The effect of treatment history on therapeutic outcome: psychological and neurobiological underpinnings.
The effect of treatment history on therapeutic outcome: psychological and neurobiological underpinnings.
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DOI：
10.1371/journal.pone.0109014
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发表时间：
2014
期刊：
影响因子：
3.7
通讯作者：
Bingel U
中科院分区：
文献类型：
--
作者：
Kessner S;Forkmann K;Ritter C;Wiech K;Ploner M;Bingel U
人们越来越认识到，医学治疗的功效在很大程度上取决于其实施的治疗环境。该背景的一个重要特征是治疗史。我们最近报告了第一个证据，证明治疗经验可以延续到不同治疗方法的后续治疗反应中。在这里，我们通过在安慰剂镇痛和调节过程的实验模型中探索治疗经验对未来治疗反应的影响的心理和神经生物学基础来扩展这些发现。在一项行为和神经影像学相结合的研究中，我们通过实验在两组健康受试者中诱导了镇痛治疗的积极或消极体验。随后，我们比较了两组之间对第二种不同镇痛治疗的反应。我们发现，在第一次治疗中经历过实验诱发的负面经历的参与者对第二次镇痛治疗的反应显着降低。有趣的是，包括焦虑、抑郁和控制点在内的一些心理特征变量调节了先前治疗经历对未来治疗结果影响的敏感性。这些行为效应得到了神经影像数据的支持，该数据显示各组之间编码疼痛和镇痛的大脑区域存在显着差异。这些激活模式的差异不仅存在于疼痛阶段，而且在疼痛刺激之前就已经存在，并随个体治疗反应而变化。我们的数据提供了行为和神经生物学证据，表明治疗史的影响随着时间和治疗方法的推移而转移。我们的实验结果强调仔细考虑治疗史和严格系统的治疗方法，以避免负面影响。
It is increasingly recognized that the efficacy of medical treatments is determined in critical part by the therapeutic context in which it is delivered. An important characteristic of that context is treatment history. We recently reported first evidence for a carry-over of treatment experience to subsequent treatment response across different treatment approaches. Here we expand on these findings by exploring the psychological and neurobiological underpinnings of the effect of treatment experience on future treatment response in an experimental model of placebo analgesia with a conditioning procedure. In a combined behavioral and neuroimaging study we experimentally induced positive or negative experiences with an analgesic treatment in two groups of healthy human subjects. Subsequently we compared responses to a second, different analgesic treatment between both groups. We found that participants with an experimentally induced negative experience with the first treatment showed a substantially reduced response to a second analgesic treatment. Intriguingly, several psychological trait variables including anxiety, depression and locus of control modulate the susceptibility for the effects of prior treatment experiences on future treatment outcome. These behavioral effects were supported by neuroimaging data which showed significant differences in brain regions encoding pain and analgesia between groups. These differences in activation patterns were present not only during the pain phase, but also already prior to painful stimulation and scaled with the individual treatment response. Our data provide behavioral and neurobiological evidence showing that the influence of treatment history transfers over time and over therapeutic approaches. Our experimental findings emphasize the careful consideration of treatment history and a strictly systematic treatment approach to avoid negative carry-over effects.
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