Erwartungseffekte im psychosozialen Behandlungskontext: Mechanismen und klinische Implikationen von Placebo- und Noceboeffekten beim Bauchschmerz

Zusammenfassung

Die Bedeutung von Behandlungserwartungen in der Therapie wird zunehmend anerkannt, insbesondere bei körperlichen Symptomen wie Schmerzen. Die Placeboforschung untersucht die Mechanismen und klinischen Implikationen dieser Erwartungseffekte für verschiedene Organsysteme und Krankheiten, wobei die Schmerzforschung umfangreiche Erkenntnisse liefert. Sowohl experimentelle als auch klinische Ergebnisse zeigen, dass Kognitionen und Emotionen die Symptomwahrnehmung erheblich beeinflussen können, wie die Placebo-Analgesie und Nocebo-Hyperalgesie zeigen. Placebo- und Nocebo-Effekte werden bei verschiedenen Schmerzarten und -erkrankungen beobachtet, unabhängig von der Schmerzlokalisation oder der spezifischen Diagnose. Sie sind besonders relevant für Bauchschmerzen und interozeptive Symptome, die in der Psychosomatischen Medizin und der Klinischen Psychologie häufig vorkommen. Das Verständnis dieser Effekte ist für die Behandlung somatoformer Störungen wie dem Reizdarmsyndrom von entscheidender Bedeutung. Die Forschung in diesem Bereich zielt darauf ab, Wissenslücken zwischen verschiedenen Disziplinen zu schließen, was wertvolle klinische Auswirkungen hat und den Weg für bessere Präventions- und Behandlungsstrategien ebnet. In dieser Übersichtsarbeit werden (1) grundlegende Mechanismen und Forschungsansätze zu Placebo- und Nocebo-Effekten, (2) Erkenntnisse zu Placebo-Effekten bei Bauchschmerzen und interozeptiven Symptomen, (3) evidenzbasierte Schlussfolgerungen und praktische Empfehlungen für die klinische Umsetzung sowie (4) Erkenntnisse und umsetzbare Vorschläge für BehandlerInnen und Betroffene dargestellt. Behandlerinnen und Behandler können Wissen aus der Placeboforschung praktisch nutzen, indem sie beispielsweise eine vertrauensvolle Beziehung aufbauen, positive Informationen gezielt in den Vordergrund stellen und Behandlungen systematisch wertschätzen und gleichzeitig Nocebo-Effekte strategisch minimieren, indem sie die negativen Vorerfahrungen der Patienten verstehen und die Kommunikation verbessern, um Missverständnissen, negativen Erwartungen und Ängsten bestmöglich vorzubeugen.

Abstract

The significance of treatment expectations in therapy is increasingly acknowledged, particularly regarding bodily symptoms like pain. Placebo research investigates the mechanisms and clinical implications of these expectation effects across various organ systems and diseases, with pain research providing extensive insights. Both experimental and clinical findings show that cognitions and emotions can significantly influence pain perception, as demonstrated by placebo analgesia and nocebo hyperalgesia. Placebo and nocebo effects are observed across different pain types and disorders, regardless of pain location or specific diagnosis. They are particularly relevant for abdominal pain and interoceptive symptoms common in psychosomatic medicine and clinical psychology. Understanding these effects is crucial for treating somatoform disorders like irritable bowel syndrome (IBS). Research in this area aims to bridge knowledge gaps across disciplines, offering valuable clinical implications and paving the way for better prevention and treatment strategies. This review outlines (1) fundamental mechanisms and research approaches to placebo and nocebo effects, (2) findings on placebo effects in abdominal pain and interoceptive symptoms, (3) evidence-based conclusions and practical recommendations for clinical implementation, and (4) insights and actionable proposals for healthcare providers and patients. Healthcare providers can strategically harness placebo effects through positive information, enhanced treatment value, and empathetic relationships, while also addressing nocebo effects by understanding patients' negative prior experiences and improving communication to reduce misunderstandings and negative expectations. A trusting collaboration between providers and patients is essential for long-term therapeutic success.

Schlüsselwörter

Placeboeffekt - Noceboeffekt - Bauchschmerz - Reizdarmsyndrom - somatische Belastungsstörung - Arzt-Patient Kommunikation

Keywords

Placebo effect - nocebo effect - abdominal pain - irritable bowel syndrome - somatic symptom disorder - doctor-patient communication

Publication History

Article published online:
09 April 2025

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