Department of Psychology and Neuroscience, University of Colorado, 345 UCB, Boulder, CO 80309, USA.
Department of Psychology and Neuroscience, University of Colorado, 345 UCB, Boulder, CO 80309, USA; Institute of Cognitive Science, University of Colorado Boulder, 344 UCB, Boulder, CO 80309, USA; Department of Biostatistics, Johns Hopkins University, 615 N Wolfe St, Baltimore, MD 21205, USA.
Prog Neurobiol. 2018 Jan;160:101-122. doi: 10.1016/j.pneurobio.2017.10.008. Epub 2017 Nov 3.
Placebo treatments are pharmacologically inert, but are known to alleviate symptoms across a variety of clinical conditions. Associative learning and cognitive expectations both play important roles in placebo responses, however we are just beginning to understand how interactions between these processes lead to powerful effects. Here, we review the psychological principles underlying placebo effects and our current understanding of their brain bases, focusing on studies demonstrating both the importance of cognitive expectations and those that demonstrate expectancy-independent associative learning. To account for both forms of placebo analgesia, we propose a dual-process model in which flexible, contextually driven cognitive schemas and attributions guide associative learning processes that produce stable, long-term placebo effects. According to this model, the placebo-induction paradigms with the most powerful effects are those that combine reinforcement (e.g., the experience of reduced pain after placebo treatment) with suggestions and context cues that disambiguate learning by attributing perceived benefit to the placebo. Using this model as a conceptual scaffold, we review and compare neurobiological systems identified in both human studies of placebo analgesia and behavioral pain modulation in rodents. We identify substantial overlap between the circuits involved in human placebo analgesia and those that mediate multiple forms of context-based modulation of pain behavior in rodents, including forebrain-brainstem pathways and opioid and cannabinoid systems in particular. This overlap suggests that placebo effects are part of a set of adaptive mechanisms for shaping nociceptive signaling based on its information value and anticipated optimal response in a given behavioral context.
安慰剂治疗在药理学上是无效的,但已知可缓解多种临床病症的症状。联想学习和认知期望在安慰剂反应中都起着重要作用,但我们才刚刚开始了解这些过程之间的相互作用如何产生强大的效果。在这里,我们回顾了安慰剂效应的心理原理以及我们目前对其大脑基础的理解,重点介绍了既证明认知期望重要性又证明期望独立联想学习的研究。为了说明两种形式的安慰剂镇痛,我们提出了一个双过程模型,其中灵活的、由情境驱动的认知图式和归因指导产生稳定的、长期的安慰剂效应的联想学习过程。根据该模型,具有最强效果的安慰剂诱导范式是那些将强化(例如,安慰剂治疗后疼痛减轻的体验)与暗示和情境线索相结合的范式,这些暗示和情境线索通过将感知到的益处归因于安慰剂来明确学习。我们使用这个模型作为概念支架,回顾并比较了人类安慰剂镇痛研究和啮齿动物行为性疼痛调节中确定的神经生物学系统。我们发现,人类安慰剂镇痛涉及的回路与调节啮齿动物多种形式基于情境的疼痛行为的回路之间存在大量重叠,包括大脑前脑-脑干通路以及特别的阿片类和大麻素系统。这种重叠表明,安慰剂效应是基于特定行为情境中的信息价值和预期最佳反应来塑造伤害性信号的一组适应性机制的一部分。
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