Department of Neurology, Pitié-Salpêtrière Hospital, Sorbonne University, Assistance Publique Hôpitaux de Paris, Brain and Spine Institute, ICM, Inserm U 1127, CNRS UMR 7225, Paris, France.
Department of Neurology, Pitié-Salpêtrière Hospital, Sorbonne University, Assistance Publique Hôpitaux de Paris, Brain and Spine Institute, ICM, Inserm U 1127, CNRS UMR 7225, Paris, France.
Int Rev Neurobiol. 2020;153:71-101. doi: 10.1016/bs.irn.2020.04.003. Epub 2020 Jun 9.
The placebo effect is a widely recognized phenomenon in clinical research, with a negative perception that it could hide the "true" drug effect. In clinical care its positive potential to increase known drug effects has been neglected for too long. The placebo and nocebo responses have been described in many neurologic disorders such as Parkinson's, Huntington's and Alzheimer's diseases, restless leg syndrome, tics, essential tremor, dystonia, functional movement disorders, neuropathic pain, headaches, migraine, amyotrophic lateral sclerosis, myasthenia gravis, chronic inflammatory demyelinating polyneuropathy, multiple sclerosis and epilepsy. Knowledge regarding placebo mechanisms and their consequences on clinical outcome have greatly improved over the last two decades. This evolution has led to reconsiderations of the importance of placebo response in the clinic and has given several clues on how to improve it in daily practice. In this chapter, we first illustrate "why," e.g. the reasons (relevance to clinical practice, help in differential diagnosis/treatment of psychogenic movements, clinical impact, proven neurobiological grounds, health economic potential), and "how," e.g. the means (increase patients' knowledge, increase learning, improve patient-doctor relationship, increase Hawthorne effect, increase positive/decrease negative expectations (the Rosenthal effect), personalize placebo response), the placebo should be maximized (and nocebo avoided) in neurological clinical practice. Future studies regarding more specific neurobiological mechanisms will allow a finer tuning of placebo response in clinical practice. The use of placebo in clinical practice raises ethical issues, and a recent expert consensus regarding placebo use in the clinic is a first step to future guidelines necessary to this field.
安慰剂效应是临床研究中广泛认可的现象，人们普遍认为它可能掩盖了“真正”的药物作用，因此长期以来一直忽视了其在临床治疗中增强已知药物作用的积极潜力。在许多神经疾病中，如帕金森病、亨廷顿病和阿尔茨海默病、不宁腿综合征、抽搐、特发性震颤、肌张力障碍、功能性运动障碍、神经病理性疼痛、头痛、偏头痛、肌萎缩侧索硬化症、重症肌无力、慢性炎症性脱髓鞘性多发性神经病、多发性硬化症和癫痫中，都描述了安慰剂和反安慰剂反应。在过去的二十年中，人们对安慰剂机制及其对临床结果的影响的认识有了很大的提高。这种演变促使人们重新考虑安慰剂反应在临床中的重要性，并为如何在日常实践中改善它提供了一些线索。在这一章中，我们首先说明“为什么”，例如原因（与临床实践相关、有助于鉴别诊断/治疗心因性运动、临床影响、已证实的神经生物学依据、健康经济潜力），以及“如何”，例如方法（增加患者的知识、增加学习、改善医患关系、增加霍桑效应、增加积极/减少消极预期（罗森塔尔效应）、个性化安慰剂反应），在神经科临床实践中应最大限度地利用安慰剂（并避免反安慰剂）。未来关于更具体神经生物学机制的研究将使我们能够在临床实践中更精细地调整安慰剂反应。安慰剂在临床实践中的应用引发了伦理问题，最近关于临床中安慰剂使用的专家共识是制定该领域未来指南的第一步。
