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Iyo placebo mhedzisiro inoreva kunzwa kwekuvandudzika kwehutano mumuviri wemunhu nekuda kwetarisiro yakanaka kana uchigamuchira kurapwa kusingashande, nepo inoenderana anti placebo mhedzisiro kuderera kwekuita kunokonzerwa netarisiro isina kunaka kana uchigamuchira zvinodhaka zvinodhaka, kana kuitika kwemhedzisiro nekuda kwetarisiro isina kunaka paunogamuchira placebo, izvo zvinogona kutungamira mukuipa kwemamiriro. Ivo vanowanzovepo mukurapwa kwekiriniki nekutsvaga, uye zvinogona kukanganisa kushanda kwemurwere nemhedzisiro.

The placebo effect uye anti placebo effect ndiwo mhedzisiro inogadzirwa nevarwere 'zvakanaka uye zvakaipa tarisiro yemamiriro avo ehutano, zvichiteerana. Migumisiro iyi inogona kuitika munzvimbo dzakasiyana-siyana dzemakiriniki, kusanganisira kushandiswa kwemishonga inoshandiswa kana placebo kurapwa mumakiriniki maitiro kana miedzo, kuwana mvumo yekuziva, kupa ruzivo rwezvokurapa, uye kuita mabasa ekusimudzira hutano hwevanhu. Iyo placebo mhedzisiro inotungamira kune yakanaka mhedzisiro, nepo anti placebo mhedzisiro inotungamira kune zvinokuvadza uye zvine njodzi mhedzisiro.

Misiyano mumhinduro yekurapa uye zviratidzo zvekuratidzira pakati pevarwere vakasiyana inogona kuverengerwa kune placebo uye anti placebo mhedzisiro. Muchiito chekiriniki, kuwanda uye kusimba kwemigumisiro ye placebo yakaoma kuziva, asi pasi pemamiriro ekuedzwa, kuwanda uye kusimba kwehuwandu hwemigumisiro ye placebo yakakura. Semuenzaniso, mune dzakawanda-mapofu makiriniki miedzo yekurapa marwadzo kana chirwere chepfungwa, mhinduro kune placebo yakafanana neyo kune zvinodhaka zvinodhaka, uye kusvika ku19% yevanhu vakuru uye 26% yevatori vechikamu vakwegura vakagamuchira placebo vakarondedzera migumisiro yechirwere. Mukuwedzera, mumakiriniki ekuedzwa, kusvika kune 1/4 yevarwere vakagamuchira placebo vakarega kutora mishonga nekuda kwemigumisiro, zvichiratidza kuti anti placebo effect inogona kutungamirira kukushanda kwezvinodhaka kurega kana kusateerera.

Iyo neurobiological nzira dze placebo uye anti placebo mhedzisiro
Iyo placebo mhedzisiro yakaratidzwa kuve yakabatana nekuburitswa kwezvinhu zvakawanda, senge endogenous opioid, cannabinoids, dopamine, oxytocin, uye vasopressin. Chiito chechinhu chimwe nechimwe chakanangana nehurongwa hwekunangwa (kureva kurwadziwa, kufamba, kana immune system) uye zvirwere (searthritis kana Parkinson's disease). Semuenzaniso, dopamine kuburitswa inobatanidzwa muiyo placebo mukurapa kwechirwere cheParkinson, asi kwete muchiitiko che placebo mukurapa kusingaperi kana kurwadziwa kwakanyanya.

Kuwedzera kwemarwadzo kunokonzerwa nekutaura kwekutaura mukuedza (an anti placebo effect) yakaratidzwa kuti inopindirana neuropeptide cholecystokinin uye inogona kuvharwa neproglutamide (iyo inonzi A uye B receptor antagonist ye cholecystokinin). Muvanhu vane hutano, mutauro uyu unokonzera hyperalgesia unobatanidzwa nekuwedzera kwekuita kwe hypothalamic pituitary adrenal axis. Mushonga we benzodiazepine diazepam unogona kupikisa hyperalgesia uye hyperactivity ye hypothalamic pituitary adrenal axis, zvichiratidza kuti kufunganya kunobatanidzwa mune izvi anti placebo madhara. Zvisinei, alanine inogona kuvhara hyperalgesia, asi haigoni kuvhara kudarika kwe hypothalamic pituitary adrenal axis, zvichiratidza kuti cholecystokinin system inobatanidzwa mu hyperalgesia chikamu che anti placebo effect, asi kwete muchikamu chekuzvidya mwoyo. Kufurira kwemajini pa placebo uye anti placebo mhedzisiro inosanganiswa ne haplotypes ye single nucleotide polymorphisms mu dopamine, opioid, uye endogenous cannabinoid majini.

