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Botvinik-Nezer R, Petre B, Ceko M, Lindquist MA, Friedman NP, Wager TD. Placebo treatment affects brain systems related to affective and cognitive processes, but not nociceptive pain. Nat Commun 2024; 15:6017. [PMID: 39019888 PMCID: PMC11255344 DOI: 10.1038/s41467-024-50103-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/29/2024] [Accepted: 06/28/2024] [Indexed: 07/19/2024] Open
Abstract
Drug treatments for pain often do not outperform placebo, and a better understanding of placebo mechanisms is needed to improve treatment development and clinical practice. In a large-scale fMRI study (N = 392) with pre-registered analyses, we tested whether placebo analgesic treatment modulates nociceptive processes, and whether its effects generalize from conditioned to unconditioned pain modalities. Placebo treatment caused robust analgesia in conditioned thermal pain that generalized to unconditioned mechanical pain. However, placebo did not decrease pain-related fMRI activity in brain measures linked to nociceptive pain, including the Neurologic Pain Signature (NPS) and spinothalamic pathway regions, with strong support for null effects in Bayes Factor analyses. In addition, surprisingly, placebo increased activity in some spinothalamic regions for unconditioned mechanical pain. In contrast, placebo reduced activity in a neuromarker associated with higher-level contributions to pain, the Stimulus Intensity Independent Pain Signature (SIIPS), and affected activity in brain regions related to motivation and value, in both pain modalities. Individual differences in behavioral analgesia were correlated with neural changes in both modalities. Our results indicate that cognitive and affective processes primarily drive placebo analgesia, and show the potential of neuromarkers for separating treatment influences on nociception from influences on evaluative processes.
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Affiliation(s)
- Rotem Botvinik-Nezer
- Department of Psychology, The Hebrew University of Jerusalem, Jerusalem, Israel.
- Department of Psychological and Brain Sciences, Dartmouth College, Hanover, NH, USA.
| | - Bogdan Petre
- Department of Psychological and Brain Sciences, Dartmouth College, Hanover, NH, USA
| | - Marta Ceko
- Institute of Cognitive Science, University of Colorado Boulder, Boulder, CO, USA
| | - Martin A Lindquist
- Department of Biostatistics, Johns Hopkins University, Baltimore, MD, USA
| | - Naomi P Friedman
- Institute for Behavioral Genetics, University of Colorado Boulder, Boulder, CO, USA
- Department of Psychology and Neuroscience, University of Colorado Boulder, Boulder, CO, USA
| | - Tor D Wager
- Department of Psychological and Brain Sciences, Dartmouth College, Hanover, NH, USA.
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Frisaldi E, Shaibani A, Benedetti F, Pagnini F. Placebo and nocebo effects and mechanisms associated with pharmacological interventions: an umbrella review. BMJ Open 2023; 13:e077243. [PMID: 37848293 PMCID: PMC10582987 DOI: 10.1136/bmjopen-2023-077243] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/29/2023] [Accepted: 09/27/2023] [Indexed: 10/19/2023] Open
Abstract
OBJECTIVES This review aimed to summarise the existing knowledge about placebo and nocebo effects associated with pharmacological interventions and their mechanisms. DESIGN Umbrella review, adopting the Assessment of Multiple Systematic Reviews 2 tool for critical appraisal. DATA SOURCES MEDLINE/PubMed, Scopus, Web of Science, PsycINFO, Cochrane Central Register of Controlled Trial were searched in September 2022, without any time restriction, for systematic reviews, narrative reviews, original articles. Results were summarised through narrative synthesis, tables, 95% CI. OUTCOME MEASURES Mechanisms underlying placebo/nocebo effects and/or their effect sizes. RESULTS The databases search identified 372 studies, for a total of 158 312 participants, comprising 41 systematic reviews, 312 narrative reviews and 19 original articles. Seventy-three per cent of the examined systematic reviews were of high quality.Our findings revealed that mechanisms underlying placebo and/or nocebo effects have been characterised, at least in part, for: pain, non-noxious somatic sensation, Parkinson's disease, migraine, sleep disorders, intellectual disability, depression, anxiety, dementia, addiction, gynaecological disorders, attention-deficit hyperactivity disorder, immune and endocrine systems, cardiovascular and respiratory systems, gastrointestinal disorders, skin diseases, influenza and related vaccines, oncology, obesity, physical and cognitive performance. Their magnitude ranged from 0.08 to 2.01 (95% CI 0.37 to 0.89) for placebo effects and from 0.32 to 0.90 (95% CI 0.24 to 1.00) for nocebo effects. CONCLUSIONS This study provides a valuable tool for clinicians and researchers, identifying both results ready for clinical practice and gaps to address in the near future. FUNDING Università Cattolica del Sacro Cuore, Milan, Italy with the 'Finanziamento Ponte 2022' grant. PROSPERO REGISTRATION NUMBER CRD42023392281.
