Benedetti Fabrizio
Department of Neuroscience, University of Turin Medical School, Turin, Italy.
J Acupunct Meridian Stud. 2012 Jun;5(3):97-103. doi: 10.1016/j.jams.2012.03.001. Epub 2012 Apr 10.
The placebo effect has evolved from being thought of as a nuisance in clinical research to a biological phenomenon worthy of scientific investigation. The study of the placebo effect and of its evil twin, the nocebo effect, is basically the study of the therapeutic ritual around the patient, and it plays a crucial role in the therapeutic outcome. In recent years, different types of placebo responses have been analyzed with sophisticated biological tools that have uncovered specific mechanisms at the neuroanatomical, neurophysiological, biochemical, and cellular levels. Most of our knowledge about the neurobiological mechanisms of the placebo response comes from pain and Parkinson's disease, whereby the neuronal networks involved in placebo responsiveness have been identified. In the first case, opioid, cannabinoid, and cholecystokinin circuits have been found to be involved. In the second case, dopaminergic activation in the striatum and neuronal changes in basal ganglia have been described. This recent research has revealed that these placebo-induced biochemical and cellular changes in a patient's brain are very similar to those induced by drugs. This new way of thinking may have profound implications in clinical trials and medical practice both for pharmacological interventions and for nonpharmacological treatments such as acupuncture.
安慰剂效应已从在临床研究中被视为一种干扰因素，演变成一种值得科学研究的生物学现象。对安慰剂效应及其“邪恶双胞胎”——反安慰剂效应的研究，本质上是对围绕患者的治疗仪式的研究，它在治疗结果中起着至关重要的作用。近年来，人们使用先进的生物学工具分析了不同类型的安慰剂反应，这些工具在神经解剖学、神经生理学、生物化学和细胞水平上揭示了特定机制。我们对安慰剂反应神经生物学机制的大部分了解来自疼痛和帕金森病的研究，由此确定了参与安慰剂反应的神经网络。在第一种情况中，发现阿片类、大麻素和胆囊收缩素回路参与其中。在第二种情况中，描述了纹状体中的多巴胺能激活和基底神经节中的神经元变化。最近的这项研究表明，患者大脑中这些由安慰剂引起的生化和细胞变化与药物引起的变化非常相似。这种新的思维方式可能会对临床试验和医学实践产生深远影响，无论是对于药物干预还是针灸等非药物治疗。
