安慰剂效应:不仅仅是安慰,可能具有一定的客观效应

2016-02-10 孙学军 孙学军博客

神经科学研究发现,安慰剂效应能启动足够强的生理反应,这些反应和药物产生的效应并没有区别,例如能让帕金森患者大脑释放多巴胺,让疼痛患者大脑释放内啡肽,这恰好是这些疾病药物的作用基础。最近意大利科学家用人体大脑电活动记录的方法,证明帕金森病患者存在确定无疑的安慰剂效应。意大利神经科学家对帕金森病患者的大脑细胞进行训练,利用安慰剂原理治疗该疾病。研究负责人,意大利都灵大学安慰剂效应研究者学Fabrizi

神经科学研究发现,安慰剂效应能启动足够强的生理反应,这些反应和药物产生的效应并没有区别,例如能让帕金森患者大脑释放多巴胺,让疼痛患者大脑释放内啡肽,这恰好是这些疾病药物的作用基础。最近意大利科学家用人体大脑电活动记录的方法,证明帕金森病患者存在确定无疑的安慰剂效应。

意大利神经科学家对帕金森病患者的大脑细胞进行训练,利用安慰剂原理治疗该疾病。研究负责人,意大利都灵大学安慰剂效应研究者学Fabrizio Benedetti说,虽然安慰剂效应会在训练后24小时消失,但是这种效应能减少药物用量,说明这种方法可以与药物配合使用。

早期研究表明,少数帕金森病患者对安慰剂产生强烈反应,但更多患者并没有那么强的反应。帕金森病患者大脑中产生多巴胺的细胞逐渐死亡,其临床特点是逐渐加重的肌肉震颤和僵硬。帕金森病常用治疗药物是多巴胺类似物,如阿朴吗啡能代替脑内多巴胺激活其受体。

临床研究表明,疼痛和免疫功能紊乱患者可以通过训练对安慰剂产生反应,或者能用训练的方法激活安慰剂效应实现治疗疾病的目的。虽然这些方法仍然没有真正投入临床应用,但是研究确实发现可以产生效果。Benedetti等猜测这种方法或许可以用于治疗帕金森病等神经系统疾病(研究基础和假说)。

他们招募了42名晚期帕金森病患者,这些患者都正在接受深部大脑电刺激治疗,这种治疗方法是通过直接电刺激大脑缓解症状。这种手术也给Benedetti团队一个难得的机会,让他们可以检测丘脑单个神经元活动,帕金森患者这些脑区神经元多巴胺水平降低。手术过程中,患者被注射生理盐水,但被告知注射了阿朴吗啡。患者的神经元一般没有反应,如果在手术前1-4天曾经注射阿朴吗啡的预适应,患者的神经元会发生放电。这些神经元对注射安慰剂产生反应的患者肌肉张力下降,评估肌肉张力的医生并不了解实验目的。Benedetti说,与患者大脑神经元电活动记录数据的比较,可以排除研究记录者和患者主观感觉的干扰。证明这种安慰剂效应确实存在。研究发现,事前注射阿朴吗啡的剂量越大,生理盐水安慰剂效应越强,如果曾注射四次阿朴吗啡,则安慰剂效应和药物效应几乎相同。这种效应不可能是过去注射阿朴吗啡的残留作用,因为这些药物注射后几小时就会被代谢掉。研究结果发表在《生理学杂志》上。

不过这种“训练”安慰剂效应只能持续几天时间。Benedetti希望通过给患者注射真实的药物来延长这种安慰剂效应的持续时间。

芝加哥拉什大学医学中心的神经学家Christopher Goetz说,这个研究非常重要,因为清楚证明了临床效应和神经元活动的关系,这种效应可以通过训练获得。研究安慰剂镇痛效应的科罗拉多大学神经科学家Tor Wager补充说,虽然这个研究的规模比较小,但是研究结果非常引人注目。Wager过去研究免疫反应和疼痛的安慰剂效应,他们发现即使受试者被告知是安慰剂,这种效应仍然能被诱导。Benedetti说,虽然尚不清楚这种诚实的安慰剂效应是否也适合于帕金森病患者,但临床实践中如果使用安慰剂效应仍然可以告诉患者这种效应需要真正的药物诱导。辛辛那提大学神经科学家Alberto Espay曾经研究过治疗帕金森病的安慰剂效应。他认为对患者的真正价值是要确定长期治疗效果。他预计安慰剂最终用于临床可能是作为减少药物剂量方面,这不仅能减少药物副作用,而且可以节约治疗成本。Benedetti的研究也说明,这种安慰剂效应对延缓药物耐受具有重要价值,这种作用使帕金森患者长期使用后药物效果逐渐减退。