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Affiliation(s)
- Elisa Frisaldi
- Department of Neuroscience "Rita Levi Montalcini", University of Turin, Turin, Italy
| | - Aziz Shaibani
- Muscle and Nerve Center, Houston, Texas, USA
- Department of Medicine, Baylor College of Medicine, Houston, Texas, USA
| | - Fabrizio Benedetti
- Department of Neuroscience "Rita Levi Montalcini", University of Turin, Turin, Italy
| | - Francesco Pagnini
- Department of Psychology, Università Cattolica del Sacro Cuore, Milan, Italy
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Botvinik-Nezer R, Petre B, Ceko M, Lindquist MA, Friedman NP, Wager TD. Placebo treatment affects brain systems related to affective and cognitive processes, but not nociceptive pain. BIORXIV : THE PREPRINT SERVER FOR BIOLOGY 2023:2023.09.21.558825. [PMID: 37790543 PMCID: PMC10543005 DOI: 10.1101/2023.09.21.558825] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 10/05/2023]
Abstract
Placebo analgesia is a replicable and well-studied phenomenon, yet it remains unclear to what degree it includes modulation of nociceptive processes. Some studies find effects consistent with nociceptive effects, but meta-analyses show that these effects are often small. We analyzed placebo analgesia in a large fMRI study (N = 392), including placebo effects on brain responses to noxious stimuli. Placebo treatment caused robust analgesia in both conditioned thermal and unconditioned mechanical pain. Placebo did not decrease fMRI activity in nociceptive pain regions, including the Neurologic Pain Signature (NPS) and pre-registered spinothalamic pathway regions, with strong support from Bayes Factor analyses. However, placebo treatment affected activity in pre-registered analyses of a second neuromarker, the Stimulus Intensity Independent Pain Signature (SIIPS), and several associated a priori brain regions related to motivation and value, in both thermal and mechanical pain. Individual differences in behavioral analgesia were correlated with neural changes in both thermal and mechanical pain. Our results indicate that processes related to affective and cognitive aspects of pain primarily drive placebo analgesia.
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Bush NJ, Boissoneault J, Letzen J, Staud R, Robinson ME. Task-dependent functional connectivity of pain is associated with the magnitude of placebo analgesia in pain-free individuals. Eur J Pain 2023; 27:1023-1035. [PMID: 37344957 PMCID: PMC10527332 DOI: 10.1002/ejp.2145] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/16/2022] [Revised: 05/03/2023] [Accepted: 06/04/2023] [Indexed: 06/23/2023]
Abstract
BACKGROUND Task-based functional connectivity (FC) of pain-related regions resulting from expectancy-based placebo induction has yet to be examined, limiting our understanding of regions and networks associated with placebo analgesia. METHODS Fifty-five healthy pain-free adults over 18 (M = 22.8 years, SD = 7.75) were recruited (65.5% women; 63.6% non-Hispanic/Latino/a/x; 58.2% White). Participants completed a baseline followed by a placebo session involving the topical application of an inactive cream in the context of an expectancy-enhancing instruction set. Noxious heat stimuli were applied to the thenar eminence of the right palm using an fMRI-safe thermode. Stimulus intensity was individually calibrated to produce pain ratings of approximately 40 on a 100-point visual analogue scale. RESULTS A total of 67.3% of the participants showed a reduction in pain intensity in the placebo condition with an average reduction in pain across the whole sample of 12.7%. Expected pain intensity was associated with reported pain intensity in the placebo session (b = 0.32, p = 0.004, R2 = 0.15). Voxel-wise analyses indicated seven clusters with significant activation during noxious heat stimulation at baseline (pFDR < 0.05). Generalized psychophysiological interaction analysis suggested that placebo-related FC changes between middle frontal gyrus-superior parietal lobule during noxious stimulation were significantly associated with the magnitude of pain reduction (pFDR < 0.05). CONCLUSIONS Results suggest that stronger expectancy-based placebo responses might be underpinned by greater FC among attentional and somatosensory regions. SIGNIFICANCE This article provides support and insight for task-dependent functional connectivity differences related to the magnitude of placebo analgesia. Our findings provide key support that the magnitude of expectation-based placebo response depends on the coupling of regions associated with somatosensory and attentional processing.
