Skip to main content
SpringerLink
Log in

Placebos in der Schmerztherapie

Grundlagen und klinische Chancen

  • FORTBILDUNG_SEMINAR
  • Published:
MMW - Fortschritte der Medizin Aims and scope

Die Placeboanalgesie gehört zu den am besten untersuchten Placeboeffekten. Richtig eingesetzt, können Placebomechanismen die Wirkung von Analgetika ergänzen und so die Schmerztherapie wirksamer und nebenwirkungsärmer gestalten. Der folgende Beitrag informiert über aktuelle neurowissenschaftliche Befunde und klinische Implikationen.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Log in via an institution

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Institutional subscriptions

Abb. 1

Literatur

  1. Klinger R. [The potential of the analgetic placebo effect - s3-guideline recommendation on the clinical use for acute and perioperative pain management]. Anasthesiol Intensivmed Notfallmed Schmerzther. 2010 Jan;45(1):22-9. PubMed PMID: 20091473. Epub 2010/01/22. Das Potenzial des analgetischen Plazeboeffektes - S3-Leitlinien-Empfehlung zur Behandlung akuter und perioperativer Schmerzen. rklinger@uni-hamburg.de. ger.

  2. Amanzio M, Benedetti F. Neuropharmacological dissection of placebo analgesia: expectation-activated opioid systems versus conditioning-activated specific subsystems. J Neurosci. 1999 Jan 1;19(1):484–94. PubMed PMID: 9870976.

    PubMed  CAS  Google Scholar 

  3. Kaptchuk TJ, Kelley JM, Conboy LA, Davis RB, Kerr CE, Jacobson EE, et al. Components of placebo effect: randomised controlled trial in patients with irritable bowel syndrome. Bmj. 2008 May 3;336(7651):999–1003. PubMed PMID: 18390493.

    Article  PubMed Central  PubMed  Google Scholar 

  4. Vase L, Riley JL, Price DD. A comparison of placebo effects in clinical analgesic trials versus studies of placebo analgesia. Pain. 2002 Oct;99(3):443–52. PubMed PMID: 12406519.

    Article  PubMed  Google Scholar 

  5. Hrobjartsson A, Gotzsche PC. Is the placebo powerless? An analysis of clinical trials comparing placebo with no treatment. N Engl J Med. 2001 May 24;344(21):1594–602. PubMed PMID: 11372012.

    Article  PubMed  CAS  Google Scholar 

  6. Vase L, Petersen GL, Riley JL, 3rd, Price DD. Factors contributing to large analgesic effects in placebo mechanism studies conducted between 2002 and 2007. Pain. 2009 Sep;145(1–2):36–44. PubMed PMID: 19559529.

    Article  PubMed  Google Scholar 

  7. Haake M, Muller HH, Schade-Brittinger C, Basler HD, Schafer H, Maier C, et al. German Acupuncture Trials (GERAC) for chronic low back pain: randomized, multicenter, blinded, parallel-group trial with 3 groups. Archives of internal medicine. 2007 Sep 24;167(17):1892–8. PubMed PMID: 17893311. Epub 2007/09/26. eng.

    Article  PubMed  Google Scholar 

  8. Levine JD, Gordon NC, Fields HL. The mechanism of placebo analgesia. Lancet. 1978 Sep 23;2(8091):654–7. PubMed PMID: 80579.

    Article  PubMed  CAS  Google Scholar 

  9. Eippert F, Finsterbusch J, Bingel U, Buchel C. Direct evidence for spinal cord involvement in placebo analgesia. Science. 2009 Oct 16;326(5951):404. PubMed PMID: 19833962.

    Article  PubMed  CAS  Google Scholar 

  10. Eippert F, Bingel U, Schoell ED, Yacubian J, Klinger R, Lorenz J, et al. Activation of the opioidergic descending pain control system underlies placebo analgesia. Neuron. 2009 Aug 27;63(4):533–43. PubMed PMID: 19709634.

    Article  PubMed  CAS  Google Scholar 

  11. Zubieta JK, Bueller JA, Jackson LR, Scott DJ, Xu Y, Koeppe RA, et al. Placebo effects mediated by endogenous opioid activity on mu-opioid receptors. J Neurosci. 2005 Aug 24;25(34):7754–62. PubMed PMID: 16120776. Epub 2005/08/27. eng.

