诺塞博预期而不是安慰剂预期影响局部疼痛缓解:一个随机临床试验
Mingxiao Yang1, Qing S Li2, Raymond E Baser3
1Department of Medical Oncology, Dana-Farber Cancer Institute, and Harvard Medical School, 450 Brookline Ave, Boston, MA 02115, USA.
概括
在使用局部疼痛治疗的癌症幸存者中,负面预期 (nocebo 效应) 显著加剧了疼痛和增加了不良事件. 这些无效疗法效应,而不是积极的期望,损害了治疗的有效性和症状严重程度的增加.
科学领域:
- 疼痛管理 疼痛管理
- 心理神经免疫学 心理神经免疫学
- 临床试验 临床试验
背景情况:
- 患者的期望会影响治疗结果,包括安慰剂和非安慰剂效应.
- 慢性肌肉骨疼痛是癌症幸存者的常见问题.
- 了解预期效应对于优化疼痛疗法至关重要.
研究的目的:
- 调查nocebo和安慰剂预期对疼痛缓解和不良事件的影响.
- 为了评估癌症幸存者的这些影响,慢性肌肉骨疼痛接受局部治疗.
主要方法:
- 随机临床试验与65名癌症幸存者.
- 干预措施:1%的坎佛基局部疼痛贴片或安慰剂14天.
- 测量:疼痛严重程度 (简要疼痛清单),不良事件和基线预期.
主要成果:
- 高的nocebo预期使疼痛改善率降低了2.5个点,疼痛反应率降低了42.7%.
- 在主动治疗组中,nocebo预期增加了22.4%的不良事件.
- 高的nocebo预期与增加的不良事件 (OR 12.0) 和减少疼痛反应有关.
结论:
- 比安慰剂预期更高的nocebo预期增加了不良事件的风险,并降低了局部疼痛干预的有效性.
- 诺塞博效应可能会通过中央疼痛放大加剧疼痛症状.
- 需要进一步的研究来探索nocebo效应对体征症状的机制.
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