FOR 1328: Expectation and Conditioning as Basic Processes of the Placebo and Nocebo Response

在许多临床研究中，大约50- 70%的医学干预的积极影响已经报告了安慰剂条件（安慰剂效应）。反之亦然，许多患者报告了药物引起的副作用，尽管他们服用了安慰剂（反安慰剂效应）。作为这些安慰剂和反安慰剂反应的中心心理机制，期望和条件反射已被确定。在过去的十年中，首次在临床环境中发现了预期和条件反射的神经生物学途径。这些结果证实，安慰剂反应经常模仿临床干预所描述的神经生物学通路的活动。对这些安慰剂和反安慰剂反应的进一步研究不仅提供了新的治疗方法，而且为理解症状发展和症状控制提供了新的模型。本研究单位提出了一种翻译方法，弥合了安慰剂和反安慰剂效应的神经生物学基础方法和临床应用之间的差距。所有子项目都在临床环境中操纵期望和/或条件作用。利用脑成像技术（fMRI）研究神经生理通路和电路。免疫、胃肠和疼痛相关系统是通过预期和条件反射范式来操纵的。涉及多巴胺能、血清素能和阿片能神经递质系统。临床应用的测试对象包括接受深部脑刺激的帕金森病患者，以及腰痛、胃肠疾病或心脏外科病人。我们假设期望和条件的系统应用在临床条件提供新的和意想不到的有效治疗方案。

In many clinical studies, about 50-70 percent of the positive effects of a medical intervention are already reported for the placebo condition (placebo effect). Vice versa, many patients report medication-induced side effects, although they received a placebo pill (nocebo effects). As central psychological mechanisms for these placebo and nocebo reactions, expectation and conditioning have been identified. During the last decade, first neurobiological pathways for expectation and conditioning in the clinical context have been detected. These results confirmed that placebo reactions frequently mimick the activity of neurobiological pathways that were described for the clinical intervention. Further investigation of these placebo- and nocebo-reactions does not only offer new treatment approaches, but offer a new model for the understanding of symptom development and symptom control. This Research Unit presents a translational approach bridging the gap between neurobiological basic approaches and clinical applications of placebo and nocebo effects. All subprojects manipulate expectation and/or conditioning effects in the clinical context. Neurophysiological pathways and circuits are investigated using brain imaging techniques (fMRI). Immunological, gastrointestinal and pain-relevant systems are manipulated by means of expectation and conditioning paradigms. Dopaminergic, serotonergic and opioidergic neurotransmitter systems are involved. Clinical applications are tested with patients suffering from Parkinson disease receiving deep brain stimulation, but also in patients with low back pain, gastrointestinal disorders or patients from cardiac surgery units. We postulate that the systematic application of expectation and conditioning in clinical conditions offers new and unexpectedly efficient treatment options.