of pain endurance given by the video observers accounted for substantial variance in their ratings of pain in the videos BACKGROUND Little is known about which characteristics of chiropractors and physiotherapists matter to patients and influence their preferences when seeking care . OBJECTIVE To examine the impact of four factors ( patient gender , practitioner gender , practitioner specialty-chiropractor or physiotherapist and practitioner reputation-technical ability or interpersonal skills ) on patients ' choice of therapist to treat low back pain . METHODS Question naire-based vignette study in which participants sample d from the general population rated the likelihood of consulting eight fictional therapists . Each fictional therapist represented a different combination of the three practitioner factors ( e.g. male chiropractor with reputation for good technical ability ) . The study was administered as a postal  survey to a simple r and om sample of residences in one postal town in Engl and . RESULTS Respondents ( n = 657 ) consistently reported that they considered a practitioner 's qualifications and technical skills important when choosing either a physiotherapist or a chiropractor ; and just less than a third thought it was important that a practitioner was a good listener . As hypothesized , female respondents preferred female practitioners and respondents had a general preference for physiotherapists over chiropractors . Contrary to our hypothesis , the practitioner 's reputation had the largest effect on respondents ' preferences and all practitioners with a reputation for technical ability were preferred over those with a reputation for interpersonal skills . CONCLUSION Similar factors are important to patients whether they are choosing an individual chiropractor or physiotherapist ; patients particularly value information about technical competence . An awareness of these factors should help primary care providers to direct patients to relevant information and support their decision-making Flaws in the design , conduct , analysis , and reporting of r and omised trials can cause the effect of an intervention to be underestimated or overestimated . The Cochrane Collaboration ’s tool for assessing risk of bias aims to make the process clearer and more OBJECTIVE Patients ' affect and expectancies can set off placebo effects and thus impact patients ' health . We assessed the relative effects of physicians ' affect-oriented communication style and raising expectations on patients ' affective state and outcome expectancies . METHOD Thirty healthy women presented severe menstrual pain in a scripted consultation with a general practitioner ( GP ) . In a 2x2 r and omized controlled trial , the GP communicated in a warm , empathic or cold , formal way and raised positive or uncertain expectations . Effects on subjects ' state anxiety , affective state and outcome expectancies were assessed . RESULTS Only warm , empathic communication combined with positive expectations led to a significant and relevant decrease in state anxiety . Subjects ' positive and negative affects were influenced by GPs affect-oriented communication style . Negative affect and outcome expectancies are influenced by GP suggestions about outcomes . CONCLUSION Manipulations in physicians ' affect-oriented and expectancy-related communication can have a large impact on patients ' affective state and outcome expectations . A combination of a warm , empathic communication style and raising positive expectations result ed in optimal subject outcomes . PRACTICE IMPLICATION S Physicians should take into account that communicating in warm , empathic way combined with raising positive expectations seems to lead to the most favorable effects on patients ' state anxiety and outcome expectancies ABSTRACT Despite the evidence for the potential of supportive communication to alleviate physical pain , no study to date has assessed the impact of supportive nonverbal behavior on the objective and subjective experience of pain . This analogue study examined the impact of an actor-physician ’s supportive nonverbal behavior on experimentally induced pain . Participants ( N = 205 ) were r and omly assigned to interact with a videotaped physician conveying high or low supportive nonverbal behaviors . Participant pain was assessed with subjective and objective measures . Participants interacting with the high nonverbal support physicians showed increased pain tolerance and a reduction in the amount of pain expressed compared to those interacting with the low nonverbal support physicians . For subjectively rated pain , a gender difference existed such that for men , high physician nonverbal support decreased pain ratings and memory of pain , but for women , high physician nonverbal support increased pain ratings and memory of pain . These results highlight the importance of nonverbal communication in altering pain with broad implication s for clinical care Objective Ginger effects on ( experimental ) nausea have been described , but also strong placebo effects and sex differences when nausea is involved . The “ balanced placebo design ” has been proposed to allow better separation of drug and placebo effects . Methods Sixty-four healthy participants ( 32 women ) were r and omly assigned to receive an antiemetic ginger preparation or placebo , and half of each group was told to have received drug or placebo . They were exposed to 5 × 2 min body rotations to induce nausea . Subjective symptoms and behavioral ( rotation tolerance , head movements ) and physiological measures ( electrogastrogram , cortisol ) were recorded . Groups were balanced for sex of participants and experimenters . Results Ginger and the information given did not affect any outcome measure , and previous sex differences could not be confirmed . Adding the experimenters revealed a significant four-factorial interaction on behavioral but not on subjective or physiological measures Men who received placebo responded to placebo information when provided by the male experimenter , and to ginger information when provided by the female experimenter . This effect was not significant in women . Conclusion The effects of an antiemetic drug and provided information interact with psychosocial variables of participants and experimenters in reports of nausea A series of studies explored how sadness impacts the accuracy of social judgments . In Study 1 , induced sadness led to reduced accuracy in judgments of teacher effectiveness from brief sample s of nonverbal behavior ( thin slices ) . In Study 2 , sad participants showed reduced accuracy in judging relationship type from thin slices as well as diminished judgmental efficiency . Study 3 revealed that higher Beck Depression Inventory scores were associated with diminished accuracy on the Profile of Nonverbal Sensitivity . Finally , Study 4 tested the possibility that sadness impairs accuracy by promoting a more deliberative information-processing style . As expected , accuracy was higher among participants in a sad mood condition who completed the judgment task while simultaneously performing a distracting cognitive load task Common practice during local anesthetic injection is to warn the patient using words such as : “ You will feel a big bee sting ; this is the worst part . ” Our hypothesis was that using gentler words for administration of the local anesthetic improves pain perception and patient comfort .  