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Zsigeri fájdalom, nocebo-hatások, placebo-analgézia

Visceral pain, nocebo-effects, placebo-analgesia

Scientia et Securitas
Author: György Bárdos

Összefoglaló. A belső szervek működési zavarai gyakran származnak viselkedési, lelki vagy pszichoszociális okokból, amelyeknek nem mindig vagyunk tudatában. Minthogy ebben a folyamatban egy bonyolult neuronális hálózat játssza a fő szerepet, ezeknek a zavaroknak a diagnózisa és terápiája számos tényező manipulálását igényli.

A funkcionális gyomor-bélhuzam rendellenességek (FGID), például az irritábilisbél-szindróma (IBS), jellemző példái ennek: olyan működési zavarokról van szó, amelyek mögött jól detektálható szervi vagy biokémiai elváltozásokat nem találnak. Ilyenkor szükségesnek tűnik a komplex megközelítés, amely többféle szakember együttműködését kívánja meg. Szerepe lehet a pszichés vagy életmód terápiának, a gyógyszeres és fizikai kezelésnek is, és – ahogy ebben a cikkben megmutatjuk – a placebo-terápiának is.

Summary. Functional disorders of the internal organs frequently are results of behavioral, mental or psycho-social dysfunctions, although we are usually not conscious about it. A typical example isirritable bowel syndrome (IBS), a characteristic functional gastro-intestinal disorder (FGID), which is regularly accompanied by abdominal pain and irregular intestinal motility and defecation. It has been shown that this disorder cannot be due to a single factor, nor is it a result of a local cause. Recently researchers have proven that malfunction of a complicated neuronal network, including several brain sites, may be responsible for IBS. It is believed now that IBS is the consequence of several nocebo-effects.

IBS is a typical source of visceral pain or discomfort, a source that is frequently difficult to identify. Main factors are stimuli originating from the gastro-intestinal tract, passing through the spinal cord and reaching several brain structures, including cortical and sub-cortical sites. It has been shown that some structures become thicker while others thinner as a result of lasting visceral pain, resulting in altered top-down effects on the visceral organs. Several hormones accompany these processes resulting in a complicated network activity.

Recent research has revealed that IBS requires a complex approach, optimally provided by a therapeutic team of physicians, psychologist/psychiatrist, associates, and even the patient himself/herself. They may apply or suggest medicines, physiotherapy, lifestyle modifications, alimentary changes etc.

An important feature is that the nocebo-effect plays an important role in the generation of IBS, thus one may think the opposite phenomenon, placebo-effect could be used in the therapeutic process. And really, placebo-analgesia is a method frequently used in the therapy of IBS. Placebo-analgesia affects brain processes, including pain processing, release of hormones, including endogenous opioids, the primary pain-decreasing factors. A top-down pain-modification system exists which can be affected and activated by the placebo-analgesia thus counteracting the nocebo-effects and improving the condition of the individual.

The placebo phenomenon is interesting in itself, too. By now, the major question is not the existence of the placebo-effect but the mechanisms behind it. Recently, as brain-mapping techniques have gained their role in research, a lot of new information proves that the placebo-effect (as well as the nocebo-effect) is a complex phenomenon that involves several different brain sites, including the brain cortex and the limbic system, respectively.P

The placebo-effect is widely used in clinical practice, first of all as a reference treatment when new drugs or medicines are tested for their effectivity. There are numerous ethical problems in this area, recently, for example, when testing Covid-19 vaccines. The main problem is whether it is legal to keep a non-treated population, whether the placebo-group should be treated immediately after the trial ends, whether the members of the placebo-group should get adequate information.

Open access

Abstract

Writing to report research writing may be a daunting task since it requires motivation, interest, background knowledge and hard work from the part of students. This paper focused on the major obstacles faced by the English foreign language learners in research writing at Belhadj Bouchaib University, Algeria, in addition to the teachers’ attitudes towards their students’ work. The study relied on a triangulated approach which enclosed quantitative and qualitative methods and its importance lied in providing insights into the nature of flaws and challenges as regards students’ academic writing practices. A questionnaire was used among 30 students followed by an interview with six teachers. The findings revealed that developing a research project and reporting the findings were among the most difficult challenges encountered by the learners. While the former requires them to identify the area of interest, choose a topic and formulate a researchable problem, the latter typically entails writing the methodology, results, and discussion sections. Between the two tasks, the students found academic writing the most challenging. The findings also revealed that teachers display negative attitudes towards their students’ research because of these reasons: lack of motivation following traditional methods of learning, insufficient background knowledge about research, paucity of library resources, sketchy number of courses related to research, and the unavailability of the Internet inside the university context. Following these flaws, some recommendations were provided.