Imwe nhanho yevatori vechikamu meta-analysis ye20 inoshanda neuroimaging zvidzidzo zvinosanganisira 603 vatori vechikamu vane hutano hwakaratidza kuti iyo placebo mhedzisiro inobatanidza nemarwadzo yakangove nemhedzisiro idiki pamarwadzo ane chekuita nekushanda kwekufungidzira kuratidzwa (kunonzi neurogenic pain signature). Iyo placebo mhedzisiro inogona kuita basa pamatanho akati wandei ehuropi network, iyo inosimudzira manzwiro uye maitiro avo pane akawanda-anopindirana subjective marwadzo zviitiko. Brain uye spinal cord imaging inoratidza kuti anti placebo mhedzisiro inotungamira mukuwedzera kwekurwadziwa chiratidzo kutapurirana kubva kumusana kuenda kuuropi. Muchiyedzo chekuyedza mhinduro yevatori vechikamu kumafuta e-placebo, makirimu aya akatsanangurwa achikonzera marwadzo uye akanyorwa seakakwira kana kuderera mumutengo. Mhedzisiro yacho yakaratidza kuti nzvimbo dzekutapurirana marwadzo muuropi nemuzongoza dzakaitwa apo vanhu vaitarisira kunzwa kurwadziwa kwakanyanya mushure mekugamuchira kurapwa nemitengo yakakwira. Saizvozvowo, zvimwe zviedzo zvakaedza kurwadziwa kunokonzerwa nekupisa kunogona kusunungurwa neine simba opioid drug remifentanil; Pakati pevatori vechikamu vaitenda kuti remifentanil yakamiswa, hippocampus yakabatidzwa, uye anti placebo effect yakavhara kushanda kwemushonga, zvichiratidza kuti kushushikana uye ndangariro zvakabatanidzwa mune izvi.

Zvinotarisirwa, Mazano eMutauro, uye Framework Effects
Zviitiko zvemamorekuru uye neural network inochinja iri pasi pe placebo uye anti placebo mhedzisiro inoyananiswa nezvavanotarisira kana zvinoonekwa ramangwana ravo. Kana tarisiro ichigona kuitika, inonzi tarisiro; Zvinotarisirwa zvinogona kuyerwa nekupesvedzerwa nekuchinja kwemaonero nekuziva. Zvinotarisirwa zvinogona kugadzirwa nenzira dzakasiyana-siyana, kusanganisira zvakaitika kare zvemigumisiro yezvinodhaka nemigumisiro (yakadai seanalgesic effects mushure memishonga), mirayiridzo yemashoko (yakadai sokuziviswa kuti mumwe mushonga unogona kuderedza marwadzo), kana kutarisa kwevanhu (zvakadai sekucherechedza zvakananga kusunungurwa kwezviratidzo kune vamwe mushure mekutora mishonga yakafanana). Nekudaro, zvimwe zvinotarisirwa uye placebo uye anti placebo mhedzisiro hazvigone kuitika. Semuenzaniso, isu tinogona kukonzeresa maitiro ekuita immunosuppressive mhinduro kune varwere vari pasi peitsvo transplantation. Iyo yehumbowo nzira ndeyekushandisa kwayakarerekera stimuli yakambopetwa nema immunosuppressants kuvarwere. Kushandiswa kwekusarerekera kusimudzira chete kunoderedzawo kuwedzera kweT cell.