One hundred forty healthy women at term gestation requesting neuraxial analgesia were r and omized to either a “ placebo ” ( “ We are going to give you a local anesthetic that will numb the area and you will be comfortable during the procedure ” ) or “ nocebo ” ( “ You are going to feel a big bee sting ; this is the worst part of the procedure ” ) group . Pain was assessed immediately after the local anesthetic skin injection using verbal analog scale scores of 0 to 10 . Median verbal analog scale pain scores were lower when reassuring words were used compared with the harsher nocebo words ( 3 [ 2–4 ] vs 5 [ 3–6 ] ; P < 0.001 ) . Our data suggest that using gentler , more reassuring words improves the subjective experience during invasive procedures Objective The purpose of this experimental study was to supplement and exp and on clinical research demonstrating that the provision of social support is associated with lower levels of acute pain . Methods Undergraduates ( 52 men and 49 women ) performed the cold pressor task either alone or accompanied by a friend or stranger who provided active support , passive support , or interaction .  Pain perception was measured on a 10-point scale . Results Participants in the active support and passive support conditions reported less pain than participants in the alone and interaction conditions , regardless of whether they were paired with a friend or stranger . Conclusions These data suggest that the presence of an individual who provides passive or active support reduces experimental pain ABSTRACT Communication , both verbal and nonverbal , between healthcare providers and patients has been shown to affect treatment outcomes in clinical setting s. Separately , accumulating research suggests a role for response expectations in altering treatment outcomes , especially in the context of inert or placebo treatment . However , few studies have examined which aspects of patient – provider communication strengthen expectations , leading to better treatment outcomes . The goal of this study is to test the effect of both verbal and nonverbal aspects of communication on response expectations and treatment outcomes in the context of a placebo exercise program . In a 2 × 2 between-subjects analogue study design , 89 healthy adults were r and omly assigned to interact with a trainer with either a warm or a neutral communication style . Each group also received from their trainer either basic or enhanced information about the placebo training program . Participants performed coordination and balance tests before and after the placebo training program , and expectations were assessed after the training but prior to the second series of tests . Participants in the warm condition had significantly higher expectations of treatment effects and reported more improvement in their performance . No such differences were found between the enhanced and basic information conditions . There were no significant effects of communication style or information on actual balance and coordination performance . These results shed light on the importance of nonverbal communication , especially facial expression and tone of voice , in strengthening expectations and increasing subjective improvement Objective To investigate whether placebo effects can experimentally be separated into the response to three components— assessment and observation , a therapeutic ritual ( placebo treatment ) , and a supportive patient-practitioner relationship— and then progressively combined to produce incremental clinical improvement in patients with irritable bowel syndrome . To assess the relative magnitude of these components . Design A six week single blind three arm r and omised controlled trial . Setting Academic medical centre . Participants 262 adults ( 76 % women ) , mean ( SD ) age 39 ( 14 ) , diagnosed by Rome II criteria for and with a score of ≥150 on the symptom severity scale . Interventions For three weeks either waiting list ( observation ) , placebo acupuncture alone ( “ limited ” ) , or placebo acupuncture with a patient-practitioner relationship augmented by warmth , attention , and confidence ( “ augmented ” ) . At three weeks , half of the patients were r and omly assigned to continue in their originally assigned group for an additional three weeks . Main outcome measures Global improvement scale ( range 1 - 7 ) , adequate relief of symptoms , symptom severity score , and quality of life . Results At three weeks , scores on the global improvement scale were 3.8 ( SD 1.0 ) v 4.3 ( SD 1.4 ) v 5.0 ( SD 1.3 ) for waiting list versus “ limited ” versus “ augmented , ” respectively ( P<0.001 for trend ) . The proportion of patients reporting adequate relief showed a similar pattern : 28 % on waiting list , 44 % in limited group , and 62 % in augmented group ( P<0.001 for trend ) . The same trend in response existed in symptom 
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Furthermore , higher confidence , competence , and professionalism of experimenters/clinicians result ed in lower pain report and higher placebo effects , whereas lower status of experimenters/clinicians such as lower confidence , competence , and professionalism generated higher reported pain and lower placebo effects .
Positive nonverbal behaviors ( e.g. , smiling , strong tone of voice , more eye contact , more leaning toward the patient/participant , and more body gestures ) contributed to lower reported pain and higher placebo effects , whereas negative nonverbal behaviors ( i.e. , no smile , monotonous tone of voice , no eye contact , leaning backward from the participant/patient , and no body gestures ) contributed to higher reported pain and nocebo effects .
Conclusion : Characteristics and nonverbal behaviors of experimenters/clinicians contribute to the elicitation and modulation of pain , placebo , and nocebo effects