Klinger Regine, Flor Herta
Outpatient Clinic of Behavior Therapy, Department of Psychology, University of Hamburg, Hamburg, Germany,
Handb Exp Pharmacol. 2014;225:217-35. doi: 10.1007/978-3-662-44519-8_13.
Expectancy and learning are the core psychological mechanisms of placebo analgesia. They interact with further psychological processes such as emotions and motivations (e.g., anxiety, desire for relief), somatic focus, or cognitions (e.g., attitudes toward the treatment). The development of placebo responsiveness and the actual placebo response in a person is the result of the complex interaction between factors traced back to the individual learning history related to analgesic drugs or treatments and factors of the current context referring to the analgesic or placebo treatment. The aim of this chapter is to depict these complex interactions in a new model of analgesic placebo effects. It joins aspects of the learning history (preexisting experiences and preexisting expectations) of a patient with aspects of the current context (current expectation as a result of external and internal situation in which a pain medication/treatment/placebo is taken, e.g., current information about pain medication, current specific context/cues, desire for pain relief, certainty about upcoming pain relief, current expectation about pain reducing course, current selective attention, increased pain experience, or decreased pain experience). In order to exploit placebo efficacy for an analgesic treatment it is worthwhile to assess in which direction each of these factors exerts its influence in order to maximize placebo effects for a specific patient. By applying placebo mechanisms in this differentiated way, the efficacy of pain treatment can be deliberately boosted.
预期和学习是安慰剂镇痛的核心心理机制。它们与进一步的心理过程相互作用，如情绪和动机（如焦虑、缓解欲望）、躯体关注或认知（如对治疗的态度）。个体安慰剂反应性的发展以及实际的安慰剂反应是多种因素复杂相互作用的结果，这些因素一方面可追溯到与镇痛药或治疗相关的个体学习史，另一方面涉及当前与镇痛或安慰剂治疗相关的情境因素。本章的目的是在一个镇痛安慰剂效应的新模型中描述这些复杂的相互作用。它将患者的学习史（既往经验和既往预期）方面与当前情境（服用止痛药物/治疗/安慰剂时由于外部和内部情况而产生的当前预期，例如关于止痛药物的当前信息、当前特定情境/线索、缓解疼痛的欲望、对即将到来的疼痛缓解的确定性、对疼痛减轻过程的当前预期、当前的选择性注意、疼痛体验增加或疼痛体验减少）方面结合起来。为了在镇痛治疗中利用安慰剂效应，评估这些因素各自在哪个方向上发挥作用是很有价值的，以便为特定患者最大化安慰剂效应。通过以这种有差别的方式应用安慰剂机制，可以有意提高疼痛治疗的疗效。