Muzvirongwa zvekliniki, zvinotarisirwa zvinokonzerwa nenzira iyo zvinodhaka zvinotsanangurwa kana "framework" inoshandiswa. Mushure mekuvhiyiwa, zvichienzaniswa nekutonga kwakavharidzirwa apo murwere asingazivi nguva yekutonga, kana kurapwa kwauchawana paunenge uchipa morphine kunoratidza kuti inogona kunyatsogadzirisa marwadzo, ichaunza zvikomborero zvakakosha. Kurudziro yakananga yemhedzisiro inogona zvakare kuzvizadzisa iwe pachako. Chimwe chidzidzo chaisanganisira varwere vanobatwa ne beta blocker atenolol yechirwere chemoyo uye hypertension, uye zvigumisiro zvakaratidza kuti chiitiko chepabonde nemigumisiro uye kusagadzikana kwe erectile kwaiva 31% kune varwere vakaudzwa nemaune nezvezvinogona kuitika, asi chiitiko chacho chaiva 16% chete kune varwere vasina kuudzwa nezvemigumisiro. Saizvozvowo, pakati pevarwere vakatora finasteride nekuda kwekuwedzera kweprostate prostate, 43% yevarwere vakanyatsoudzwa nezvehutano hwepabonde vakawana migumisiro, asi pakati pevarwere vakanga vasina kuziviswa nezvehutano hwepabonde, chikamu ichi chaiva 15%. Ongororo yaisanganisira varwere veasthma vakafemesa nebulized saline uye vakaudzwa kuti vaifemesa allergens. Zvigumisiro zvakaratidza kuti inenge hafu yevarwere vakawana matambudziko ekufema, kuwedzera kwekudzivirira kwemhepo, uye kuderera kwemapapu. Pakati pevarwere veasthma vakafema bronchoconstrictor, avo vakaudzwa nezvebronchoconstrictor vakawana kushushikana kwakanyanya kwekufema uye kusagadzikana kwemhepo kupfuura avo vakaudzwa nezvebronchodilator.

Mukuwedzera, zvinotarisirwa nemutauro zvinogona kukonzera zviratidzo zvakadai sekurwadziwa, kuputika, uye kusvotwa. Mushure mekutaura kwemutauro, zvinokurudzira zvine chokuita nekurwadziwa kwakadzika-pasi zvinogona kuonekwa sekurwadziwa kwepamusoro-soro, asi tactile stimuli inogona kuonekwa sekurwadziwa. Kunze kwekukurudzira kana kuwedzera zviratidzo, tarisiro dzisina kunaka dzinogonawo kuderedza kushanda kwemishonga inoshanda. Kana ruzivo rwenhema rwekuti mishonga ichawedzera pane kuderedza marwadzo ichiendeswa kuvarwere, mhedzisiro yeanalgesics yemunharaunda inogona kuvharwa. Kana iyo 5-hydroxytryptamine receptor agonist rizitriptan yakanyorwa zvisiri izvo se placebo, inogona kuderedza kushanda kwayo mukurapa migraine kurwisa; Saizvozvo, tarisiro dzisina kunaka dzinogonawo kuderedza mhedzisiro yeanalgesic yemishonga yeopioid pakurwadziwa kunoitwa nekuedza.

Nzira dzekudzidza mu placebo uye anti placebo mhedzisiro
Zvese kudzidza uye classical conditioning zvinobatanidzwa mu placebo uye anti placebo mhedzisiro. Muzviitiko zvakawanda zvekiriniki, kukurudzira kwazvakarerekera kwaimbove kwakabatana nekubatsira kana kukuvadza mhedzisiro yezvinodhaka kuburikidza neiyo classical conditioning inogona kuburitsa mabhenefiti kana mhedzisiro pasina kushandiswa kwemishonga inoshanda mune ramangwana.

Semuyenzaniso, kana zvakatipoteredza kana zvekuravira zvikaramba zvichibatanidzwa ne morphine, iwo matinji anoshandiswa ne placebo pachinzvimbo che morphine anogona kuramba achiburitsa analgesic mhedzisiro. Muvarwere vepsoriasis vakagamuchira kupindirana kwekushandiswa kwedosi yakaderedzwa glucocorticoids uye placebo (inonzi dhigirii rekuwedzera placebo), mwero wekudzoka kwe psoriasis wakafanana neuyo wevarwere vanowana yakazara dosi yeglucocorticoid kurapwa. Muboka rinodzora revarwere vakagamuchira imwechete corticosteroid kuderedza regimen asi vasina kugamuchira placebo panguva dzenguva, kudzoka kwekudzoka kwaive kwakakwirira kudarika katatu iyo yedhesi yekuenderera mberi kweboka rekurapa placebo. Mamiriro akafanana emamiriro ezvinhu akashumwa mukurapwa kwekushaya hope kusingaperi uye mukushandiswa kwemaamphetamines kuvana vane hanya nekushomeka kwe hyperactivity disorder.

