慢性疼痛患者的治疗史以及对实验性和临床疼痛的安慰剂反应。

Treatment history and placebo responses to experimental and clinical pain in chronic pain patients.

作者信息

Müller M, Kamping S, Benrath J, Skowronek H, Schmitz J, Klinger R, Flor H

机构信息

Department of Cognitive and Clinical Neuroscience, Central Institute of Mental Health, Medical Faculty Mannheim, Heidelberg University, Germany.

Department of Anesthesiology, Center of Pain Therapy, University Medical Center Mannheim, Medical Faculty Mannheim, Heidelberg University, Germany.

出版信息

Eur J Pain. 2016 Oct;20(9):1530-41. doi: 10.1002/ejp.877. Epub 2016 Apr 7.

DOI:10.1002/ejp.877

PMID:27062187

Abstract

BACKGROUND

Placebo analgesia refers to the reduction in pain due to the administration of an inert treatment. It is induced by expectations of pain relief which are enhanced by learning mechanisms. In healthy humans, prior positive experiences enhance the placebo response. However, the effects of patients' prior experiences with treatment on placebo responses have not yet been examined. This study investigated how verbal information, learning and treatment history influence the magnitude of placebo analgesia in chronic pain.

METHODS

We administered a pharmacological placebo intervention in a sample of chronic pain patients (n = 49) who were seeking treatment in an outpatient pain clinic. Analyses were based on placebo responders.

RESULTS

We found that verbal information about a potent pain-relieving effect of the intervention induced a large placebo analgesic response to both acute experimental (F(1,44) = 43.35, p < 0.001) and chronic pain (F(1,44) = 37.72, p < 0.001). However, the placebo responses to experimental and chronic pain were not significantly related (r = 0.012, p = 0.95). An additional conditioning procedure did not significantly enhance placebo analgesia. Treatment history modulated the magnitude of the placebo response: patients with a more negative pain-related treatment history reported significantly larger placebo responses to their own chronic pain (τ = 0.271, p = 0.044).

CONCLUSIONS

We could show that placebo responses to both acute and chronic pain are high in pain treatment settings and that treatment history modulates this effect. Different mechanisms might underlie placebo responses to acute and chronic pain. Our findings highlight the necessity of considering placebo responses and treatment history in the treatment of chronic pain. WHAT DOES THIS STUDY ADD?: Placebo analgesia following verbal information of potent pain relief is high in chronic pain patients in a clinical setting. It is modulated by treatment history. Different mechanisms might underlie placebo analgesia to acute and chronic pain.

摘要

背景

安慰剂镇痛是指因给予惰性治疗而导致的疼痛减轻。它由对疼痛缓解的期望所诱发，这种期望通过学习机制得到增强。在健康人群中，先前的积极体验会增强安慰剂反应。然而，患者先前的治疗经历对安慰剂反应的影响尚未得到研究。本研究调查了言语信息、学习和治疗史如何影响慢性疼痛中安慰剂镇痛的程度。

方法

我们对在门诊疼痛诊所寻求治疗的慢性疼痛患者样本（n = 49）进行了药理学安慰剂干预。分析基于安慰剂反应者。

结果

我们发现，关于干预具有强效止痛效果的言语信息对急性实验性疼痛（F(1,44) = 43.35，p < 0.001）和慢性疼痛（F(1,44) = 37.72，p < 0.001）均诱发了较大的安慰剂镇痛反应。然而，对实验性疼痛和慢性疼痛的安慰剂反应并无显著相关性（r = 0.012，p = 0.95）。额外的条件作用程序并未显著增强安慰剂镇痛效果。治疗史调节了安慰剂反应的程度：与疼痛相关治疗史更消极的患者对自身慢性疼痛的安慰剂反应显著更大（τ = 0.271，p = 0.044）。

结论

我们能够表明，在疼痛治疗环境中，对急性和慢性疼痛的安慰剂反应都很高，且治疗史会调节这种效应。对急性和慢性疼痛的安慰剂反应可能存在不同机制。我们的研究结果凸显了在慢性疼痛治疗中考虑安慰剂反应和治疗史的必要性。本研究的新增内容是什么？：在临床环境中，慢性疼痛患者在获得强效止痛的言语信息后，安慰剂镇痛效果显著。它受到治疗史的调节。对急性和慢性疼痛的安慰剂镇痛可能存在不同机制。