Parkinson's Disease and Movement Disorders Center, Division of Neurology, Department of Medicine, The Ottawa Hospital Research Institute, University of Ottawa Brain and Mind Institute, Ottawa, Ontario, Canada.
Division of Neurology, Department of Medicine, The Ottawa Hospital Research Institute, University of Ottawa Brain and Mind Institute, Ottawa, Ontario, Canada.
Mov Disord. 2018 Aug;33(8):1195-1203. doi: 10.1002/mds.27409. Epub 2018 Aug 25.
The placebo effect alongside the detrimental nocebo and lessebo effects associated with the use of placebos are well-recognized phenomena. Research conducted in the last two decades has demonstrated that the placebo effect is a measurable health benefit with well-known neurobiological correlates. In this review, we describe the current knowledge about how to best make use of the placebo effect to improve clinical research and optimize clinical care. We will cover four key topics: (1) setting the stage: historical perspectives on the use of placebos; (2) optimizing the use of placebos in clinical trials; (3) use of placebos in clinical practice; and (4) how can we minimize the ethical risks of using placebos? The adoption of the placebo-controlled trial as a standard in the therapeutic development reduced the placebo effect to background noise in a therapeutic signal. Strategies to minimize the placebo effect in clinical trials have been used to obtain positive efficacy results. In more recent years, new study paradigms encouraged a change in the views on placebos and the placebo effect. Alternative study designs and the development of biomarkers for a placebo response permit a better understanding of the contribution of the placebo effect to the results of interventional studies, without minimizing it. In clinical practice, optimizing the placebo effect (and reducing nocebo effects) has the potential to improve care for our patients, but raises ethical challenges. An enhanced patient-physician relationship would be central to any evidence-based intervention used in clinical care to heighten the placebo effect. © 2018 International Parkinson and Movement Disorder Society.
安慰剂效应以及与安慰剂使用相关的有害反安慰剂和低安慰效应是众所周知的现象。过去二十年的研究表明，安慰剂效应是一种可衡量的健康益处，具有已知的神经生物学相关性。在这篇综述中，我们描述了如何最好地利用安慰剂效应来改善临床研究和优化临床护理的现有知识。我们将涵盖四个关键主题：（1）背景：安慰剂使用的历史观点；（2）优化临床试验中安慰剂的使用；（3）安慰剂在临床实践中的应用；以及（4）如何将使用安慰剂的伦理风险最小化？安慰剂对照试验作为治疗开发的标准的采用将安慰剂效应降低为治疗信号中的背景噪音。在临床试验中最小化安慰剂效应的策略已被用于获得积极的疗效结果。近年来，新的研究范式鼓励改变对安慰剂和安慰剂效应的看法。替代研究设计和安慰剂反应的生物标志物的开发允许更好地了解安慰剂效应对干预研究结果的贡献，而不会将其最小化。在临床实践中，优化安慰剂效应（并减少反安慰剂效应）有可能改善我们患者的护理，但也带来了伦理挑战。增强医患关系将是任何基于证据的干预措施在临床护理中提高安慰剂效应的核心。©2018 国际帕金森病和运动障碍协会。