Zvakamboitika zvekurapa uye nzira dzekudzidza zvakare dzinofambisa iyo anti placebo mhedzisiro. Pakati pevakadzi vanowana chemotherapy nekuda kwekenza yemazamu, 30% yavo inenge yakatarisira kusvotwa mushure mekusangana nemamiriro ekunze (sekuuya kuchipatara, kusangana nevashandi vezvokurapa, kana kupinda mukamuri rakafanana nekamuri yekupinza) iyo yakanga isina kwayakarerekera isati yaonekwa asi yakange yakabatana nekuiswa. Vana vachangozvarwa vakadzokororwa venipuncture vanobva varatidza kuchema uye kurwadziwa panguva yekucheneswa kwedoro kweganda ravo vasati vabatwa. Kuratidza allergens mumidziyo yakavharwa kune varwere veasthma kunogona kukonzera kurwiswa kweasthma. Kana mvura ine munhuwi chaiwo asi isina zvipenyu zvinobatsira yakasanganiswa nemushonga unoshanda une maside effects (senge tricyclic antidepressants) kare, kushandiswa kwemvura iyoyo ne placebo kunogonawo kukonzera maside effects. Kana zviratidzo zvekuona (zvakadai sechiedza nemifananidzo) zvakambobatanidzwa nekurwadziwa kwekuedza, zvino kushandisa izvi zvinoonekwa chete zvinogona kukonzera marwadzo mune ramangwana.

Kuziva zviitiko zvevamwe zvinogona zvakare kutungamira kune placebo uye anti placebo mhedzisiro. Kuona kusunungurwa kwemarwadzo kubva kune vamwe kunogonawo kukonzera placebo analgesic effect, iyo yakafanana muhukuru kune analgesic effect inogamuchirwa iwe pachako usati warapwa. Pane humbowo hwekuyedza hunoratidza kuti magariro evanhu uye kuratidzira zvinogona kukonzera mhedzisiro. Semuenzaniso, kana vatori vechikamu vakapupurira vamwe vachirondedzera migumisiro yechirwere che placebo, taura marwadzo mushure mekushandisa chizoro chisingaiti, kana kufema mweya wemukati unotsanangurwa se "zvingangoita chepfu," zvinogonawo kutungamirira kumigumisiro yechirwere kune vatori vechikamu vanoonekwa kune imwechete placebo, chizoro chisingaiti, kana mhepo yemukati.

Midhiya midhiya uye zvisiri zvehunyanzvi midhiya mishumo, ruzivo rwakawanikwa kubva paInternet, uye kuonana zvakananga nevamwe vanhu vane zviratidzo zvese zvinogona kusimudzira anti placebo reaction. Semuyenzaniso, mwero wekutaura wekuipa kwakashata kune statins unodyidzana nekusimba kwekutaura kwakashata pama statins. Pane imwe muenzaniso wakajeka apo nhamba yezviitiko zvakashata zvakashumwa zvakawedzera ne2000 nguva mushure memashoko asina kunaka uye nhepfenyuro dzeterevhizheni dzakaratidza kuchinja kunokuvadza mumushonga wemishonga yethyroid, uye inongobatanidza zviratidzo zvakananga zvakataurwa mumishumo yakaipa. Saizvozvo, mushure mekusimudzirwa kweruzhinji kunotungamira vagari venharaunda kuti vatende zvisiri izvo kuti vari kuoneswa zvinhu zvine chepfu kana tsvina ine njodzi, chiitiko chezviratidzo zvinokonzerwa nekufumurwa kunofungidzirwa kunowedzera.

