Wenn aus einem Bauchgefühl viszerale Schmerzen werden: Placebo- und Nocebo-Mechanismen entlang der Darm-Hirn-Achse

Zusammenfassung

Das Erleben von Schmerz ist nach heutigem Verständnis durch eine Vielzahl biologischer, psychologischer und sozialer Faktoren geprägt und somit eine komplexe, von der Nozizeption abzugrenzende, psychologische Erfahrung. Entsprechend ist das Schmerzerleben durch psychologische Faktoren modulierbar und chronische Schmerzen werden als biopsychosoziale Erkrankungen verstanden. Dies gilt auch für den Viszeralschmerz, dem spezifische psychophysiologische Prinzipien und neurobiologische Mechanismen zugrunde liegen, was eine interdisziplinäre Betrachtung unter Einbeziehung der Psychologie und der Neurowissenschaften erforderlich macht. Ausgehend von den bidirektionalen Verbindungen zwischen Darm und Hirn und aufbauend auf einem biopsychosozialen Krankheitsmodell beschreibt dieser Übersichtsbeitrag psychologische Mechanismen, die bei der Entstehung, Aufrechterhaltung und Therapie viszeraler Schmerzen wichtig sind. Dabei liegt der Fokus auf positiven und negativen Erwartungseffekten im psychosozialen Behandlungskontext. Therapieerwartungen können Krankheitssymptome sowohl positiv als auch negativ beeinflussen. Diese gemeinhin als Placebo- und Noceboeffekte bekannten Phänomene, die durch die Arzt-Patient Kommunikation, Lernprozesse, Stress und Furcht vermittelt werden, sind auch für den Viszeralschmerz bei gastrointestinalen Erkrankungen zunehmend anerkannt und Gegenstand aktueller grundlagenwissenschaftlicher und klinischer Forschungsaktivitäten. Neue interdisziplinäre und translationale Forschungsansätze aus der Forschung zu Placebo- und Noceboeffekten liefern spannende Einblicke in die zahlreichen Verbindungen und Wechselbeziehungen zwischen Darm und Gehirn bei normalen wie auch pathologischen Darm-Hirn Interaktionen und können dazu beitragen, die Pathophysiologie von Erkrankungen, die mit viszeralen Schmerzen einhergehen, besser zu verstehen und wichtige Erkenntnisse für neue Therapieansätze zu gewinnen.

Abstract

The experience of pain is shaped by a multitude of biological, psychological and social factors and is thus a complex psychological experience to be distinguished from nociception. Accordingly, the experience of pain can be modulated by psychological factors, and chronic pain conditions constitute biopsychosocial disorders. This is also true for visceral pain, which involves specific psychophysiological principles and neurobiological mechanisms, calling for an interdisciplinary approach at the interface of gastroenterology, psychology, pain research and the neurosciences. Based on the bidirectional connections between the gut and the brain and building on a biopsychosocial model, this review article describes psychological mechanisms that are important in the development, maintenance, and treatment of visceral pain. The focus is on positive and negative expectancy effects within the psychosocial treatment context. Treatment expectations can influence symptoms of the gut-brain axis, especially visceral pain, both positively and negatively. These phenomena, commonly known as placebo and nocebo effects, are mediated by doctor-patient communication, learning processes, stress, and fear. New interdisciplinary and translational research approaches from research on placebo and nocebo effects provide exciting insights into normal and pathological gut-brain interactions and may improve our knowledge about the etiology and pathophysiology of visceral hyperalgesia and interoceptive hypervigilance and provide important insights into new therapeutic approaches.

Schlüsselwörter

Placebo - Nocebo - Erwartungen - Viszeraler Schmerz - Darm-Hirn Achse

Key words

Placebo - Nocebo - Expectations - Visceral Pain - Gut-Brain Axis

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