Impendulo ye-placebo—ingqondo phezu kwendaba, kanye nengqondo inendaba

Iminyaka eminingi, impendulo ye-placebo kokubili kwezokwelapha nasezifundweni zomtholampilo yayiyimpendulo enenzuzo yomzimba ekwelashweni okungokwemvelo okungenampilo. Isayensi yakubona njengokushintshashintsha kwezibalo okubangelwa abantu abathile abanamandla okuthinta ingqondo, ingqondo nomzimba—impendulo eyadala imizwa yenhlalakahle ngamandla enkolelo kanye nesimo sengqondo esihle ngokulindela imiphumela emihle. Kwakuyimpendulo yesiguli eyisisekelo ezifundweni zomtholampilo ukuze ziphumelele. Kodwa emashumini ambalwa eminyaka adlule, sekudume kabi ngokusebenza ngokulingana nezidakamizwa ezivivinyweni zomtholampilo zama-antidepressants.

Umcwaningi we-Placebo, u-Fabrizio Benedetii, eNyuvesi yaseTurin, uxhume ukusabela kwamakhemikhali amaningi okubangela impendulo ye-placebo. Waqala ngokuthola ucwaningo oludala olwenziwa ososayensi base-US olwabonisa ukuthi i-naloxone yesidakamizwa ingavimba amandla okudambisa izinhlungu empendulo ye-placebo. Ubuchopho bukhiqiza ama-opioid, amaphilisi ezinhlungu emvelo, kanye nama-placebo avusa lawa ma-opioid afanayo ngaphezu kwama-neurotransmitters afana ne-dopamine, okusiza ekudambiseni ubuhlungu nomuzwa wenhlalakahle. Ngaphezu kwalokho, wabonisa ukuthi iziguli ze-Alzheimer ezinokukhubazeka kokusebenza kwengqondo ezingakwazi ukwenza imibono mayelana nekusasa, okungukuthi, ukudala umuzwa wokulindela okuhle, azikwazanga ukuzwa noma yikuphi ukukhululeka kobuhlungu bokwelashwa kwe-placebo. Izisekelo ze-neurophysiological zezifo eziningi zengqondo, njengokukhathazeka komphakathi, ubuhlungu obungapheli, nokudangala aziqondwa kahle, futhi lezi yizimo ezifanayo ezinezimpendulo ezinenzuzo ekwelashweni kwe-placebo. 

Ngenyanga edlule, abacwaningi be-neuroscience yomtholampilo eNyuvesi yaseNorthwestern University bashicilele okutholakele okusha okusekelwe umklamo oqinile wokuhlola kanye nezibalo ezibonisa ukuthi impendulo ye-placebo yesiguli iyalinganiswa futhi ngokuhlehlayo bangabikezela ngokunemba okungu-95% impendulo ye-placebo yesiguli ngokusekelwe ebuchosheni besiguli. ukuxhumana okusebenzayo ngaphambi kokuqala isifundo. Basebenzise imaging ye-resonance magnetic resonance esebenzayo yesimo sokuphumula, i-rs-fMRI, ikakhulukazi i-blood-oxygen-level dependent (BOLD) rs-fMRI. Kuleli fomu le-MRI, umcabango owamukelwe kahle wokuthi amazinga e-oksijini yegazi ebuchosheni ayashintshashintsha kuye ngomsebenzi we-neural futhi lezi zinguquko ze-metabolic ebuchosheni zibonwa kusetshenziswa i-BOLD fMRI. Abacwaningi bahlanganisa ukushintshashintsha kokusebenza kobuchopho besiguli ekushutheni kwesithombe futhi kusukela esicongweni sokuthwebula bangabonisa futhi bathole ukuxhumana okusebenzayo kobuchopho, okungukuthi ukwabelana ngolwazi lobuchopho. 

Abacwaningi basemtholampilo eNyakatho-ntshonalanga, babheke umsebenzi wobuchopho obususelwe ku-fMRI kwabaphethwe yi-osteoarthritis bephendula i-placebo kanye ne-duloxetine yomuthi wobuhlungu. Ocwaningweni lokuqala, abacwaningi benze uhlolo lwe-placebo oluyimpumputhe eyodwa. Bathola cishe uhhafu weziguli uphendule i-placebo kanti enye ayiphendulanga. Abaphenduli be-placebo babonise ukuxhumana okukhudlwana kokusebenza kobuchopho uma kuqhathaniswa nabangaphenduli be-placebo endaweni yobuchopho ebizwa ngokuthi i-right midfrontal gyrus, i-r-MFG. 

Ocwaningweni lwesibili, abacwaningi basebenzise isilinganiso sokuxhumana sokusebenza kobuchopho se-r-MFG ukubikezela iziguli ezingaphendula i-placebo ngokunemba okungu-95%. 

Ocwaningweni lokugcina lwesithathu, babheke iziguli ezasabela kuphela ku-duloxetine futhi bathola ukuxhumana okusebenzayo okutholakala ku-fMRI kwenye indawo yobuchopho (i-parahippocampus gyrus efanele, i-r-PHG) njengokubikezela kwempendulo ye-analgesic ku-duloxetine. Ukutholwa kokugcina kuhambisana nesenzo sekhemisi esaziwayo se-duloxetine ebuchosheni. 

Ekugcineni, bahlanganisa lokho abakutholile mayelana nokuxhumana okusebenzayo kwe-r-PHG ukuze babikezele impendulo ye-duloxetine kulo lonke iqembu leziguli bese belungisa impendulo ebikezelwe ye-analgesic ku-placebo. Bathole ukuthi i-duloxetine ithuthukisa futhi yanciphisa impendulo ye-placebo. Lokhu kuholela emphumela ongathandeki ongakaze ubonwe womuthi osebenzayo onciphisa impendulo ye-placebo. Indlela yokusebenzisana phakathi kwe-r-PHG ne-r-MFG isazonqunywa.