Nocebo hyperalgesia: how anxiety is turned into pain
Nocebo hyperalgesia: how anxiety is turned into pain
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DOI：
10.1097/aco.0b013e3282b972fb
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发表时间：
2007-10-01
影响因子：
2.5
通讯作者：
Benedetti, Fabrizio
中科院分区：
文献类型：
--
作者：
Colloca, Luana;Benedetti, Fabrizio
综述目的Nocebo痛觉过敏是一种与安慰剂镇痛相反的现象，其中疼痛增加的预期起着至关重要的作用。近年来，反安慰剂效应和反安慰剂相关效应的神经解剖学和神经化学基础已经开始探索。在这里，我们强调最近的进展，我们的理解nocebo hyperalgesic effect.Recent findingsA典型nocebo hyperalgesic反应发生后，管理的惰性物质，受试者认为是一个hyperalgesic剂（负安慰剂或nocebo）。研究表明，受试者对疼痛恶化的负面预期会诱发对即将发生的疼痛增加的预期焦虑，这会触发胆囊收缩素的激活，进而促进疼痛传递。因此，已经发现胆囊收缩素拮抗剂可以预防这种焦虑诱导的痛觉过敏。脑成像研究表明，疼痛刺激的感知强度以下的负面预期的疼痛增加是高于在没有负面预期，这是与变化的激活特定的大脑regions.SummarySince疼痛似乎是放大焦虑通过激活胆囊收缩素系统，新的治疗策略，如新的胆囊收缩素拮抗剂，当疼痛有一个重要的焦虑成分时，可以设想。
Purpose of reviewNocebo hyperalgesia is a phenomenon that is opposite to placebo analgesia and whereby expectation of pain increase plays a crucial role. In recent times, both the neuroanatomical and the neurochemical bases of the nocebo effect and of nocebo-related effects have begun to be explored. Here, we highlight recent advances in our understanding of the neurobiology of the nocebo hyperalgesic effect.Recent findingsA typical nocebo hyperalgesic response occurs following the administration of an inert substance which the subject believes to be a hyperalgesic agent (negative placebo or nocebo). It has been shown that the subject's negative expectations of pain worsening induce anticipatory anxiety about the impending pain increase and this triggers the activation of cholecystokinin that, in turn, facilitates pain transmission. Accordingly, cholecystokinin antagonists have been found to prevent this anxiety-induced hyperalgesia. Brain-imaging studies have shown that the perceived intensity of a painful stimulus following negative expectations of pain increase is higher than in the absence of negative expectations and this is associated with changes in activation of specific brain regions.SummarySince pain appears to be amplified by anxiety through the activation of cholecystokininergic systems, new therapeutic strategies, such as new cholecystokinin antagonists, can be envisaged whenever pain has an important anxiety component.