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首页> 美国卫生研究院文献>BMC Musculoskeletal Disorders >Clinical relevance of contextual factors as triggers of placebo and nocebo effects in musculoskeletal pain
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Clinical relevance of contextual factors as triggers of placebo and nocebo effects in musculoskeletal pain

机译：背景因素在肌肉骨骼疼痛中引发安慰剂和诺西博作用的临床相关性

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Placebo and nocebo effects are embodied psycho-neurobiological responses capable of modulating pain and producing changes at different neurobiological, body at perceptual and cognitive levels. These modifications are triggered by different contextual factors (CFs) presented in the therapeutic encounter between patient and healthcare providers, such as healing rituals and signs. The CFs directly impact on the quality of the therapeutic outcome: a positive context, that is a context characterized by the presence of positive CFs, can reduce pain by producing placebo effects, while a negative context, characterized by the presence of negative CFs, can aggravate pain by creating nocebo effects. Despite the increasing interest about this topic; the detailed study of CFs as triggers of placebo and nocebo effects is still lacked in the management of musculoskeletal pain.Increasing evidence suggest a relevant role of CFs in musculoskeletal pain management. CFs are a complex sets of internal, external or relational elements encompassing: patient’s expectation, history, baseline characteristics; clinician’s behavior, belief, verbal suggestions and therapeutic touch; positive therapeutic encounter, patient-centered approach and social learning; overt therapy, posology of intervention, modality of treatment administration; marketing features of treatment and health care setting. Different explanatory models such as classical conditioning and expectancy can explain how CFs trigger placebo and nocebo effects. CFs act through specific neural networks and neurotransmitters that were described as mediators of placebo and nocebo effects.Available findings suggest a relevant clinical role and impact of CFs. They should be integrated in the clinical reasoning to increase the number of treatment solutions, boosts their efficacy and improve the quality of the decision-making. From a clinical perspective, the mindful manipulation of CFs represents a useful opportunity to enrich a well-established therapy in therapeutic setting within the ethical border. From a translational perspective, there is a strong need of research studies on CFs close to routine and real-world clinical practice in order to underline the uncertainty of therapy action and help clinicians to implement knowledge in daily practice.
机译：安慰剂和诺西波的作用体现在心理神经生物学反应上，能够调节疼痛并在不同的神经生物学，身体的知觉和认知水平上产生变化。这些修改是由患者和医护人员之间在治疗中遇到的不同背景因素（CF）触发的，例如治疗习惯和体征。 CFs直接影响治疗结果的质量：积极的情境（以阳性CFs的存在为特征）可以通过产生安慰剂效应来减轻疼痛，而消极的情境（以CFs阴性的存在为特征）可以减轻疼痛。通过产生nocebo效应加剧疼痛。尽管对该主题越来越感兴趣；在肌肉骨骼疼痛的治疗中仍缺乏对CFs作为安慰剂和Nocebo效应的触发因素的详细研究。越来越多的证据表明CFs在肌肉骨骼疼痛的治疗中具有重要作用。 CF是内部，外部或相关因素的复杂集合，包括：患者的期望，病史，基线特征；临床医生的行为，信念，口头建议和治疗手法；积极的治疗相遇，以患者为中心的方法和社会学习；公开治疗，干预措施，治疗方式；治疗和保健设置的营销特征。不同的解释模型（例如经典条件和期望值）可以解释CF如何触发安慰剂和Nocebo效应。 CFs通过特定的神经网络和神经递质起作用，这些神经网络和神经递质被描述为安慰剂和Nocebo的介质。现有发现提示CFs具有相关的临床作用和影响。它们应与临床推理相结合，以增加治疗方案的数量，提高其疗效并提高决策质量。从临床角度来看，对CFs的谨慎操作代表了一个有益的机会，可以在伦理范围内丰富治疗环境中的既定治疗方法。从翻译的角度来看，迫切需要对接近常规和现实世界临床实践的CF进行研究，以强调治疗措施的不确定性并帮助临床医生在日常实践中运用知识。

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