OPEN-LABEL PLACEBO reflections on a research agenda
OPEN-LABEL PLACEBO reflections on a research agenda
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DOI：
10.1353/pbm.2018.0045
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发表时间：
2018-06-01
影响因子：
1
通讯作者：
Kaptchuk, Ted J.
中科院分区：
文献类型：
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作者：
Kaptchuk, Ted J.
诚实地开出的开放标签安慰剂(OLP)安慰剂药片挑战了安慰剂需要欺骗或隐瞒才能产生健康益处的观念。本文描述了作者如何得出反直觉的OLP假说，讨论了OLP有效性的证据，并检验了OLP的机械解释。目前占主导地位的理论，如预期和条件反射，被发现是不充分的或不准确的。作者认为，新兴的预测和错误处理(PEP)、贝叶斯脑和具身认知等概念是理解OLP的更合适的模型。作为一种神经处理模型，PEP认为感官预测是嵌入在感知中的，并且与感知密不可分；PEP绕过了身心二元论。作者讨论了口腔扁平苔藓(主要是无意识的)如何干扰异常症状的放大和中枢敏感化，导致症状改善的感觉。安慰剂效应是一种神经学编码的预测，患者的想法更少，他们的行动和执行更多。
Open-label placebos (OLP) placebo pills honestly prescribed have challenged the notion that placebos require either deception or concealment to evoke salubrious benefits. This essay describes how the author arrived at the counterintuitive OLP hypothesis, discusses evidence for OLP effectiveness, and examines mechanistic explanations for OLP. Current dominant theories such as expectation and conditioning are found to be insufficient or inaccurate. The author proposes that emerging concepts of prediction and error processing (PEP), Bayesian brain, and embodied cognition are more appropriate models for understanding OLP. As a neural processing model, PEP argues that sensory predictions are embedded in and inseparable from perceptions; PEP circumvents mind-body dualism. The author discusses how OLP, mostly non-consciously, might perturb aberrant symptom amplifications and central sensitization resulting in perceptions of improvement in symptoms. Placebo effects are neurologically encoded predictions, less what patients think and more what they enact and perform.