School of Psychology, University of New South Wales, Sydney, NSW, Australia.
Department of Psychology and Neuroscience, La Sierra University, Riverside, CA, United States.
Int Rev Neurobiol. 2018;139:379-406. doi: 10.1016/bs.irn.2018.07.016. Epub 2018 Aug 6.
Nocebo effects comprise two broad types: primary nocebo effects, in which overall treatment efficacy is reduced; and nocebo side effects, which result in the increased experience of unpleasant secondary side effects. An important factor in generating nocebo effects of both types is the patient's expectations of how well a treatment will work, and how likely it is to cause side effects. One source of negative expectations is the presence of generic-as opposed to brand name-labeling. A medicine's labeling is likely to be one of the first aspects of a treatment that is encountered by a patient, and perhaps the most common labeling information on pharmaceuticals is the labeling that identifies the drug as being made by the originator brand manufacturer, or as a generic copy. Although generic medicines are pharmaceutically equivalent to their brand name counterparts, generics are often viewed with distrust and perceived to be inferior to branded medicines. Negative perceptions of generic pharmaceuticals may contribute to reduced treatment efficacy via enhanced primary nocebo effects, and increased nocebo side effects. This chapter reviews evidence for the role of brand and generic labeling in treatment outcomes across a range of contexts-most often laboratory research assessing pain outcomes, as well as the influence of related factors including price, familiarity, and treatment switches. Although increasing evidence suggests that labeling of medicines can shape nocebo effects, interventions to improve perceptions of generics do not necessarily translate into more positive treatment outcomes.
原发性反安慰剂效应，其中整体治疗效果降低；以及反安慰剂副作用，导致不愉快的二次副作用增加。产生这两种反安慰剂效应的一个重要因素是患者对治疗效果的预期，以及它引起副作用的可能性。负面预期的一个来源是通用标签，而不是品牌标签。药品的标签很可能是患者首先遇到的治疗方法的一个方面，也许药品最常见的标签信息是将药物标识为原始品牌制造商制造的药物，或者是通用的仿制药。虽然仿制药在药物学上与品牌名称的药物等效，但仿制药往往受到不信任，被认为不如品牌药物。对仿制药的负面看法可能会通过增强原发性反安慰剂效应和增加反安慰剂副作用，从而导致治疗效果降低。这一章回顾了品牌和通用标签在一系列背景下的治疗效果中的作用的证据——最常见的是评估疼痛结果的实验室研究，以及相关因素的影响，包括价格、熟悉度和治疗转换。尽管越来越多的证据表明药物标签可以塑造反安慰剂效应，但改善对仿制药看法的干预措施并不一定转化为更积极的治疗效果。
