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Dipartimento di Neuroscienze, Università degli Studi di Torino e
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Transcript of Dipartimento di Neuroscienze, Università degli Studi di Torino e
Dipartimento di Neuroscienze, Università degli Studi di Torinoe
Istituto Nazionale di Neuroscienze (INN), Torino
www.personalweb.unito.it / fabrizio.benedettiwww.ist-nazionale-neuroscienze.unito.it
Placebo
Improvement
Spontaneousremission
Regression tothe mean
Biases
Detectionambiguity
Unidentifiedco-interventions
Psychosocial-psychobiologicalfactors
Pavlovianconditioning
Expectation
Rewardmechanisms
Anxietymechanisms
PLACEBO RESPONSE
IMPROVEMENT IN THE PLACEBO GROUP
COGNITION• Expectation• Belief• Trust• Hope
Conditioned stimulus
Unconditioned stimulus (e.g. drug)
Conditioned response
EffectEffect
UnconsciousConscious
IFN-, IL-2 5-HT1B-1D 5-HT re-uptake D2-D3 CCK-A/B -opioid -adrenergic
immuno sumatriptan anti anti CCK narcotic -blockersuppressive depressant parkinsonian antagonist
Psychosocial context
D r u g s
e x p e c t a t i o na n d / o r c o n d i t i o n i n g
Analgesia andcardiovascularsystem
Hyperalgesia
Parkinson
DepressionHormonalresponsesImmune
responses
Analgesia andrespiratorycenters
Benedetti (2008) Annu Rev Pharmacol Toxicol 48: 33-60
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Pain
reduct
ion
BUPRENORPHINE TRAMADOL KETOROLAC METAMIZOL
open openopen openhidden hiddenhidden hidden
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Open injection Hidden injection
computer
Pharmacodynamic effect
Psychological effect
Benedetti et al (1995) Lancet 346: 1231Amanzio et al. (2001) Pain 90:205-15Colloca et al (2004) Lancet Neurol. 3: 679-684
TRIAL Met#2 (Colloca and Benedetti, Nature Rev Neurosci 6: 545-552, 2005)
Is metamizol (300 mg) effective in post-thymectomy pain?
Open metamizol injection group (N=10)
Hidden metamizol injection group (N=10)Informed consent “You will receive metamizol but you don’t know when”Double blind
Pai
n in
ten
sity
(N
RS
)
0 1 2 3 4 5 60
2
4
6
8
10
Pai
n in
ten
sity
(N
RS
)
0
2
4
6
8
10
Open injection of metamizol
Hidden injection of metamizol
hours
www.personalweb.unito.it / fabrizio.benedettiwww.ist-nazionale-neuroscienze.unito.it
NEUROFISIOLOGIA
Antonella PolloLuana CollocaSergio Vighetti
PSICOLOGIA
Martina AmanzioClaudia ArduinoElisa Carlino
NEUROLOGIA
Leonardo LopianoInnocenzo RaineroGiovanni Asteggiano
CHIRURGIA
Giuliano MaggiCaterina CasadioAnna Arslanian
NEUROCHIRURGIA
Michele LanotteAntonio Melcarne
Dipartimento di Neuroscienze, Università degli Studi di Torinoe
Istituto Nazionale di Neuroscienze (INN), Torino