Price Donald D, Finniss Damien G, Benedetti Fabrizio
Division of Neuroscience, Oral and Maxillofacial Surgery, University of Florida, Gainesville, Florida 32610-0416, USA.
Annu Rev Psychol. 2008;59:565-90. doi: 10.1146/annurev.psych.59.113006.095941.
Our understanding and conceptualization of the placebo effect has shifted in emphasis from a focus on the inert content of a physical placebo agent to the overall simulation of a therapeutic intervention. Research has identified many types of placebo responses driven by different mechanisms depending on the particular context wherein the placebo is given. Some placebo responses, such as analgesia, are initiated and maintained by expectations of symptom change and changes in motivation/emotions. Placebo factors have neurobiological underpinnings and actual effects on the brain and body. They are not just response biases. Other placebo responses result from less conscious processes, such as classical conditioning in the case of immune, hormonal, and respiratory functions. The demonstration of the involvement of placebo mechanisms in clinical trials and routine clinical practice has highlighted interesting considerations for clinical trial design and opened up opportunities for ethical enhancement of these mechanisms in clinical practice.
我们对安慰剂效应的理解和概念化已从关注物理安慰剂制剂的无活性成分，转向对治疗干预的整体模拟。研究发现，根据给予安慰剂的特定背景，有许多由不同机制驱动的安慰剂反应类型。一些安慰剂反应，如镇痛，是由对症状变化的期望以及动机/情绪的变化引发并维持的。安慰剂因素具有神经生物学基础，且对大脑和身体有实际影响。它们不仅仅是反应偏差。其他安慰剂反应则源于不太有意识的过程，例如在免疫、激素和呼吸功能方面的经典条件作用。安慰剂机制在临床试验和常规临床实践中的参与证明，突出了临床试验设计中有趣的考量因素，并为在临床实践中从伦理上增强这些机制创造了机会。
