School of Medicine, Department of Anesthesiology, Perioperative and Pain Medicine, Division of Pain Medicine, Psychiatry and Behavioral Sciences (by courtesy), Stanford University, Palo Alto, CA, United States.
Department of Pain Translational Symptom Science, School of Nursing, University of Maryland, Baltimore, MD, United States; Departments of Anesthesiology and Psychiatry, School of Medicine, University of Maryland, Baltimore, MD, United States; Center to Advance Chronic Pain Research, University of Maryland, Baltimore, MD, United States.
Int Rev Neurobiol. 2018;139:129-157. doi: 10.1016/bs.irn.2018.07.022. Epub 2018 Aug 6.
Pain, a noxious psychosensory experience, motivates escape behavior to assure protection and survival. Psychological factors alter the experience and trajectory of pain, as well as behavior and treatment response. In the context of pain, the placebo effect (expectation for pain relief) releases endogenous opioids and facilitates analgesia from exogenously administered opioids. Nocebo hyperalgesia (expectation for persistent or worsening pain) opposes endogenous opioid analgesia and patient engagement in prescription opioid tapering. Reductions in nocebo hyperalgesia and pain catastrophizing may enhance descending modulation of pain, mediate adaptive structural brain changes and promote patient engagement in opioid tapering. Interventions that minimize nocebo and optimize placebo may adaptively shape the central nervous system toward pain relief and potentially opioid reduction. Here we provide a critical description of catastrophizing and its impact on pain, placebo and nocebo effects. We also consider the importance of minimizing nocebo and optimizing placebo effects during prescription opioid tapering, and offer a clinical toolkit of resources to accomplish these goals clinically.
疼痛是一种有害的知觉体验，它会激发逃避行为，以确保身体的安全和生存。心理因素会改变疼痛的体验和轨迹，以及行为和治疗反应。在疼痛的背景下，安慰剂效应（对疼痛缓解的期望）会释放内源性阿片类物质，并促进外源性阿片类药物的镇痛作用。而反安慰剂效应（对持续或恶化的疼痛的预期）则会抑制内源性阿片类物质的镇痛作用，并使患者参与处方类阿片类药物的逐渐减少。减少反安慰剂效应和疼痛灾难化可能会增强下行性疼痛调制，介导适应性的大脑结构变化，并促进患者参与阿片类药物的逐渐减少。最小化反安慰剂和最大化安慰剂的干预措施可能会使中枢神经系统适应疼痛缓解，并可能减少阿片类药物的使用。在这里，我们对灾难化及其对疼痛、安慰剂和反安慰剂效应的影响进行了批判性描述。我们还考虑了在处方类阿片类药物逐渐减少期间最小化反安慰剂和最大化安慰剂效应的重要性，并提供了一套临床资源工具包，以在临床上实现这些目标。