Mhedzisiro ye placebo uye anti placebo mhedzisiro pakutsvaga uye kiriniki maitiro
Zvinogona kubatsira kuona kuti ndiani angangoita placebo uye anti placebo maitiro pakutanga kwekurapa. Zvimwe zvine chekuita nemhinduro idzi zvinozivikanwa parizvino, asi tsvakiridzo yeramangwana inogona kupa humbowo huri nani hwezvinhu izvi. Tarisiro uye kukonzeresa kurudziro hazviratidzike kunge zvine hukama nemhinduro ku placebo. Pane humbowo hunoratidza kuti anti placebo effect inowanzoitika kune varwere vanonyanya kuzvidya mwoyo, vakamboona zviratidzo zvezvikonzero zvisingazivikanwe zvekurapa, kana vane kushushikana kwakanyanya kwepfungwa pakati pevaya vanotora mishonga inoshanda. Parizvino hapana humbowo hwakajeka maererano nebasa revakadzi mu placebo kana anti placebo mhedzisiro. Kufungidzira, njodzi yemajini akawanda, genome-wide association zvidzidzo, uye zvidzidzo zvemapatya zvinogona kubatsira kujekesa kuti maitiro ehuropi uye genetics zvinotungamira sei kukuchinja kwebiological iyo inoshanda sehwaro hwe placebo uye anti placebo mhedzisiro.

Kudyidzana pakati pevarwere uye vanachiremba vemakiriniki kunogona kukanganisa mukana wemigumisiro ye placebo uye zvakataurwa nemigumisiro mushure mekugamuchira placebo nemishonga inoshanda. Kuvimba kwevarwere mune vanachiremba vemakiriniki uye hukama hwavo hwakanaka, pamwe nekukurukurirana kwechokwadi pakati pevarwere nevarapi, zvakaratidzwa kuti zvinoderedza zviratidzo. Naizvozvo, varwere vanodavira kuti varapi vanonzwira urombo uye vanoshuma zviratidzo zvedzihwa inopfava zvikuru uye ipfupi munhambo yenguva kupfuura avo vanodavira kuti varapi havanzwiri tsitsi; Varwere vanotenda kuti varapi vanonzwira tsitsi vanoonawo kuderera kwezviratidzo zvekuzvimba, senge interleukin-8 uye neutrophil count. Izvo zvinotarisirwa zvakanaka zvechiremba vanachiremba vanoitawo basa mune placebo effect. Chidzidzo chidiki kuenzanisa anesthetic analgesics uye placebo kurapwa mushure mekubviswa zino kwakaratidza kuti vanachiremba vaiziva kuti varwere vanowana analgesics vaibatanidzwa nekurerutsira kukuru kwemarwadzo.

Kana tichida kushandisa mushonga weplacebo kuvandudza mhedzisiro yekurapa tisingatore nzira yebaba, imwe nzira ndeyekutsanangura kurapwa nenzira yechokwadi asi yakanaka. Kusimudza tarisiro yezvibatsiro zvekurapa kwakaratidzwa kuvandudza mhinduro yemurwere kune morphine, diazepam, kudzika kwehuropi kukurudzirwa, intravenous administration ye remifentanil, hutungamiri hwemunharaunda ye lidocaine, kupindirana uye kusanganiswa kwemishonga (yakadai se acupuncture), uye kunyange kuvhiyiwa.

Kuongorora zvinotarisirwa nemurwere ndiyo danho rekutanga mukubatanidza zvinotarisirwa izvi mukuita kwekiriniki. Paunenge uchiongorora zvinotarisirwa mhedzisiro yekiriniki, varwere vanogona kukumbirwa kushandisa chiyero che 0 (hapana rubatsiro) kune 100 (yakanyanya inofungidzira kubatsirwa) kuti vaongorore zvavanotarisira zvikomborero zvekurapa. Kubatsira varwere kunzwisisa zvavanotarisira pakuvhiyiwa kwemwoyo kwakasarudzwa kunoderedza migumisiro yekuremara pamwedzi we6 mushure mekuvhiyiwa; Kupa hutungamiri pamusoro pekugadzirisa mazano kune varwere vasati vavhiyiwa mukati memudumbu zvakanyanya kuderedza kurwadziwa kwepashure uye anesthesia mishonga dosage (ne50%). Nzira dzekushandisa idzi mhedzisiro mhedzisiro dzinosanganisira kwete chete kutsanangura kukodzera kwekurapa kuvarwere, asiwo kutsanangura chikamu chevarwere vanobatsirwa nacho. Somuenzaniso, kusimbisa kushanda kwomushonga kuvarwere kunogona kuderedza kudikanwa kwemishonga yokuderedza marwadzo pashure pokuvhiyiwa iyo varwere vanogona kuzvidzora vamene.

