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Academia Mexicana de Neurología, A.C.

2006, Número 4

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Rev Mex Neuroci 2006; 7 (4)


Neurobiología de la respuesta placebo

Aguilar E

Idioma: Español
Referencias bibliográficas: 79
Paginas: 300-307
Archivo PDF: 88.29 Kb.


RESUMEN

Introducción: Los procesos neurales de la respuesta placebo han venido aclarándose gracias a los estudios de neurofarmacología, neurofisiología y neuroimagen, sobre todo en las áreas del dolor y la depresión. Algunas regiones cerebrales observadas en la respuesta placebo analgésica son: corteza del cíngulo anterior, corteza orbitofrontal, ínsula anterior, sustancia gris periacueductal, puente inferior y bulbo. Con estos datos se considera que, durante la analgesia placebo, es activado un circuito descendente modulador del dolor que va de corteza a tallo cerebral e involucra zonas ricas en receptores opioides. También se describe una fase de anticipación de la respuesta placebo en la cual se activan toda la corteza prefrontal y la sustancia gris periacueductal, a manera de una red cognitiva evaluativa, y en seguida disminuye la actividad metabólica en tálamo, cíngulo e ínsula anteriores. Material y métodos: Los estudios neurofarmacológicos apoyan la participación de los sistemas opioides en la analgesia placebo. Por otro lado, la respuesta placebo antidepresiva incluye activación del cíngulo posterior desde la primera semana de tratamiento y más adelante, al remitir los síntomas, se ve activación de cortezas prefrontal, premotora, cíngulos anterior y posterior, e ínsula posterior; al tiempo que disminuye la actividad en el cíngulo subgenual, hipotálamo, tálamo y parahipocampo. Asimismo, se considera la participación de una vía descendente que inicia en cortezas del cíngulo posterior y prefrontal, y ejerce su función a nivel de tallo cerebral a la manera de los fármacos antidepresivos. Conclusión: El proceso iniciador de la respuesta placebo sería la expectativa del beneficio clínico, de tal modo las vías descendentes mencionadas reciben el nombre de vías de la expectativa. La expectativa en este caso es considerada como una respuesta de origen sociocultural.


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