De La Fuente-Fernández Raúl, Stoessl A Jon
Pacific Parkinson's Research Centre, University of British Columbia.
Eval Health Prof. 2002 Dec;25(4):387-98. doi: 10.1177/0163278702238052.
The authors propose that the placebo effect is mediated by reward-related mechanisms. Recent evidence suggests that it is the expectation of reward (in this case, the expectation of clinical benefit) that triggers the placebo response. In Parkinson's disease, the placebo effect is mediated by the release of dopamine in the striatum. The authors argue that placebo-induced dopamine release in limbic structures, particularly in the nucleus accumbens, could also be a major biochemical substrate for the placebo effect encountered in other medical disorders. Other neuroactive substances involved in the reward circuitry (e.g., opioids) are also likely to contribute to the placebo response, and such contribution may be disorder specific (e.g., opioid release in placebo analgesia; serotonin regulation in response to placebo antidepressants). In addition, placebos may have a role in substitution programs for the treatment of drug addiction.
作者们提出，安慰剂效应是由与奖励相关的机制介导的。最近的证据表明，正是对奖励的期望（在这种情况下，是对临床益处的期望）引发了安慰剂反应。在帕金森病中，安慰剂效应是由纹状体中多巴胺的释放介导的。作者们认为，安慰剂诱导的边缘结构尤其是伏隔核中的多巴胺释放，也可能是其他医学疾病中所遇到的安慰剂效应的主要生化基础。参与奖励回路的其他神经活性物质（如阿片类物质）也可能对安慰剂反应有贡献，而且这种贡献可能因疾病而异（例如，安慰剂镇痛中的阿片类物质释放；对安慰剂抗抑郁药反应中的血清素调节）。此外，安慰剂在药物成瘾治疗的替代方案中可能有作用。