Mukuita kwekiriniki, panogona kunge paine dzimwe nzira dzetsika dzekushandisa iyo placebo mhedzisiro. Zvimwe zvidzidzo zvinotsigira kushanda kwe "open label placebo" nzira, iyo inosanganisira kugovera placebo pamwe chete nemushonga unoshanda uye nekutendeka kuzivisa varwere kuti kuwedzera placebo kwakaratidza kuti kunowedzera zvinobatsira zvemushonga unoshanda, nekudaro uchiwedzera kushanda kwawo. Mukuwedzera, zvinokwanisika kuchengetedza kushanda kwemushonga unoshanda kuburikidza nekugadzirisa apo zvishoma nezvishoma kuderedza kuyerwa. Iyo chaiyo yekuvhiya nzira ndeyekubatanidza mushonga nemanzwiro, ayo anonyanya kubatsira kune chepfu kana zvinodhaka zvinodhaka.

Zvakasiyana, ruzivo runotyisa, zvitendero zvisizvo, tarisiro isina tariro, zviitiko zvisina kunaka zvakapfuura, ruzivo rwemagariro evanhu, uye nharaunda yekurapa zvinogona kutungamirira kumigumisiro uye kuderedza mabhenefiti ezviratidzo uye kurapa kwepalliative. Zvisiri zvakananga mhedzisiro yemishonga inoshanda (inopindirana, yakasiyana-siyana, dose yakazvimirira, uye kusavimbika kuberekana) yakajairika. Izvi zvinokonzerwa nemigumisiro inogona kutungamirira kuhutano husina kunaka hwevarwere kune chirongwa chekurapa (kana kuti chirongwa chekurega) chinorayirwa nachiremba, chinoda kuti vashandure kune mumwe mushonga kana kuwedzera mamwe mishonga yekurapa migumisiro iyi. Kunyange zvazvo tichida tsvakurudzo yakawanda kuti tione kushamwaridzana kwakajeka pakati pezviviri, izvi zvisiri izvo zvinokonzerwa nemigumisiro inogona kukonzerwa ne anti placebo effect.

Zvinogona kubatsira kutsanangura mhedzisiro kumurwere uchiratidzirawo mabhenefiti. Zvinogonawo kubatsira kutsanangura mhedzisiro nenzira inotsigira kwete nenzira yekunyengera. Semuenzaniso, kutsanangurira varwere chikamu chevarwere vasina migumisiro, panzvimbo yehuwandu hwevarwere vane migumisiro yechirwere, inogona kuderedza kuitika kwemigumisiro iyi.

Vanachiremba vane chisungo chekuwana mvumo yechokwadi kubva kuvarwere vasati vashandisa kurapwa. Sechikamu cheruzivo rwemvumo, vanachiremba vanofanirwa kupa ruzivo rwakakwana kubatsira varwere mukuita sarudzo dzine ruzivo. Vanachiremba vanofanira kutsanangura zvakajeka uye zvakarurama zvose zvinogona kuva nengozi uye kliniki yakakosha migumisiro, uye kuzivisa varwere kuti migumisiro yose inofanira kutaurwa. Zvisinei, kunyora migumisiro yakaipa uye isiri-yakananga iyo isingade kurapwa imwe neimwe inowedzera mukana wekuitika kwavo, zvichiunza dambudziko kune vanachiremba. Imwe mhinduro inogoneka ndeye kuunza anti placebo maitiro kuvarwere uye wobvunza kana vachida kudzidza nezve hutsinye, husiri-chaiyo mhedzisiro yekurapwa mushure mekuziva nezvemamiriro ezvinhu aya. Iyi nzira inonzi "contextualized ruzivo mvumo" uye "kutariswa kwakatenderwa".

