反安慰剂效应及其内在机制

摘要/Abstract

摘要： 反安慰剂效应在临床治疗和现实生活中普遍存在,是与安慰剂效应对立而存在的一种现象,因此又被称为阴性安慰剂效应。消极预期可以引起反安慰剂效应,并产生相应的生理变化。目前对反安慰剂效应的关键性突破几乎全部来自疼痛领域,研究者发现在疼痛背景下,消极预期引起的焦虑介导了反安慰剂的疼痛过敏反应,这其中涉及到了胆囊收缩素(CCK)和阿片肽两种神经递质系统的相互作用;脑影像研究发现,反安慰剂状态下的疼痛刺激会激活内侧痛觉系统相关脑区的活动,同时,海马可能在反安慰剂痛敏反应中有重要作用。本文介绍了疼痛背景下反安慰剂的神经生理机制以及研究进展,并提出了未来的方向。

关键词: 反安慰剂, 疼痛过敏, 胆囊收缩素, 预期, 机制

Abstract: Nocebo effect exists widely not only in the clinical practice but also in society, which is the negative equivalent of placebo phenomena. Nocebo effect results from people's expectation about negative outcome, and may lead to the amplification of pain or the deterioration of a symptoms. Almost all the crucial breakthroughs of nocebo effect in recent years come from the field of pain. Researchers found that anticipatory anxiety about the impending pain increase mediates the nocebo hyperalgesia, and in this process the interaction of cholecystokinin and opioid were involved. Brain imaging study showed that nocebo hyperalgesia would activate the medial pain system with its related cerebral regions, and hippocampus may play an important role in this process. On the basis of previous research, this study presents the underlying neurophysiological mechanism of nocebo effect mainly in pain, and provide some useful suggestions for future studies in this field.

Key words: nocebo, hyperalgesia, cholecystokinin, expectation, mechanism

中图分类号:

R749
R964

邓潇斐, 罗非, 郭建友. 反安慰剂效应及其内在机制[J]. 中国临床药理学与治疗学, 2015, 20(5): 591-596.

DENG Xiao-fei, LUO Fei, GUO Jian-you. Nocebo effect and its underlying mechanism[J]. Chinese Journal of Clinical Pharmacology and Therapeutics, 2015, 20(5): 591-596.

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