安慰剂的奖励:安慰剂对运动表现影响的潜在机制。

The reward for placebos: mechanisms underpinning placebo-induced effects on motor performance.

机构信息

Exercise Psychophysiology Research Group, School of Arts, Sciences and Humanities, University of São Paulo, São Paulo, Brazil.

Human Movement Science and Rehabilitation Program, Federal University of São Paulo, Santos, Brazil.

出版信息

Eur J Appl Physiol. 2022 Nov;122(11):2321-2329. doi: 10.1007/s00421-022-05029-8. Epub 2022 Aug 25.

Abstract

Different from the most popular thinking, the placebo effect is not a purely psychological phenomenon. A body of knowledge from multidisciplinary fields has shown that the expectation of a potential benefit when receiving a treatment induces a cascade of neurochemical-electrophysiological alterations in brain reward areas, including motor-related ones. Alterations in the dopamine, opioid, and glutamate metabolism are the neural representation converting reward-derived declarative forms into an attractive and wanted behavior, thereby changing the activation in reward subcortical and cortical structures involved in motor planning, motor execution, and emotional-cognitive attributes of decision-making. We propose that the expectation of receiving a treatment that is beneficial to motor performance triggers a cascade of activations in brain reward areas that travels from motor planning and motor command areas, passing through corticospinal pathways until driving the skeletal muscles, therefore facilitating the motor performance. Although alternative explanations cannot be totally ruled out, this mechanistic route is robust in explaining the results of placebo-induced effects on motor performance and could lead to novel insights and applications in the exercise sciences. Factors such as sex differences in reward-related mechanisms and aversion-induced nocebo effects should also be addressed.

摘要

与最普遍的观点不同,安慰剂效应并非纯粹的心理现象。来自多学科领域的大量知识表明,当接受治疗时对潜在益处的期望会在大脑奖励区域中引发一连串的神经化学-电生理变化,包括与运动相关的区域。多巴胺、阿片类和谷氨酸代谢的改变是将奖励衍生的陈述形式转化为有吸引力和想要的行为的神经表现,从而改变涉及运动计划、运动执行以及决策的情感认知属性的奖励性皮质下和皮质结构的激活。我们提出,接受对运动表现有益的治疗的期望会引发大脑奖励区域中的一连串激活,该激活从运动计划和运动指令区域开始,穿过皮质脊髓通路,直到驱动骨骼肌,从而促进运动表现。尽管不能完全排除替代解释,但这种机械途径在解释安慰剂对运动表现的影响的结果方面非常可靠,并且可能为运动科学带来新的见解和应用。还应解决与奖励相关机制的性别差异和厌恶引起的反安慰剂效应等因素。

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