    Article  PubMed  CAS  Google Scholar 

  12. Wager TD, Scott DJ, Zubieta JK. Placebo effects on human mu-opioid activity during pain. Proc Natl Acad Sci U S A. 2007 Jun 26;104(26):11056–61. PubMed PMID: 17578917.

    Article  PubMed Central  PubMed  CAS  Google Scholar 

  13. Benedetti F, Amanzio M, Rosato R, Blanchard C. Nonopioid placebo analgesia is mediated by CB1 cannabinoid receptors. Nature medicine. 2011 Oct;17(10):1228–30. PubMed PMID: 21963514. Epub 2011/10/04. eng.

    Article  PubMed  CAS  Google Scholar 

  14. Benedetti F, Carlino E, Pollo A. Hidden administration of drugs. Clin Pharmacol Ther. 2011 Nov;90(5):651–61. PubMed PMID: 21993425.

    Article  PubMed  CAS  Google Scholar 

  15. Pollo A, Amanzio M, Arslanian A, Casadio C, Maggi G, Benedetti F. Response expectancies in placebo analgesia and their clinical relevance. Pain. 2001 Jul;93(1):77–84. PubMed PMID: 11406341.

    Article  PubMed  CAS  Google Scholar 

  16. Colloca L, Lopiano L, Lanotte M, Benedetti F. Overt versus covert treatment for pain, anxiety, and Parkinson's disease. Lancet Neurol. 2004 Nov;3(11):679–84. PubMed PMID: 15488461.

    Article  PubMed  Google Scholar 

  17. Kirk JM, Doty P, De Wit H. Effects of expectancies on subjective responses to oral delta9-tetrahydrocannabinol. Pharmacol Biochem Behav. 1998 Feb;59(2):287–93. PubMed PMID: 9476972.

    Article  PubMed  CAS  Google Scholar 

  18. Metrik J, Rohsenow DJ, Monti PM, McGeary J, Cook TA, de Wit H, et al. Effectiveness of a marijuana expectancy manipulation: Piloting the balanced-placebo design for marijuana. Exp Clin Psychopharmacol. 2009 Aug;17(4):217–25. PubMed PMID: 19653787.

    Article  PubMed Central  PubMed  Google Scholar 

  19. Volkow ND, Wang GJ, Ma Y, Fowler JS, Zhu W, Maynard L, et al. Expectation enhances the regional brain metabolic and the reinforcing effects of stimulants in cocaine abusers. J Neurosci. 2003 Dec 10;23(36):11461–8. PubMed PMID: 14673011.

    PubMed  CAS  Google Scholar 

  20. Bingel U, Wanigasekera V, Wiech K, Ni Mhuircheartaigh R, Lee MC, Ploner M, et al. The effect of treatment expectation on drug efficacy: imaging the analgesic benefit of the opioid remifentanil. Sci Transl Med. 2011 Feb 16;3(70):70ra14. PubMed PMID: 21325618.

    Article  PubMed  CAS  Google Scholar 

  21. Rief W, Nestoriuc Y, Weiss S, Welzel E, Barsky AJ, Hofmann SG. Meta-analysis of the placebo response in antidepressant trials. Journal of affective disorders. 2009 Nov;118(1–3):1–8. PubMed PMID: 19246102. Epub 2009/02/28. eng.

    Article  PubMed  CAS  Google Scholar 

  22. Rief W, Avorn J, Barsky AJ. Medication-attributed adverse effects in placebo groups: implications for assessment of adverse effects. Archives of internal medicine. 2006 Jan 23;166(2):155–60. PubMed PMID: 16432082. Epub 2006/01/25. eng.

    Article  PubMed  Google Scholar 

  23. Nestoriuc Y, Orav EJ, Liang MH, Horne R, Barsky AJ. Prediction of nonspecific side effects in rheumatoid arthritis patients by beliefs about medicines. Arthritis care & research. 2010 Jun;62(6):791–9. PubMed PMID: 20191574. Pubmed Central PMCID: 2940323. Epub 2010/03/02. eng.

    Article  Google Scholar 

  24. Klinger R. [The potential of the analgetic placebo effect - s3-guideline recommendation on the clinical use for acute and perioperative pain management]. Anasthesiol Intensivmed Notfallmed Schmerzther. Jan;45(1):22-9. PubMed PMID: 20091473. Das Potenzial des analgetischen Plazeboeffektes - S3-Leitlinien-Empfehlung zur Behandlung akuter und perioperativer Schmerzen. rklinger@uni-hamburg.de.

