Knezevic Nebojsa Nick, Sic Aleksandar, Worobey Samantha, Knezevic Emilija
Department of Anesthesiology, Advocate Illinois Masonic Medical Center, Chicago, IL 60657, USA.
Department of Anesthesiology, University of Illinois, Chicago, IL 60612, USA.
Medicines (Basel). 2025 Feb 24;12(1):5. doi: 10.3390/medicines12010005.
The placebo effect has been widely documented across various medical conditions, demonstrating its ability to influence both subjective and objective outcomes. Placebo responses can significantly improve symptoms in these different conditions, such as pain, Parkinson's disease, depression, anxiety, and addiction. Psychological mechanisms, particularly the power of patient expectations, appear to play a central role, with neurobiological evidence supporting the activation of dopamine, endogenous opioids, and endocannabinoids in response to placebo interventions. Studies have demonstrated that placebo injections and more complex procedures, including sham surgeries, can produce therapeutic effects comparable to real treatments, particularly in pain management and neurological disorders. Moreover, placebo responses could be amplified when patients are aware of receiving treatment, as shown by research on open-label placebos and open versus hidden medical treatments. The effectiveness of 0.9% sodium chloride solution as a placebo in clinical trials is debated, with some studies indicating its potential to induce clinical improvements, though it may not be an ideal control in inflammatory pain conditions. Advances in neuroimaging have revealed that placebo treatments trigger tangible biological processes in the brain and body and are supported by psychological and physiological mechanisms that interact, suggesting real biological processes are involved in the observed effects. Overall, the growing understanding of placebo mechanisms suggests that incorporating placebo-based strategies, with patient awareness and appropriate ethical considerations, may offer significant potential for improving patient outcomes, particularly in chronic pain, mental health, and neurological conditions.
安慰剂效应已在各种医疗状况中得到广泛记录，证明了其影响主观和客观结果的能力。安慰剂反应能在这些不同状况下显著改善症状，如疼痛、帕金森病、抑郁症、焦虑症和成瘾问题。心理机制，尤其是患者期望的力量，似乎起着核心作用，神经生物学证据支持在安慰剂干预下多巴胺、内源性阿片类物质和内源性大麻素的激活。研究表明，安慰剂注射以及包括假手术在内的更复杂程序，能够产生与真实治疗相当的治疗效果，特别是在疼痛管理和神经疾病方面。此外，正如对开放标签安慰剂以及开放与隐蔽医疗治疗的研究所显示的，当患者知晓正在接受治疗时，安慰剂反应可能会增强。0.9%氯化钠溶液作为临床试验中的安慰剂的有效性存在争议，一些研究表明它有可能带来临床改善，不过在炎症性疼痛状况下它可能并非理想的对照。神经影像学的进展揭示，安慰剂治疗会在大脑和身体中引发切实的生物学过程，并得到相互作用的心理和生理机制的支持，这表明观察到的效果涉及真实的生物学过程。总体而言，对安慰剂机制的日益了解表明，在有患者知晓且有适当伦理考量的情况下，纳入基于安慰剂的策略可能为改善患者预后提供巨大潜力，尤其是在慢性疼痛、心理健康和神经疾病方面。
