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应对患者的治疗期望——我们能从顺势疗法中学到什么。

Working with patients' treatment expectations - what we can learn from homeopathy.

作者信息

Wilhelm Marcel, Hermann Christiane, Rief Winfried, Schedlowski Manfred, Bingel Ulrike, Winkler Alexander

机构信息

Department of Clinical Psychology, Philipps-University Marburg, Marburg, Germany.

Department of Clinical Psychology, Justus-Liebig-University Giessen, Giessen, Germany.

出版信息

Front Psychol. 2024 May 27;15:1398865. doi: 10.3389/fpsyg.2024.1398865. eCollection 2024.


DOI:10.3389/fpsyg.2024.1398865
PMID:38860049
原文链接:https://pmc.ncbi.nlm.nih.gov/articles/PMC11163137/
Abstract

The usual homeopathic remedy, "globules," does not contain any pharmacologically active ingredient. However, many patients and practitioners report beneficial effects of homeopathic treatment on various health outcomes. Experimental and clinical research of the last two decades analyzing the underlying mechanisms of the placebo effect could explain this phenomenon, with patients' treatment expectations as the predominant mechanism. Treatment expectations can be optimized through various factors, such as prior information, communication, and treatment context. This narrative review analyses how homeopathy successfully utilizes these factors. Subsequently, it is discussed what evidence-based medicine could learn from homeopathic practice to optimize treatment expectations (e.g., using an empathic, patient-centered communication style, deliberately selecting objects in practice rooms, or using clear treatment rituals and salient contextual stimuli) and thereby treatment effectiveness. Homeopathic remedy does not work beyond the placebo effect but is recommended or prescribed as an active treatment by those who believe in it. Thus, practitioners need to understand the manner in which homeopathy (as an example of inert treatment) works and are advised to reintegrate its underlying effective placebo mechanisms into evidence-based medicine. This promises to increase treatment efficacy, tolerability, satisfaction, and compliance with evidence-based treatments, and addresses the desires patients are trying to satisfy in homeopathy in an ethical, fully informed way that is grounded in evidence-based medicine.

摘要

常见的顺势疗法药物“小球剂”不含有任何药理活性成分。然而,许多患者和从业者报告称顺势疗法治疗对各种健康结果有有益影响。过去二十年对安慰剂效应潜在机制进行分析的实验和临床研究可以解释这一现象,其中患者的治疗期望是主要机制。治疗期望可以通过各种因素得到优化,如先前信息、沟通和治疗环境。这篇叙述性综述分析了顺势疗法如何成功利用这些因素。随后,讨论了循证医学可以从顺势疗法实践中学到什么来优化治疗期望(例如,采用共情、以患者为中心的沟通方式,在诊疗室中刻意选择物品,或使用明确的治疗仪式和显著的环境刺激),从而提高治疗效果。顺势疗法药物除了安慰剂效应外并无作用,但那些相信它的人会将其作为一种有效治疗方法进行推荐或开出处方。因此,从业者需要了解顺势疗法(作为惰性治疗的一个例子)的作用方式,并建议将其潜在的有效安慰剂机制重新纳入循证医学。这有望提高治疗效果、耐受性、满意度以及对循证治疗的依从性,并以基于循证医学的道德、充分知情的方式满足患者在顺势疗法中试图满足的愿望。

https://cdn.ncbi.nlm.nih.gov/pmc/blobs/defd/11163137/00effe619a31/fpsyg-15-1398865-g001.jpg
https://cdn.ncbi.nlm.nih.gov/pmc/blobs/defd/11163137/00effe619a31/fpsyg-15-1398865-g001.jpg
https://cdn.ncbi.nlm.nih.gov/pmc/blobs/defd/11163137/00effe619a31/fpsyg-15-1398865-g001.jpg

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引用本文的文献

[1]
Design of a Randomized Sham-Controlled Trial: Strengthening Positive Treatment Expectations Using a Communication Model for Maximized Antiemetic Effects of Acupuncture and Antiemetics During Emetogenic Neo-/Adjuvant Chemotherapy.

Integr Cancer Ther. 2025

[2]
Effects of open-label placebos across populations and outcomes: an updated systematic review and meta-analysis of randomized controlled trials.

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[3]
Commentary: Working with patients' treatment expectations - what we can learn from homeopathy.

Front Psychol. 2024-12-16

[4]
Understanding Placebo and Nocebo Responses Based on a Randomized Sham-Controlled Study on Acupuncture in Integrative Cancer Care.

Integr Cancer Ther. 2024

本文引用的文献

[1]
Translating knowledge on placebo and nocebo effects into clinical practice.

Pain Rep. 2024-3-25

[2]
Hype or hope? High placebo response in major depression treatment with ketamine and esketamine: a systematic review and meta-analysis.

Front Psychiatry. 2024-3-8

[3]
Uncovering null effects in null fields: the case of homeopathy.

J Clin Epidemiol. 2024-2

[4]
Nocebo effects in visceral pain: concept and design of the experimental randomized-controlled pain study 'NoVis'.

Front Psychiatry. 2023-10-13

[5]
Overview and quality assessment of health economic evaluations for homeopathic therapy: an updated systematic review.

Expert Rev Pharmacoecon Outcomes Res. 2024-1

[6]
The impact of pharmaceutical form and simulated side effects in an open-label-placebo RCT for improving psychological distress in highly stressed students.

Sci Rep. 2023-4-19

[7]
Homeopathy can offer empirical insights on treatment effects in a null field.

J Clin Epidemiol. 2023-3

[8]
Prevalence and associated factors with homeopathy use in Brazil: a population-based study.

Cad Saude Publica. 2022-9-23

[9]
Nocebo Effects of Clinical Communication and Placebo Effects of Positive Suggestions on Respiratory Muscle Strength.

Front Psychol. 2022-3-11

[10]
What Do Placebo and Nocebo Effects Have to Do With Health Equity? The Hidden Toll of Nocebo Effects on Racial and Ethnic Minority Patients in Clinical Care.

Front Psychol. 2021-12-23

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