Department of Pain and Translational Symptom Science, School of Nursing; Department of Anesthesiology, School of Medicine; and Center to Advance Chronic Pain Research, University of Maryland, Baltimore, Maryland 21201, USA; email:
Annu Rev Pharmacol Toxicol. 2019 Jan 6;59:191-211. doi: 10.1146/annurev-pharmtox-010818-021542. Epub 2018 Sep 14.
Pharmacological strategies for pain management have primarily focused on dampening ascending neurotransmission and on opioid receptor-mediated therapies. Little is known about the contribution of endogenous descending modulatory systems to clinical pain outcomes and why some patients are mildly affected while others suffer debilitating pain-induced dysfunctions. Placebo effects that arise from patients' positive expectancies and the underlying endogenous modulatory mechanisms may in part account for the variability in pain experience and severity, adherence to treatment, distinct coping strategies, and chronicity. Expectancy-induced analgesia and placebo effects in general have emerged as useful models to assess individual endogenous pain modulatory systems. Different systems and mechanisms trigger placebo effects that highly impact pain processing, clinical outcomes, and sense of well-being. This review illustrates critical elements of placebo mechanisms that inform the methodology of clinical trials, the discovery of new therapeutic targets, and the advancement of personalized pain management.
疼痛管理的药理学策略主要集中在抑制上行神经传递和阿片受体介导的治疗上。对于内源性下行调节系统对临床疼痛结果的贡献以及为什么有些患者受影响较轻，而有些患者则患有衰弱性疼痛相关功能障碍知之甚少。患者的积极期望和潜在的内源性调节机制产生的安慰剂效应可能部分解释了疼痛体验和严重程度、治疗依从性、不同的应对策略和慢性疼痛的变异性。期望引起的镇痛和一般的安慰剂效应已经成为评估个体内源性疼痛调节系统的有用模型。不同的系统和机制引发的安慰剂效应对疼痛处理、临床结果和幸福感有很大的影响。本综述说明了安慰剂机制的关键要素，这些要素为临床试验的方法学、新治疗靶点的发现以及个性化疼痛管理的进展提供了信息。
