Nocebo refers to non-pharmacological adverse effects of an intervention. Well-intended procedural warnings frequently function as a nocebo. Both nocebo and placebo are integral to the generation of 'real' treatment effects and their associated 'real' side-effects. They are induced or exacerbated by: context; negative expectancy; and negative conditioning surrounding treatment. Since the late 1990s, the neuroscience literature has repeatedly demonstrated that the nocebo effect is mediated by discrete neurobiological mechanisms and specific physiological modulations. Although no single biological mechanism has been found to explain the nocebo effect, nocebo hyperalgesia is thought to initiate from the dorsal lateral prefrontal cortex subsequently triggering the brain's descending pain modulatory system and other pain regulation pathways. Functional magnetic resonance imaging shows that expectation of increased pain is accompanied by increased neural activity in the hippocampus and midcingulate cortex which is not observed when analgesia is expected. Functional magnetic resonance imaging studies have shown that the anterior cingulate cortex is pivotal in the perception of affective pain evoked by nocebo words. Research has also explored neurotransmitters which mediate the nocebo effect. The neuropeptide cholecystokinin appears to play a key role in the modulation of pain by nocebo. Hyperalgesia generated by nocebo also increases the activity of the hypothalamic-pituitary-adrenal axis as indicated by increases in plasma cortisol. The avoidance or mitigation of nocebo needs to be recognised as a core clinical skill in optimising anaesthesia care. Embracing the evidence around nocebo will allow for phrases such as 'bee sting' and 'sharp scratch' to be thought of as clumsy verbal relics of the past. Anaesthesia as a profession has always prided itself on practicing evidence-based medicine, yet for decades anaesthetists and other healthcare staff have communicated in ways counter to the evidence. The premise of every interaction should be 'primum non nocere' (first, do no harm). Whether the context is research or clinical anaesthesia practice, the nocebo can be ignored no longer.

中文翻译：

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反安慰剂在麻醉护理中的意义。

Nocebo 是指干预的非药物副作用。善意的程序警告经常起到反安慰剂的作用。反安慰剂和安慰剂都是产生“真实”治疗效果及其相关“真实”副作用的组成部分。它们是由以下因素引起或加剧的：上下文；负预期；和消极调节周边治疗。自 1990 年代后期以来，神经科学文献一再证明，反安慰剂效应是由离散的神经生物学机制和特定的生理调节介导的。虽然没有发现单一的生物学机制来解释反安慰剂效应，但反安慰剂痛觉过敏被认为是从背侧前额叶皮层开始，随后触发大脑。s下行疼痛调节系统和其他疼痛调节途径。功能性磁共振成像显示，疼痛增加的预期伴随着海马和扣带回皮层神经活动的增加，这在预期镇痛时未观察到。功能性磁共振成像研究表明，前扣带回皮层在感知反安慰剂词引起的情感疼痛中起关键作用。研究还探索了介导反安慰剂效应的神经递质。神经肽胆囊收缩素似乎在反安慰剂调节疼痛中起关键作用。反安慰剂产生的痛觉过敏也增加了下丘脑-垂体-肾上腺轴的活性，如血浆皮质醇增加所示。需要将避免或减轻反安慰剂视为优化麻醉护理的核心临床技能。接受有关 nocebo 的证据将使诸如“蜜蜂蜇伤”和“尖锐划痕”之类的短语被认为是过去的笨拙口头遗物。麻醉作为一个职业，一直以实践循证医学为荣，但几十年来，麻醉师和其他医护人员的沟通方式与证据背道而驰。每次互动的前提都应该是“primum non nocere”（首先，不伤害）。无论是研究还是临床麻醉实践，都不能再忽视反安慰剂。被认为是过去笨拙的口头遗物。麻醉作为一个职业，一直以实践循证医学为荣，但几十年来，麻醉师和其他医护人员的沟通方式与证据背道而驰。每次互动的前提都应该是“primum non nocere”（首先，不伤害）。无论是研究还是临床麻醉实践，都不能再忽视反安慰剂。被认为是过去笨拙的口头遗物。麻醉作为一个职业，一直以实践循证医学为荣，但几十年来，麻醉师和其他医护人员的沟通方式与证据背道而驰。每次互动的前提都应该是“primum non nocere”（首先，不伤害）。无论是研究还是临床麻醉实践，都不能再忽视反安慰剂。