Plazeboanalgesie: Grundlagen und klinische Implikationen

Subtitle: Principles of placebo analgesia and clinical implications

Article type: Research Article

Authors: Wrobel, Nathalie | Bingel, Ulrike

Affiliations: Klinik für Neurologie, Institut für Systemische Neurowissenschaften, Universitätsklinikum Hamburg-Eppendorf, Hamburg

Note: [] Korrespondenzadresse: Nathalie Wrobel, Klinik für Neurologie, Institut für Systemische Neurowissenschaften, Universitätsklinikum Hamburg-Eppendorf, Martinistraße 52, 20246 Hamburg. Fax: +49-40-7410-59955; E-mail: n.wrobel@uke.de

Abstract: Placebo analgesia is one of the best-studied placebo effects. In placebo analgesia, the administration of a pharmacological inert substance produces a pain-relieving effect if the subject is convinced that a potent analgesic is being delivered. As a powerful clinical example of the cognitive modulation of pain it has become a popular experimental model to examine central mechanisms of endogenous pain modulation. Converging evidence from experimental placebo research of the past three decades has revealed placebo analgesia as a complex phenomenon involving psycho-neuro-biological interactions. Expectancy and classical conditioning have been identified as two key psychological mechanisms in the formation of placebo responses. Neuroimaging studies support the concept that during placebo analgesia, cingulofrontal regions interact with subcortical structures involved in endogenous, opioidergic antinociception to produce the placebo-induced reduction in pain perception. The reported reductions in pain sensations during placebo analgesia are accompanied by reduced activity in pain-associated areas even involving early stages of nociceptive processing such as the spinal cord. The efficacy of placebo analgesic treatments has not only been verified in experimental but also in numerous clinical and empirical studies. However, the application of "pure" placebo treatments is constrained by both ethical and legal limitations. Here we propose, that the true potential of placebo analgesia lies in the positive interaction with active pharmacological or other treatments. A better understanding of patient, context, and potentially disease depended interactions between psychological factors and specific medical treatments are an essential requirement for the optimization of medical treatments and the reductions of side-effects.

Keywords: Pain, placebo analgesia, review, neurotransmitter, clinical implications

Journal: Zeitschrift für Medizinische Psychologie, vol. 19, no. 3-4, pp. 110-119, 2010