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Results were summarised through narrative synthesis, tables, 95% CI.<\/jats:p><\/jats:sec><jats:sec><jats:title>Outcome measures<\/jats:title><jats:p>Mechanisms underlying placebo\/nocebo effects and\/or their effect sizes.<\/jats:p><\/jats:sec><jats:sec><jats:title>Results<\/jats:title><jats:p>The databases search identified 372 studies, for a total of 158\u2009312 participants, comprising 41 systematic reviews, 312 narrative reviews and 19 original articles. Seventy-three per cent of the examined systematic reviews were of high quality.<\/jats:p><jats:p>Our findings revealed that mechanisms underlying placebo and\/or nocebo effects have been characterised, at least in part, for: pain, non-noxious somatic sensation, Parkinson\u2019s disease, migraine, sleep disorders, intellectual disability, depression, anxiety, dementia, addiction, gynaecological disorders, attention-deficit hyperactivity disorder, immune and endocrine systems, cardiovascular and respiratory systems, gastrointestinal disorders, skin diseases, influenza and related vaccines, oncology, obesity, physical and cognitive performance. Their magnitude ranged from 0.08 to 2.01 (95% CI 0.37 to 0.89) for placebo effects and from 0.32 to 0.90 (95% CI 0.24 to 1.00) for nocebo effects.<\/jats:p><\/jats:sec><jats:sec><jats:title>Conclusions<\/jats:title><jats:p>This study provides a valuable tool for clinicians and researchers, identifying both results ready for clinical practice and gaps to address in the near future.<\/jats:p><\/jats:sec><jats:sec><jats:title>Funding<\/jats:title><jats:p>Universit\u00e0 Cattolica del Sacro Cuore, Milan, Italy with the \u2018Finanziamento Ponte 2022\u2019 grant.<\/jats:p><\/jats:sec><jats:sec><jats:title>PROSPERO registration number<\/jats:title><jats:p>CRD42023392281.<\/jats:p><\/jats:sec>","DOI":"10.1136\/bmjopen-2023-077243","type":"journal-article","created":{"date-parts":[[2023,10,17]],"date-time":"2023-10-17T15:57:10Z","timestamp":1697558230000},"page":"e077243","update-policy":"https:\/\/doi.org\/10.1136\/crossmarkpolicy","source":"Crossref","is-referenced-by-count":46,"title":["Placebo and nocebo effects and mechanisms associated with pharmacological interventions: an umbrella review"],"prefix":"10.1136","volume":"13","author":[{"ORCID":"https:\/\/orcid.org\/0000-0002-3783-1997","authenticated-orcid":false,"given":"Elisa","family":"Frisaldi","sequence":"first","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-9828-0861","authenticated-orcid":false,"given":"Aziz","family":"Shaibani","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-4057-1150","authenticated-orcid":false,"given":"Fabrizio","family":"Benedetti","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-1612-4211","authenticated-orcid":false,"given":"Francesco","family":"Pagnini","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"239","published-online":{"date-parts":[[2023,10,17]]},"reference":[{"key":"2023101708551963000_13.10.e077243.1","doi-asserted-by":"publisher","DOI":"10.1016\/j.neuron.2014.10.023"},{"key":"2023101708551963000_13.10.e077243.2","doi-asserted-by":"publisher","DOI":"10.1016\/S0140-6736(09)61706-2"},{"key":"2023101708551963000_13.10.e077243.3","doi-asserted-by":"publisher","DOI":"10.1056\/NEJMra1907805"},{"key":"2023101708551963000_13.10.e077243.4","doi-asserted-by":"publisher","DOI":"10.1152\/physrev.00043.2012"},{"key":"2023101708551963000_13.10.e077243.5","doi-asserted-by":"crossref","first-page":"227","DOI":"10.1002\/wps.20627","article-title":"The need to investigate Nocebo effects in more detail","volume":"18","author":"Benedetti","year":"2019","journal-title":"World Psychiatry"},{"key":"2023101708551963000_13.10.e077243.6","doi-asserted-by":"publisher","DOI":"10.1146\/annurev-pharmtox-052120-104536"},{"key":"2023101708551963000_13.10.e077243.7","doi-asserted-by":"publisher","DOI":"10.1159\/000490354"},{"key":"2023101708551963000_13.10.e077243.8","doi-asserted-by":"publisher","DOI":"10.1146\/annurev.pharmtox.48.113006.094711"},{"key":"2023101708551963000_13.10.e077243.9","doi-asserted-by":"publisher","DOI":"10.1016\/S1474-4422(16)00066-1"},{"key":"2023101708551963000_13.10.e077243.10","doi-asserted-by":"crossref","unstructured":"Weimer K , Buschhart C , Broelz EK , et al . 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