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Placeboreaktion – Mechanismen und klinische Anwendungen

Placebo response – Mechanisms and clinical applications

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Zusammenfassung

In den letzten Jahren hat die Placeboforschung bedeutende Fortschritte erreicht. Placeboreaktionen sind psychobiologische Ereignisse, die dem gesamten therapeutischen Kontext zuzuordnen sind. Sie können jederzeit auftreten, nicht nur in experimentellen oder klinischen Studien. Einige wenige Untersuchungen zum Verständnis des analgetischen Placeboeffekts weisen darauf hin, dass bei Patienten im Vergleich zu Gesunden stärkere Effekte entstehen und dass diese längerfristig andauern können. Erwartungen spielen bei der Placeboanalgesie eine Schlüsselrolle. Sie lassen sich über drei zentrale psychologische Mechanismen erzeugen: 1. über Instruktionen, 2. über die klassische Konditionierung und 3. über soziale Lernprozesse. Diese Mechanismen werden über neurobiologische Signalwege gesteuert und modulieren die Schmerzwahrnehmung bei positiver Erwartung zugunsten einer Schmerzlinderung und bei negativer Erwartung in Richtung Schmerzsteigerung, als sog. Noceboeffekt.

Auch im Bereich des Juckreizes werden diese psychologischen Mechanismen zum Aufbau und Erhalt von juckreizreduzierenden Placeboreaktionen diskutiert.

Der aktuelle Stand der Forschung weist darauf hin, dass Placeboreaktionen klinisch relevant sind. Ihre gezielte Anwendung ist innerhalb ethischer Richtlinien möglich und kann eine Steigerung der Wirksamkeit einer pharmakologischen Substanz erzeugen. Die Voraussetzungen dafür sind, dass die Forschungsergebnisse von Gesunden auf Patienten übertragen werden können und die Placeboreaktion replizierbar herstellbar ist.

Abstract

Research on placebo responses has made major progress in recent years. Placebo responses are psychobiological events, which are created by the entire therapeutic context. They can appear at any time, not only in experimental and clinical settings. Several studies on analgesia-related placebo research showed that patients have higher placebo responses in comparison to healthy participants, which may also last longer. Expectations play a key role in placebo analgesia. They can be induced via three central psychological mechanisms: 1) expectation induced via instructions, 2) expectation induced via classical conditioning and 3) expectation induced via social learning. These mechanisms are controlled by neurobiological structures and modulate pain perception resulting in pain relief by positive expectations and increased pain by negative expectations, the so-called nocebo effect. There is an ongoing discussion that these psychological mechanisms may also play a central role in inducing and maintaining itch-reducing placebo responses. The current state of research suggests that placebo responses could be used in clinical contexts and should not be viewed as being in competition with medications but as an additive increase in efficacy of a pharmacological substance through specifically induced placebo responses. This targeted use is also possible within ethical guidelines. Important prerequisites are that the research results can be transferred from healthy participants to patients and that the placebo responses are reproducible.

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Förderung

Förderung durch die Deutsche Forschungsgemeinschaft: PD Dr. Regine Klinger (KL1350/3-1, KL1350/4-1), Prof. Dr. Margitta Worm (WO541/12-1), Prof. Dr. Herta Flor (FL156/33-1).

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Authors and Affiliations

  1. Klinik und Poliklinik für Anästhesiologie, Bereich Schmerzmedizin und Schmerzpsychologie, Universitätsklinikum Hamburg-Eppendorf (UKE), Martinistraße 52, 20246, Hamburg, Deutschland

    A. Sölle & R. Klinger

  2. Allergie-Centrum, Klinik für Dermatologie, Allergologie und Venerologie, Charité – Universitätsmedizin Berlin, Berlin, Deutschland

    M. Worm

  3. Zentralinstitut für Seelische Gesundheit, Institut für Neuropsychologie und Klinische Psychologie, Medizinische Fakultät Mannheim, Universität Heidelberg, Mannheim, Deutschland

    H. Flor

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  1. A. Sölle
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  4. R. Klinger
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Correspondence to A. Sölle.

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Interessenkonflikt

A. Sölle, M. Worm, H. Flor und R. Klinger geben an, dass kein Interessenkonflikt besteht.

Dieser Beitrag beinhaltet keine von den Autoren durchgeführten Studien an Menschen oder Tieren.

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Sölle, A., Worm, M., Flor, H. et al. Placeboreaktion – Mechanismen und klinische Anwendungen. Schmerz 30, 386–394 (2016). https://doi.org/10.1007/s00482-016-0138-1

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