在疼痛治疗和研究中安慰剂效应的重要性
J A Turner1, R A Deyo, J D Loeser
1Department of Psychiatry, University of Washington, Seattle 98195.
JAMA
|May 25, 1994
概括
安慰剂效应显著影响疼痛治疗结果,通常超过三分之一,并影响包括手术在内的各种干预措施的结果. 了解这些影响对于准确的疼痛研究和患者护理至关重要.
科学领域:
- 疼痛研究 疼痛研究
- 医学心理学 医学心理学
- 临床试验方法论 临床试验方法论
背景情况:
- 安慰剂效应是疼痛治疗和研究中的一个重要因素.
- 它们的规模,持续时间和影响因素需要彻底调查.
研究的目的:
- 审查关于安慰剂效应在疼痛管理方面的文献.
- 评估它们的重要性,影响,规模,持续时间,影响条件和建议的解释.
主要方法:
- 在MEDLINE和PsycLIT数据库 (1967-1993) 中进行了全面的文献搜索.
- 包括与疼痛中安慰剂效应相关的英语文章和书籍.
- 补充了文献综述和专家咨询.
主要成果:
- 对安慰剂的反应率差异很大,往往超过通常引用的三分之一.
- 避孕药具有与活性药物相似的时间效应曲线和效应 (峰值,累积,转移).
- 手术可以诱导实质性的安慰剂效应,在病例系列中经常被低估.
- 没有确定一致的安慰剂-响应者个性;个人反应各不相同.
- 提出的解释包括焦虑,期望和学习.
结论:
- 安慰剂效应会影响各种治疗的结果,包括手术,当患者和临床医生认为有效时.
- 高积极的结果可以来自于安慰剂效应,自然疾病进展和回归平均值,可能错误地归因于特定的治疗方法.
- 在没有严格的随机对照试验的情况下,治疗后疼痛改善的确切机制仍然不清楚.
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