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2015 ; 112
(ä): 197-207
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Distinct neural representations of placebo and nocebo effects
#MMPMID25776211
Freeman S
; Yu R
; Egorova N
; Chen X
; Kirsch I
; Claggett B
; Kaptchuk TJ
; Gollub RL
; Kong J
Neuroimage
2015[May]; 112
(ä): 197-207
PMID25776211
show ga
Expectations shape the way we experience the world. In this study, we used fMRI
to investigate how positive and negative expectation can change pain experiences
in the same cohort of subjects. We first manipulated subjects' treatment
expectation of the effectiveness of three inert creams, with one cream labeled
"Lidocaine" (positive expectancy), one labeled "Capsaicin" (negative expectancy)
and one labeled "Neutral" by surreptitiously decreasing, increasing, or not
changing respectively, the intensity of the noxious stimuli administered
following cream application. We then used fMRI to investigate the signal changes
associated with administration of identical pain stimuli before and after the
treatment and control creams. Twenty-four healthy adults completed the study.
Results showed that expectancy significantly modulated subjective pain ratings.
After controlling for changes in the neutral condition, the subjective pain
rating changes evoked by positive and negative expectancies were significantly
associated. fMRI results showed that the expectation of an increase in pain
induced significant fMRI signal changes in the insula, orbitofrontal cortex, and
periaqueductal gray, whereas the expectation of pain relief evoked significant
fMRI signal changes in the striatum. No brain regions were identified as common
to both "Capsaicin" and "Lidocaine" conditioning. There was also no significant
association between the brain response to identical noxious stimuli in the pain
matrix evoked by positive and negative expectancies. Our findings suggest that
positive and negative expectancies engage different brain networks to modulate
our pain experiences, but, overall, these distinct patterns of neural activation
result in a correlated placebo and nocebo behavioral response.