Relieving pain using dose-extending placebos: a scoping review.
Relieving pain using dose-extending placebos: a scoping review.
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DOI：
10.1097/j.pain.0000000000000566
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发表时间：
2016-08
期刊：
影响因子：
7.4
通讯作者：
DeGrazia D
中科院分区：
文献类型：
--
作者：
Colloca L;Enck P;DeGrazia D
安慰剂经常被临床医生使用，通常是欺骗性的，几乎没有理由或证据的好处，使他们的使用道德问题。与其典型的当前使用相反，一项具有挑衅性的研究表明，安慰剂可以被有意地利用来延长镇痛治疗效果。是否有可能通过散布安慰剂来延长药物治疗的效果？我们回顾了一个安慰剂研究数据库，寻找表明在反复给予积极治疗后给予安慰剂获得药物样作用的研究。我们发现了总共22项在动物和人类身上进行的研究，这些研究暗示了安慰剂可能作为活性止痛药的一种剂量扩展剂的证据。只要能有效缓解临床疼痛，这种安慰剂的使用就能提供几个优势。首先，通过使用安慰剂来延长止痛药的效果可能会减少药物的总摄入量和副作用。其次，剂量延长安慰剂可能会降低患者的依赖性。第三，在部分治疗过程中使用安慰剂沿着活性药物，应限制剂量增加并降低成本。重要的是，如果在知情同意过程中预先授权不披露，并且有力的证据表明治疗获益与标准全剂量治疗方案相当，则应考虑将剂量延长安慰剂引入临床武器库。这种安慰剂使用的新前景有可能改变我们对止痛药治疗的一般想法，止痛药应用的典型方案，以及治疗评估的方式。
Placebos are often used by clinicians, usually deceptively and with little rationale or evidence of benefit, making their use ethically problematic. In contrast with their typical current use, a provocative line of research suggests that placebos can be intentionally exploited to extend analgesic therapeutic effects. Is it possible to extend the effects of drug treatments by interspersing placebos? We reviewed a database of placebo studies, searching for studies that indicate that placebos given after repeated administration of active treatments acquire medication-like effects. We found a total of 22studies in both animals and humans hinting of evidence that placebos may work as a sort of dose extender of active painkillers. Wherever effective in relieving clinical pain, such placebo use would offer several advantages. First, extending the effects of a painkiller through the use of placebos may reduce total drug intake and side effects. Second, dose-extending placebos may decrease patient dependence. Third, using placebos along with active medication, for part of the course of treatment, should limit dose escalation and lower costs. Importantly, provided that nondisclosure is pre-authorized in the informed consent process and that robust evidence indicates therapeutic benefit comparable to that of standard full-dose therapeutic regimens, introducing dose-extending placebos into the clinical arsenal should be considered. This novel prospect of placebo use has the potential to change our general thinking about painkiller treatments, the typical regimens of painkiller applications, and the ways in which treatments are evaluated.