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Affiliation(s)
- Nicholas J Bush
- Department of Clinical and Health Psychology, University of Florida, Gainesville, Florida, USA
- Center for Pain Research and Behavioral Health, University of Florida, Gainesville, Florida, USA
| | - Jeff Boissoneault
- Department of Clinical and Health Psychology, University of Florida, Gainesville, Florida, USA
- Center for Pain Research and Behavioral Health, University of Florida, Gainesville, Florida, USA
| | - Janelle Letzen
- Center for Pain Research and Behavioral Health, University of Florida, Gainesville, Florida, USA
- Department of Psychiatry and Behavioral Sciences, Johns Hopkins University, Baltimore, Maryland, USA
| | - Roland Staud
- Center for Pain Research and Behavioral Health, University of Florida, Gainesville, Florida, USA
- Department of Medicine, University of Florida, Gainesville, Florida, USA
| | - Michael E Robinson
- Department of Clinical and Health Psychology, University of Florida, Gainesville, Florida, USA
- Center for Pain Research and Behavioral Health, University of Florida, Gainesville, Florida, USA
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Morellini L, Izzo A, Celeghin A, Palermo S, Morese R. Sensory processing sensitivity and social pain: a hypothesis and theory. Front Hum Neurosci 2023; 17:1135440. [PMID: 37388415 PMCID: PMC10303917 DOI: 10.3389/fnhum.2023.1135440] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/31/2022] [Accepted: 05/24/2023] [Indexed: 07/01/2023] Open
Abstract
Sensory-processing sensitivity (SPS) defined, as a personality trait, seems to be characterized by emotional sensitivity, and stronger reactivity to both external and internal stimuli. SPS can represent a risk factor for developing clinical conditions during childhood and adolescence. This personality trait is not to be considered a pathological clinical condition, however, can expose to greater environmental vulnerability. In particular, the recent studies about SPS can be contextualized to social situations that evoke traumatic and stressful emotional responses such as social exclusion. We hypothesize that highly sensitive people (HSP) are more vulnerable to social exclusion and social pain. This hypothesis could help structure new educational and intervention models designed to improve coping strategies and promote HSP's psychophysical and social well-being.
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Affiliation(s)
- Lucia Morellini
- Faculty of Biomedical Sciences, Università della Svizzera italiana, Lugano, Switzerland
| | - Alessia Izzo
- Faculty of Biomedical Sciences, Università della Svizzera italiana, Lugano, Switzerland
| | | | - Sara Palermo
- Department of Psychology, University of Turin, Turin, Italy
- Neuroradiology Unit, Diagnostic and Technology Department, Fondazione Istituto di Ricovero e Cura a Carattere Scientifico (IRCCS), Istituto Neurologico Carlo Besta, Milan, Italy
| | - Rosalba Morese
- Faculty of Biomedical Sciences, Università della Svizzera italiana, Lugano, Switzerland
- Faculty of Communication, Culture and Society, Università della Svizzera italiana, Lugano, Switzerland
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Targeting neural correlates of placebo effects. COGNITIVE, AFFECTIVE, & BEHAVIORAL NEUROSCIENCE 2022; 23:217-236. [PMID: 36517733 DOI: 10.3758/s13415-022-01039-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Accepted: 09/26/2022] [Indexed: 12/15/2022]
Abstract
Harnessing the placebo effects would prompt critical ramifications for research and clinical practice. Noninvasive brain stimulation (NIBS) techniques, such as transcranial magnetic stimulation and multifocal transcranial electric stimulation, could manipulate the placebo response by modulating the activity and excitability of its neural correlates. To identify potential stimulation targets, we conducted a meta-analysis to investigate placebo-associated regions in healthy volunteers, including studies with emotional components and painful stimuli. Using biophysical modeling, we identified NIBS solutions to manipulate placebo effects by targeting either a single key region or multiple connected areas. Moving to a network-oriented approach, we then ran a quantitative network mapping analysis on the functional connectivity profile of clusters emerging from the meta-analysis. As a result, we suggest a multielectrode optimized montage engaging the connectivity patterns of placebo-associated functional brain networks. These NIBS solutions hope to provide a starting point to actively control, modulate or enhance placebo effects in future clinical studies and cognitive enhancement studies.