Kuongorora nyaya idzi nevarwere kunogona kubatsira sekutenda kusina kururama, tarisiro dzinoshungurudza, uye zviitiko zvisina kunaka nemishonga yapfuura zvinogona kutungamirira kune anti placebo effect. Ndezvipi zvinogumbura kana kuti zvine ngozi zvazvakamboita kare? Ndeapi maside effects avanonetseka nawo? Kana ivo parizvino vari kutambura ne-benign side effects, vangani maitiro avanofunga kuti aya maside effects ane? Vanotarisira kuti maside effects acho anowedzera nekufamba kwenguva here? Mhinduro dzinopiwa nevarwere dzingabatsira vanachiremba kuderedza kunetseka kwavo pamusoro pemigumisiro yakaipa, zvichiita kuti kurapwa kuve nyore. Vanachiremba vanogona kuvimbisa varwere kuti kunyange zvazvo migumisiro yechirwere ichigona kunetsa, chaizvoizvo haina ngozi uye haina ngozi mune zvokurapa, izvo zvingaderedza kuzvidya mwoyo kunokonzera migumisiro yakaipa. Pane zvinopesana, kana kuwirirana pakati pevarwere nevarapi vekiriniki hakugone kuderedza kushushikana kwavo, kana kutowedzera, kunowedzera mhedzisiro. Ongororo yemhando yezvidzidzo zvekuyedza uye zvekiriniki inoratidza kuti maitiro asina kunaka asingatauriki uye nzira dzekutaurirana dzisina hanya (sekutaura kunzwira tsitsi, kushaikwa kwekuonana nevarwere, kutaura kusinganzwisisike, uye kusanyemwerera pachiso) kunogona kukurudzira anti placebo effect, kuderedza kushivirira kwevarwere kumarwadzo, uye kuderedza mhedzisiro ye placebo. Zvinofungidzirwa kuti mhedzisiro inowanzova zviratidzo izvo zvaimbofuratirwa kana kufuratirwa, asi zvino zvinonzi zvakakonzerwa nemushonga. Kugadzirisa fungidziro iyi isiriyo kunogona kuita kuti mushonga ugone kushiviririka.

Mamiriro ezvinhu anotaurwa nevarwere anogona kuratidzwa pasina kutaura uye nekuvanda, kuratidza kusava nechokwadi, kusagutsikana, kana kunetseka pamusoro pemushonga, chirongwa chekurapa, kana hunyanzvi hwehunyanzvi hwachiremba. Kuenzaniswa nekutaura kusava nechokwadi zvakananga kuvarapi vekiriniki, migumisiro yechirwere chikonzero chinonyadzisa uye chinogamuchirwa nyore chekurega mishonga. Mumamiriro ezvinhu aya, kujekesa uye kutaura zviri pachena zvinonetsa omurwere zvinogona kubatsira kudzivirira mamiriro ekurega kana kusateedzera.

Tsvagiridzo yezve placebo uye anti placebo mhedzisiro ine chirevo mukugadzira uye kuita kwekiriniki miedzo, pamwe nekududzirwa kwemhedzisiro. Chekutanga, pazvinogoneka, kuyedzwa kwekiriniki kunofanirwa kusanganisira kupindira mahara mapoka ekupindira kuti atsanangure zvinovhiringidza zvinhu zvine chekuita ne placebo uye anti placebo mhedzisiro, senge symptom regression zvinoreva. Chechipiri, iyo longitudinal dhizaini yekuedzwa ichakanganisa chiitiko chekupindura kune placebo, kunyanya mucrossover dhizaini, sekune vatori vechikamu vakagamuchira mushonga unoshanda pakutanga, zviitiko zvakapfuura zvakanaka zvaizounza zvinotarisirwa, nepo vatori vechikamu vakagamuchira placebo pakutanga havana. Sezvo kuzivisa varwere nezvemabhenefiti chaiwo uye nemhedzisiro yekurapa kunogona kuwedzera chiitiko chezvibatsiro izvi uye nemhedzisiro, zviri nani kuchengetedza kuenderana mune zvinobatsira uye nemhedzisiro ruzivo rwakapihwa panguva yeruzivo rwemvumo nzira pamiyedzo yekudzidza chaiyo mushonga. Mune meta-analysis apo ruzivo rwunotadza kusvika pakuenderana, mhedzisiro inofanirwa kududzirwa nekuchenjerera. Zvakanakisisa kune vatsvakurudzi vanounganidza data pamusoro pemigumisiro kuti vasaziva zvose boka rekurapa uye mamiriro emigumisiro. Paunenge uchiunganidza dhiyabhorosi data, yakarongeka chiratidzo chinyorwa chiri nani pane yakavhurika ongororo.