PubMed · 3334216
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J M Rees. 1987. Endogenous opioids.. https://doi.org/10.1016/s0950-3579(87)80028-6
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The placebo response is commonly invoked as a factor in the therapeutic relationship between the family physician and the patient, but important recent literature can be difficult for family physicians to access. Coordinated interdisciplinary research into the placebo response as it occurs in primary care settings is lacking. Although there is controversy about the nature and scope of the placebo response, important suggestions are emerging about its psychological mechanisms (expectancy and conditioning) and the biochemical pathways that act as psychosomatic linkages (endorphins, catecholamines and cortisol, psychoneuroimmumunology). The available research justifies interventions by family physicians that maximize the placebo response in everyday patient encounters. These include the sustained partnership approach, working with patients on the narratives they construct to explain illness, listening to patients, providing them with satisfactory explanations, expressing care and concern, and enhancing their sense of control. Notable opportunities exist for family medicine investigators to expand the understanding of this phenomenon.
At the beginning of the 70-ties various studies showed the existence of endogenous opiates in central nervous system. The chemical structure of first endogenous pentapeptides called enkephalins (met-enkephalin and leu-enkephalin) and their receptor was already known in 1975. Further investigations confirmed the existence of opiates (endorphins) in brain, pituitary gland, spinal cord and other tissues. Endorphins may exert various effects: analgesic (especially dynorphin and b-endorphin), antidiuretic, depressive on respiratory center, constipative, they also cause physical and mental dependence. These peptides, which are not known thoroughly may play a big part in the regulation of many biochemical and hemodynamic processes. Many of these mechanisms are already described and changes in concentrations of endorphins, for example in patients with silent myocardial ischaemia, are basic in the pathogenesis of this disease. Many of these mechanisms are controversial, the role of endogenous opiates in pathogenesis of hypertension or congestive heart failure is still unknown. This study summerizes the present knowledge endorphins and tries to answer whether changes in the concentration of endorphins are primary or secondary to the biochemical and hemodynamic disturbances in 2 diseases.