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[安慰剂镇痛的神经生物学和神经化学机制]

[Neurobiological and neurochemical mechanisms of placebo analgesia].

作者信息

Asan Livia, Bingel Ulrike, Kunkel Angelika

机构信息

Klinik für Neurologie und Center for Translational Neuro- and Behavioral Sciences (C-TNBS), Unversitätsmedizin Essen, Hufelandstraße 55, 45147, Essen, Deutschland.

出版信息

Schmerz. 2022 Jun;36(3):205-212. doi: 10.1007/s00482-022-00630-4. Epub 2022 Mar 17.

DOI:10.1007/s00482-022-00630-4
PMID:35301592
原文链接:https://pmc.ncbi.nlm.nih.gov/articles/PMC9156503/
Abstract

BACKGROUND

The efficacy of pain therapies can be substantially modulated by treatment expectations, which is reflected by the substantial placebo effects observed in pain (so called placebo analgesia).

QUESTION

What is currently known about the neurobiological and neurochemical mechanisms underlying placebo analgesia?

MATERIALS AND METHODS

A focused presentation of key publications in the field embedded in a structured overview of the mechanistic concepts and current theories according to recent evidence.

RESULTS

Experimental studies with functional neuroimaging showed that the effect of placebo analgesia is reflected by changes in brain activity related to pain processing and cognitive control. The important neurotransmitters involved include opioids and dopamine.

CONCLUSION

Placebo analgesia is associated with complex neurobiological and -physiological mechanisms. An advanced comprehension of these processes should be applied to optimize existing and future therapeutic approaches in pain therapy.

摘要

背景

疼痛治疗的疗效会受到治疗预期的显著调节，这在疼痛中观察到的显著安慰剂效应（即所谓的安慰剂镇痛）中得到体现。

问题

目前关于安慰剂镇痛背后的神经生物学和神经化学机制有哪些了解？

材料与方法

根据最新证据，对该领域的关键出版物进行重点介绍，并融入机制概念和当前理论的结构化概述。

结果

功能性神经成像的实验研究表明，安慰剂镇痛的效果通过与疼痛处理和认知控制相关的大脑活动变化得以体现。涉及的重要神经递质包括阿片类物质和多巴胺。

结论

安慰剂镇痛与复杂的神经生物学和生理机制相关。对这些过程的深入理解应用于优化现有和未来的疼痛治疗方法。

https://cdn.ncbi.nlm.nih.gov/pmc/blobs/3935/9156503/4e79543ac47b/482_2022_630_Fig4_HTML.jpg
https://cdn.ncbi.nlm.nih.gov/pmc/blobs/3935/9156503/cac5b38202c0/482_2022_630_Fig1_HTML.jpg
https://cdn.ncbi.nlm.nih.gov/pmc/blobs/3935/9156503/c22aca720d3d/482_2022_630_Fig2_HTML.jpg
https://cdn.ncbi.nlm.nih.gov/pmc/blobs/3935/9156503/996cdad5f5ad/482_2022_630_Fig3_HTML.jpg
https://cdn.ncbi.nlm.nih.gov/pmc/blobs/3935/9156503/4e79543ac47b/482_2022_630_Fig4_HTML.jpg
https://cdn.ncbi.nlm.nih.gov/pmc/blobs/3935/9156503/cac5b38202c0/482_2022_630_Fig1_HTML.jpg
https://cdn.ncbi.nlm.nih.gov/pmc/blobs/3935/9156503/c22aca720d3d/482_2022_630_Fig2_HTML.jpg
https://cdn.ncbi.nlm.nih.gov/pmc/blobs/3935/9156503/996cdad5f5ad/482_2022_630_Fig3_HTML.jpg
https://cdn.ncbi.nlm.nih.gov/pmc/blobs/3935/9156503/4e79543ac47b/482_2022_630_Fig4_HTML.jpg

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本文引用的文献

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Manipulating placebo analgesia and nocebo hyperalgesia by changing brain excitability.通过改变大脑兴奋性来操纵安慰剂镇痛和反安慰剂痛觉过敏。
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Placebo effect in the management of chronic pain.安慰剂效应在慢性疼痛管理中的作用
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Pain Rep. 2020 Jul 20;5(4):e828. doi: 10.1097/PR9.0000000000000828. eCollection 2020 Jul-Aug.
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Positive Treatment Expectancies Reduce Clinical Pain and Perceived Limitations in Movement Ability Despite Increased Experimental Pain: A Randomized Controlled Trial on Sham Opioid Infusion in Patients with Chronic Back Pain.积极的治疗预期可减轻慢性腰痛患者接受模拟阿片输注时的临床疼痛和运动能力受限的感知，尽管实验性疼痛增加：一项随机对照试验。
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Dopaminergic tone does not influence pain levels during placebo interventions in patients with chronic neuropathic pain.多巴胺能活动对慢性神经性疼痛患者安慰剂干预期间的疼痛水平没有影响。
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