安慰剂效应的分子基础仍然不清楚,Goetz认为,安慰剂可能是一个单纯“条件反射”,是药物治疗给患者带来的效应经验条件反射。安慰剂效应研究的经典解释是,如果患者对治疗产生有效预期,就会产生安慰剂效应。Benedetti等的研究说明,患者产生安慰剂效应时大脑本身发生了变化。


原始出处:

Benedetti F, Dogue S. Different Placebos, Different Mechanisms, Different Outcomes: Lessons for Clinical Trials. PLoS One. 2015 Nov 4;10(11):e0140967

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    2016-03-01 忠诚向上

    应该认真对待

    0

  2. [GetPortalCommentsPageByObjectIdResponse(id=66675, encodeId=039c666e56b, content=应该认真对待, beContent=null, objectType=article, channel=null, level=null, likeNumber=106, replyNumber=0, topicName=null, topicId=null, topicList=[], attachment=null, authenticateStatus=null, createdAvatar=, createdBy=45101626056, createdName=忠诚向上, createdTime=Tue Mar 01 22:24:00 CST 2016, time=2016-03-01, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=1304322, encodeId=608613043227d, content=<a href='/topic/show?id=81724580886' target=_blank style='color:#2F92EE;'>#安慰剂#</a>, beContent=null, objectType=article, channel=null, level=null, likeNumber=38, replyNumber=0, topicName=null, topicId=null, topicList=[TopicDto(id=45808, encryptionId=81724580886, topicName=安慰剂)], attachment=null, authenticateStatus=null, createdAvatar=, createdBy=4cce318, createdName=wleon8895, createdTime=Fri Feb 12 14:20:00 CST 2016, time=2016-02-12, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=63884, encodeId=df906388457, content=心理作用在疾病治疗作用是未知的, beContent=null, objectType=article, channel=null, level=null, likeNumber=73, replyNumber=0, topicName=null, topicId=null, topicList=[], attachment=null, authenticateStatus=null, createdAvatar=, createdBy=841a1636000, createdName=lietome1, createdTime=Thu Feb 11 09:22:00 CST 2016, time=2016-02-11, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=63885, encodeId=e8dd6388567, content=但潜力巨大,如果能受医生控制的话。。。, beContent=null, objectType=article, channel=null, level=null, likeNumber=77, replyNumber=0, topicName=null, topicId=null, topicList=[], attachment=null, authenticateStatus=null, createdAvatar=, createdBy=841a1636000, createdName=lietome1, createdTime=Thu Feb 11 09:22:00 CST 2016, time=2016-02-11, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=63882, encodeId=aa676388251, content=学习!, beContent=null, objectType=article, channel=null, level=null, likeNumber=105, replyNumber=0, topicName=null, topicId=null, topicList=[], attachment=null, authenticateStatus=null, createdAvatar=, createdBy=841a1636000, createdName=lietome1, createdTime=Thu Feb 11 09:21:00 CST 2016, time=2016-02-11, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=63883, encodeId=1931638839b, content=不是心理的作用嘛, beContent=null, objectType=article, channel=null, level=null, likeNumber=98, replyNumber=0, topicName=null, topicId=null, topicList=[], attachment=null, authenticateStatus=null, createdAvatar=, createdBy=841a1636000, createdName=lietome1, createdTime=Thu Feb 11 09:21:00 CST 2016, time=2016-02-11, status=1, ipAttribution=)]
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    2016-02-11 lietome1