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Sitsen E, Khalili-Mahani N, de Rover M, Dahan A, Niesters M. Effect of spinal anesthesia-induced deafferentation on pain processing in healthy male volunteers: A task-related fMRI study. FRONTIERS IN PAIN RESEARCH 2022; 3:1001148. [PMID: 36530772 PMCID: PMC9748364 DOI: 10.3389/fpain.2022.1001148] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/22/2022] [Accepted: 11/04/2022] [Indexed: 10/17/2023] Open
Abstract
BACKGROUND Spinal anesthesia causes short-term deafferentation and alters the crosstalk among brain regions involved in pain perception and pain modulation. In the current study, we examined the effect of spinal anesthesia on pain response to noxious thermal stimuli in non-deafferented skin areas using a functional magnetic resonance imaging (fMRI) paradigm. METHODS Twenty-two healthy subjects participated in the study. We performed a task-based fMRI study using a randomized crossover design. Subjects were scanned under two conditions (spinal anesthesia or control) at two-time points: before and after spinal anesthesia. Spinal anesthesia resulted in sensory loss up to dermatome Th6. Calibrated heat-pain stimuli were administered to the right forearm (C8-Th1) using a box-car design (blocks of 10s on/25s off) during MRI scanning. Pain perception was measured using a visual analogue scale (1-100) at the beginning and the end of each session. Generalized estimating equations were used to examine the effect of intervention by time by order on pain scores. Similarly, higher-level effects were tested with appropriate general linear models (accounting for within-subject variations in session and time) to examine: (1) Differences in BOLD response to pain stimulus under spinal anesthesia versus control; and (2) Effects of spinal anesthesia on pain-related modulation of the cerebral activation. RESULTS Complete fMRI data was available for eighteen participants. Spinal anesthesia was associated with moderate pain score increase. Significant differences in brain response to noxious thermal stimuli were present in comparison of spinal versus control condition (post-pre). Spinal condition was associated with higher BOLD signal in the bilateral inferior parietal lobule and lower BOLD signal in bilateral postcentral and precentral gyrus. Within the angular regions, we observed a positive correlation between pain scores and BOLD signal. These observations were independent from order effect (whether the spinal anesthesia was administered in the first or the second visit). However, we did observe order effect on brain regions including medial prefrontal regions, possibly related to anticipation of the experience of spinal anesthesia. CONCLUSIONS The loss of sensory and motor activity caused by spinal anesthesia has a significant impact on brain regions involved in the sensorimotor and cognitive processing of noxious heat pain stimuli. Our results indicate that the anticipation or experience of a strong somatosensory response to the spinal intervention might confound and contribute to increased sensitivity to cognitive pain processing. Future studies must account for individual differences in subjective experience of pain sensation within the experimental context.
