Nonspecific medication side effects and the nocebo phenomenon
Nonspecific medication side effects and the nocebo phenomenon
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DOI：
10.1001/jama.287.5.622
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发表时间：
2002-02-06
影响因子：
120.7
通讯作者：
Borus, JF
中科院分区：
文献类型：
--
作者：
Barsky, AJ;Saintfort, R;Borus, JF
服用活性药物的患者经常会出现不良的、非特异性的副作用，这些副作用不是药物特定药理作用的直接结果。尽管这种现象很常见、令人痛苦且代价高昂，但人们却很少对其进行研究和了解。反安慰剂现象，即安慰剂产生不良副作用，为非特异性副作用报告提供了一些见解。我们对文献进行了重点回顾，确定了与反安慰剂现象和/或服用积极药物时非特异性副作用报告相关的几个因素：患者在治疗开始时对不良反应的预期；一个调节过程，患者从以前的经验中学习将服药与躯体症状联系起来；某些心理特征，如焦虑、抑郁和躯体化倾向；以及情境和背景因素。医生和其他卫生保健人员可以尝试通过提前识别那些最有可能出现这些副作用的患者，并通过与患者的合作关系来解释和帮助患者理解和忍受这些令人烦恼但无害的症状，从而尝试改善活性药物的非特异性副作用。
Patients taking active medications frequently experience adverse, nonspecific side effects that are not a direct result of the specific pharmacological action of the drug. Although this phenomenon is common, distressing, and costly, it is rarely studied and poorly understood. The nocebo phenomenon, in which placebos produce adverse side effects, offers some insight into nonspecific side effect reporting. We performed a focused review of the literature, which identified several factors that appear to be associated with the nocebo phenomenon and/or reporting of nonspecific side effects while taking active medication: the patient's expectations of adverse effects at the outset of treatment; a process of conditioning in which the patient learns from prior experiences to associate medication-taking with somatic symptoms; certain psychological characteristics such as anxiety, depression, and the tendency to somatize; and situational and contextual factors. Physicians and other health care personnel can attempt to ameliorate nonspecific side effects to active medications by identifying in advance those patients most at risk for developing them and by using a collaborative relationship with the patient to explain and help the patient to understand and tolerate these bothersome but nonharmful symptoms.