    心理作用在疾病治疗作用是未知的

    0

  4. [GetPortalCommentsPageByObjectIdResponse(id=66675, encodeId=039c666e56b, content=应该认真对待, beContent=null, objectType=article, channel=null, level=null, likeNumber=106, replyNumber=0, topicName=null, topicId=null, topicList=[], attachment=null, authenticateStatus=null, createdAvatar=, createdBy=45101626056, createdName=忠诚向上, createdTime=Tue Mar 01 22:24:00 CST 2016, time=2016-03-01, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=1304322, encodeId=608613043227d, content=<a href='/topic/show?id=81724580886' target=_blank style='color:#2F92EE;'>#安慰剂#</a>, beContent=null, objectType=article, channel=null, level=null, likeNumber=38, replyNumber=0, topicName=null, topicId=null, topicList=[TopicDto(id=45808, encryptionId=81724580886, topicName=安慰剂)], attachment=null, authenticateStatus=null, createdAvatar=, createdBy=4cce318, createdName=wleon8895, createdTime=Fri Feb 12 14:20:00 CST 2016, time=2016-02-12, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=63884, encodeId=df906388457, content=心理作用在疾病治疗作用是未知的, beContent=null, objectType=article, channel=null, level=null, likeNumber=73, replyNumber=0, topicName=null, topicId=null, topicList=[], attachment=null, authenticateStatus=null, createdAvatar=, createdBy=841a1636000, createdName=lietome1, createdTime=Thu Feb 11 09:22:00 CST 2016, time=2016-02-11, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=63885, encodeId=e8dd6388567, content=但潜力巨大,如果能受医生控制的话。。。, beContent=null, objectType=article, channel=null, level=null, likeNumber=77, replyNumber=0, topicName=null, topicId=null, topicList=[], attachment=null, authenticateStatus=null, createdAvatar=, createdBy=841a1636000, createdName=lietome1, createdTime=Thu Feb 11 09:22:00 CST 2016, time=2016-02-11, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=63882, encodeId=aa676388251, content=学习!, beContent=null, objectType=article, channel=null, level=null, likeNumber=105, replyNumber=0, topicName=null, topicId=null, topicList=[], attachment=null, authenticateStatus=null, createdAvatar=, createdBy=841a1636000, createdName=lietome1, createdTime=Thu Feb 11 09:21:00 CST 2016, time=2016-02-11, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=63883, encodeId=1931638839b, content=不是心理的作用嘛, beContent=null, objectType=article, channel=null, level=null, likeNumber=98, replyNumber=0, topicName=null, topicId=null, topicList=[], attachment=null, authenticateStatus=null, createdAvatar=, createdBy=841a1636000, createdName=lietome1, createdTime=Thu Feb 11 09:21:00 CST 2016, time=2016-02-11, status=1, ipAttribution=)]
    2016-02-11 lietome1

    但潜力巨大,如果能受医生控制的话。。。

    0

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    2016-02-11 lietome1

    学习!

    0

  6. [GetPortalCommentsPageByObjectIdResponse(id=66675, encodeId=039c666e56b, content=应该认真对待, beContent=null, objectType=article, channel=null, level=null, likeNumber=106, replyNumber=0, topicName=null, topicId=null, topicList=[], attachment=null, authenticateStatus=null, createdAvatar=, createdBy=45101626056, createdName=忠诚向上, createdTime=Tue Mar 01 22:24:00 CST 2016, time=2016-03-01, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=1304322, encodeId=608613043227d, content=<a href='/topic/show?id=81724580886' target=_blank style='color:#2F92EE;'>#安慰剂#</a>, beContent=null, objectType=article, channel=null, level=null, likeNumber=38, replyNumber=0, topicName=null, topicId=null, topicList=[TopicDto(id=45808, encryptionId=81724580886, topicName=安慰剂)], attachment=null, authenticateStatus=null, createdAvatar=, createdBy=4cce318, createdName=wleon8895, createdTime=Fri Feb 12 14:20:00 CST 2016, time=2016-02-12, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=63884, encodeId=df906388457, content=心理作用在疾病治疗作用是未知的, beContent=null, objectType=article, channel=null, level=null, likeNumber=73, replyNumber=0, topicName=null, topicId=null, topicList=[], attachment=null, authenticateStatus=null, createdAvatar=, createdBy=841a1636000, createdName=lietome1, createdTime=Thu Feb 11 09:22:00 CST 2016, time=2016-02-11, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=63885, encodeId=e8dd6388567, content=但潜力巨大,如果能受医生控制的话。。。, beContent=null, objectType=article, channel=null, level=null, likeNumber=77, replyNumber=0, topicName=null, topicId=null, topicList=[], attachment=null, authenticateStatus=null, createdAvatar=, createdBy=841a1636000, createdName=lietome1, createdTime=Thu Feb 11 09:22:00 CST 2016, time=2016-02-11, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=63882, encodeId=aa676388251, content=学习!, beContent=null, objectType=article, channel=null, level=null, likeNumber=105, replyNumber=0, topicName=null, topicId=null, topicList=[], attachment=null, authenticateStatus=null, createdAvatar=, createdBy=841a1636000, createdName=lietome1, createdTime=Thu Feb 11 09:21:00 CST 2016, time=2016-02-11, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=63883, encodeId=1931638839b, content=不是心理的作用嘛, beContent=null, objectType=article, channel=null, level=null, likeNumber=98, replyNumber=0, topicName=null, topicId=null, topicList=[], attachment=null, authenticateStatus=null, createdAvatar=, createdBy=841a1636000, createdName=lietome1, createdTime=Thu Feb 11 09:21:00 CST 2016, time=2016-02-11, status=1, ipAttribution=)]
    2016-02-11 lietome1

    不是心理的作用嘛

    0

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