Open access

Abstract

Over the last few decades, several countries have entrenched a special subcategory of law, which is adopted by stricter procedural rules than the requirements of the ordinary legislative process. These laws are enacted by qualified majority, by the consent of the two chambers of the legislation, and are subject to mandatory constitutional review before their promulgation, or additional safeguards are implemented in the ordinary legislative process. It is beyond doubt that this legal instrument influences the prevalence of the separation of powers and the constitutional principle of democracy in a remarkable way; therefore, it might be an important tool for populist politicians to concrete their preferences for the long term. In this study, my aim is to conceptualize the most highly contested issues regarding the legal nature of qualified laws, and to provide a deeper understanding of the interdependence between qualified laws and the separation of powers. This analysis might also clarify how qualified laws may serve the ambitions of populist political groups in certain specific circumstances. My contribution provides general theoretic considerations, and does not outline the particular constitutional frameworks in detail. I would rather just use the specific examples to demonstrate how the mechanism of qualified law works in practice as an instrument of constitutional law.

Open access

Abstract

This paper discusses whether the methods of restorative justice (RJ), broadly interpreted as alternatives to criminal proceedings and sanctions, are applicable to hate crimes. It builds on the premises that RJ methods are appropriate tools to deal with hate crimes and conflicts that arise from them, as there are social conflicts behind these actions that can be resolved by a sensitive and empathetic approach that focuses on restoration. However, there are dilemmas and factors where caution and an in-depth reflection should be observed to understand how these techniques can work well without further harming either party.

Open access

Abstract

Contexts, knowledge, and theory matter for faculty development (also known as staff, academic, or educational development) because of the complexity of higher education and therefore of faculty professional development. This paper attempts to unpack this complexity by examining higher education contexts more closely, in particular: academic identity in relation to research and the discipline, change management in higher education, and the importance to academic development of valuing teaching in a coherent, integrated, and holistic way. The paper is framed by two ‘big ideas’, that of pedagogical content knowledge (Shulman, 1986, 1987), and that of learning as acquisition and participation (Sfard, 1998). I end by providing examples of practice underpinned by these ideas and considering implications for academic development.

Open access

Abstract

The paper focuses on the democratic rule of law principle as it appeared in the practice of the Hungarian Constitutional Court under the 1989 Constitution and the 2012 Fundamental Law. The rule of law doctrine had a paramount role in the argumentation of the Court in the 1990s as a normative fact and a programme of the Hungarian state. Under the Fundamental Law introduced in 2012, however, it has been somewhat relegated to the background in case law. The study first recalls the main achievements and characteristics of the democratic rule of law state interpretations of the Constitutional Court and then focuses on developments since the introduction of the Fundamental Law. On the one hand, it outlines the constitutional and institutional capacity of the court regarding the protection of the rule of law principle. On the other hand, it reveals the characteristics of the post-FL interpretation through case studies in the field of legal certainty and judicial independence, both of which were representative elements of the pre-2010 constitutional practice from the point of view of the democratic rule of law state doctrine.

Open access

Abstract

The number of hate crime cases in certain countries that was brought to the authorities' attention and was included in the official statistics of countries and relevant international organizations could be negligibly low. However, alternative databases do not provide such a serene landscape as these data sets aim to provide a more credible picture of the real volume of hate crimes. The results of the victim surveys conducted amongst members of the potential victim groups can be even more shocking. Now it is obvious that only a small number of these crime cases is officially reported and behind the high latency, numerous personal and institutional causes can be identified, most notably in relation to victims and law enforcement authorities. The main objective of this literature review is to present these reasons and barriers that authorities are facing, difficulties of enforcement in individual cases and the significant structural problems in the application of law.

Open access

Abstract

Recent constitutional reforms in Poland have demonstrated a lack of respect for the rule of law and for the fundamental values which form the foundations of the EU legal order. The Polish authorities have substantially deviated from principles that the country has accepted as a part of the Copenhagen criteria. The aim of the article is to analyse the mechanisms and procedures applied by the EU institutions to address the systemic threats to the rule of law in Poland. The main focus of the assessment is on the effectiveness of the measure and its potential for a proper solution to the problem. The response provided by the EU demonstrate that there has been a shift from a political to judicial enforcement of values. The article argues that the remedies that were deemed to be the least suitable to address the systemic deficiencies in the rule of law – an infringement action and a preliminary ruling procedure – proved to be the most effective remedy to defend independence of the Polish judiciary. Unexpectedly, the most efficient institution to ensure the respect for values enshrined in Article 2 TEU in Poland proved to be the CJEU, providing extensive interpretation of Article 19 (1) TEU and Article 47 of the Charter. Nevertheless the values are still much more difficult to enforce than the law. While the most serious infringements have been reversed, this has not prevented the Polish authorities from further violating the rule of law.

Full access

Abstract

The paper reflects on academic literature on the international normative and institutional framework related to hate crimes. Various theoretical and pragmatic issues have been discussed by academic authors, such as the challenges coming with the obligation of states to record hate crimes or to conduct efficient investigation, the limits of the potential impact of international review mechanisms, or the aims and content of resolutions adopted by international institutions and judgments delivered by the European Court of Human Rights. However, a wide range of practical and conceptual issues related to the existing international standards and the efficiency of international review mechanisms remain to be discussed in the academic sphere.

Open access