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Affiliation(s)
- Elske Sitsen
- Department of Anesthesiology, Leiden University Medical Center, Leiden, Netherlands
| | - Najmeh Khalili-Mahani
- McGill Centre for Integrative Neuroscience, Montreal Neurological Institute, McGill University, Montreal, QC, Canada
| | - Mischa de Rover
- Department of Clinical Psychology, Institute of Psychology, Leiden University, Leiden, Netherlands
- Leiden Institute of Brain and Cognition, Leiden, Netherlands
| | - Albert Dahan
- Department of Anesthesiology, Leiden University Medical Center, Leiden, Netherlands
| | - Marieke Niesters
- Department of Anesthesiology, Leiden University Medical Center, Leiden, Netherlands
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Sun YL, Yao M, Zhu YF, Yin MC, Liu JT, Chen X, Huang J, Dai YX, Wang WH, Ma ZB, Wang YJ, Cui XJ. Consideration in Randomized Placebo-Controlled Trial on Neck Pain to Avoid the Placebo Effect in Analgesic Action. Front Pharmacol 2022; 13:836008. [PMID: 35662695 PMCID: PMC9160467 DOI: 10.3389/fphar.2022.836008] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/15/2021] [Accepted: 04/05/2022] [Indexed: 11/13/2022] Open
Abstract
Background: In neck pain treatment, many therapies are focused on etiology, while it is well-known that placebo analgesia is also present in these therapies. The specific efficacy for etiology may be underestimated by ignoring their actual placebo effect. In this study, a logistic regression analysis is used to explore the risk factors causing different placebo responses in patients with neck pain among two RCTs. The probability of the placebo effect is predicted based on these risk factors. Methods: Trial A and Trial B were similarly designed, randomized, double-/single-blind, placebo-controlled trials in patients treating neck pain with Qishe pill or Shi-style manipulation. Both studies set a placebo pill twice a day or traction for every other day as control. For further analyses on the placebo effect in neck pain management, logistic regression was used to assess subgroup-placebo interactions. The odds ratio assessed a significant influence on the placebo effect. Results: In this pooled analysis, the total number of patients recruited for these two studies was 284, of which 162 patients received placebo treatment (placebo drug or traction for every other day). No statistically significant differences are found at baseline between the participants with placebo effect and non-placebo effect in the gender, age, and disease duration except in VAS and NDI at the initial time. There are numerically more patients with placebo effect in the shorter disease duration subgroup (< 4 months [76%]), higher initial VAS subgroup (>60 mm [90%]), and worse initial NDI subgroup (>24 [72%]) compared with the gender and age subgroup. An ROC curve is established to assess the model-data fit, which shows an area under the curve of 0.755 and a 95% confidence interval of 0.677–0.830. Participants who show placebo effect after 2 weeks have significantly lower VAS scores after 4 weeks, while there is no significant difference in NDI improvement between the two groups after 4 weeks. Conclusion: Neck pain patients with shorter disease duration are more likely to overscore their pain severity, because of their less experience in pain perception, tolerance, and analgesia expectation.
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Affiliation(s)
- Yue-Li Sun
- Longhua Hospital, Shanghai University of Traditional Chinese Medicine, Shanghai, China
- Spine Institute, Shanghai University of Traditional Chinese Medicine, Shanghai, China
- Key Laboratory of the Ministry of Education of Chronic Musculoskeletal Disease, Shanghai, China
| | - Min Yao
- Longhua Hospital, Shanghai University of Traditional Chinese Medicine, Shanghai, China
- Spine Institute, Shanghai University of Traditional Chinese Medicine, Shanghai, China
- Key Laboratory of the Ministry of Education of Chronic Musculoskeletal Disease, Shanghai, China
| | - Yue-Feng Zhu
- Spine Institute, Shanghai University of Traditional Chinese Medicine, Shanghai, China
- Huadong Hospital, Fudan University, Shanghai, China
- Institutes of Integrative Medicine, Fudan University Institute of Geriatrics and Gerontology, Shanghai, China