  25. Miller FG, Colloca L. The legitimacy of placebo treatments in clinical practice: evidence and ethics. Am J Bioeth. 2009 Dec;9(12):39–47. PubMed PMID: 20013499.

    Article  PubMed  Google Scholar 

  26. Doering BK, Rief W. Utilizing placebo mechanisms for dose reduction in pharmacotherapy. Trends Pharmacol Sci. 2012 Mar;33(3):165–72. PubMed PMID: 22284159. Epub 2012/01/31. eng.

    Article  PubMed  CAS  Google Scholar 

  27. Goebel MU, Meykadeh N, Kou W, Schedlowski M, Hengge UR. Behavioral conditioning of antihistamine effects in patients with allergic rhinitis. Psychother Psychosom. 2008;77(4):227–34. PubMed PMID: 18418029.

    Article  PubMed  Google Scholar 

  28. Sandler AD, Glesne CE, Bodfish JW. Conditioned placebo dose reduction: a new treatment in attention-deficit hyperactivity disorder? Journal of developmental and behavioral pediatrics: JDBP. 2010 Jun;31(5):369–75. PubMed PMID: 20495473. Pubmed Central PMCID: 2902360. Epub 2010/05/25. eng.

    Article  PubMed Central  PubMed  Google Scholar 

  29. Ader R, Cohen N. Behaviorally conditioned immunosuppression and murine systemic lupus erythematosus. Science. 1982 Mar 19;215(4539):1534–6. PubMed PMID: 7063864. Epub 1982/03/19. eng.

    Article  PubMed  CAS  Google Scholar 

  30. Schedlowski M, Pacheco-Lopez G. The learned immune response: Pavlov and beyond. Brain, behavior, and immunity. 2010 Feb;24(2):176–85. PubMed PMID: 19698779. Epub 2009/08/25. eng.

    Article  PubMed  Google Scholar 

  31. Enck P, Bingel U, Schedlowski M, Rief W. The placebo response in medicine: minimize, maximize or personalize? Nature reviews Drug discovery. 2013 Mar;12(3):191–204. PubMed PMID: 23449306.

    Article  PubMed  CAS  Google Scholar 

  32. Hall KT, Lembo AJ, Kirsch I, Ziogas DC, Douaiher J, Jensen KB, et al. Catechol-O-methyltransferase val158met polymorphism predicts placebo effect in irritable bowel syndrome. PloS one. 2012;7(10):e48135. PubMed PMID: 23110189. Pubmed Central PMCID: 3479140. Epub 2012/10/31. eng.

    Article  PubMed Central  PubMed  CAS  Google Scholar 

  33. Stein N, Sprenger C, Scholz J, Wiech K, Bingel U. White matter integrity of the descending pain modulatory system is associated with interindividual differences in placebo analgesia. Pain. 2012 Nov;153(11):2210–7. PubMed PMID: 22959599. Epub 2012/09/11. eng.

    Article  PubMed  Google Scholar 

  34. Rief W, Bingel U, Schedlowski M, Enck P. Mechanisms Involved in Placebo and Nocebo Responses and Implications for Drug Trials. Clin Pharmacol Ther. 2011 Oct 5. PubMed PMID: 21975346.

  35. Laferton JA, Shedden Mora M, Auer CJ, Moosdorf R, Rief W. Enhancing the efficacy of heart surgery by optimizing patients' preoperative expectations: study protocol of a randomized controlled trial. American heart journal. 2013 Jan;165(1):1–7. PubMed PMID: 23237127. Epub 2012/12/15. eng.

    Article  PubMed  Google Scholar 

Download references

Author information

Authors and Affiliations

  1. Klinik für Neurologie, Unviersitätsklinikum Essen, Hufelandstr. 55, D-45147, Essen, Deutschland

    Ulrike Bingel

Authors
  1. Ulrike Bingel
    View author publications

    You can also search for this author in PubMed Google Scholar

Corresponding author

Correspondence to Ulrike Bingel.

Rights and permissions

Reprints and permissions

About this article

Cite this article

Bingel, U. Placebos in der Schmerztherapie. MMW - Fortschritte der Medizin 156, 81–85 (2014). https://doi.org/10.1007/s15006-014-2812-5

Download citation

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1007/s15006-014-2812-5

Keywords - Placebo analgesia

Search

Navigation