| | - Meng-Chen Yin
- Longhua Hospital, Shanghai University of Traditional Chinese Medicine, Shanghai, China
- Spine Institute, Shanghai University of Traditional Chinese Medicine, Shanghai, China
- Key Laboratory of the Ministry of Education of Chronic Musculoskeletal Disease, Shanghai, China
| | - Jin-Tao Liu
- Suzhou TCM Hospital, Nanjing University of Chinese Medicine, Suzhou, China
| | - Xin Chen
- Gansu University of Traditional Chinese Medicine, Lanzhou, China
- Affiliated Hospital of Gansu University of Traditional Chinese Medicine, Lanzhou, China
| | - Jin Huang
- Gansu Provincial Hospital of TCM, Lanzhou, China
| | - Yu-Xiang Dai
- Longhua Hospital, Shanghai University of Traditional Chinese Medicine, Shanghai, China
- Spine Institute, Shanghai University of Traditional Chinese Medicine, Shanghai, China
- Key Laboratory of the Ministry of Education of Chronic Musculoskeletal Disease, Shanghai, China
- Suzhou TCM Hospital, Nanjing University of Chinese Medicine, Suzhou, China
| | - Wen-Hao Wang
- Huadong Hospital, Fudan University, Shanghai, China
- Institutes of Integrative Medicine, Fudan University Institute of Geriatrics and Gerontology, Shanghai, China
| | - Zeng-Bin Ma
- Spine Institute, Shanghai University of Traditional Chinese Medicine, Shanghai, China
- Beijing Hospital, Lanzhou, China
| | - Yong-Jun Wang
- Longhua Hospital, Shanghai University of Traditional Chinese Medicine, Shanghai, China
- Spine Institute, Shanghai University of Traditional Chinese Medicine, Shanghai, China
- Key Laboratory of the Ministry of Education of Chronic Musculoskeletal Disease, Shanghai, China
- *Correspondence: Yong-Jun Wang, ; Xue-Jun Cui,
| | - Xue-Jun Cui
- Longhua Hospital, Shanghai University of Traditional Chinese Medicine, Shanghai, China
- Spine Institute, Shanghai University of Traditional Chinese Medicine, Shanghai, China
- Key Laboratory of the Ministry of Education of Chronic Musculoskeletal Disease, Shanghai, China
- *Correspondence: Yong-Jun Wang, ; Xue-Jun Cui,
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Gui P, Wang L, Guo L, Wu C, Zhang B, Chen C, Xie Y. Effects of transcranial direct current stimulation on cough reflex and urge-to-cough in healthy young adults. Respir Res 2022; 23:99. [PMID: 35449062 PMCID: PMC9027036 DOI: 10.1186/s12931-022-02020-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/30/2021] [Accepted: 04/09/2022] [Indexed: 11/22/2022] Open
Abstract
Background Chronic cough is prevalent in the clinic. The existing therapies are mostly limited to medical treatment, with poor curative effects and serious side effects. Studies have suggested that the right dorsolateral prefrontal cortex (rDLPFC) may play an active role in the inhibitory pathway of cough elicitation. Thus, this study explored the effect of transcranial direct current stimulation (tDCS) on the rDLPFC activation in relation to cough reflex and urge-to-cough sensitivity. Methods Twenty-three healthy young adults completed the experiment. Participants randomly received tDCS anodal stimulation, cathodal stimulation, and sham stimulation, and the interval between every two stimuli was at least one week. The tDCS (2 mA, 30 min) stimulated brain rDLPFC region. After tDCS intervention, cough reflex threshold and urge-to-cough were evaluated immediately by inhalation of citric acid-saline solution. Results Compared with sham stimulation, the cough reflex thresholds logC2 and logC5 have increased under tDCS anodal stimulation (1.78 ± 0.55 g/L vs. 1.57 ± 0.57 g/L, p < 0.05; 1.92 ± 0.53 g/L vs. 1.67 ± 0.56 g/L, p < 0.05), accompanied by the increase of the urge-to-cough threshold LogCu (0.76 ± 0.53 g/L vs. 0.47 ± 0.44 g/L, p < 0.05). In contrast, the urge-to-cough sensitivity expressed as UTC slope was not significantly changed (1.21 ± 0.86 point·L/g vs. 1.00 ± 0.37 point·L/g, p > 0.05), and there were no apparent changes in cough reflex thresholds Log C2 and logC5, urge-to-cough threshold LogCu, and urge-to-cough sensitivity UTC slope under tDCS cathodal stimulation, compared with sham stimulation. Conclusions This study found that anodal tDCS stimulation of rDLPFC could significantly decrease cough reflex sensitivity, accompanied by the increase of urge-to-cough threshold. Further investigations targeting different brain regions using multiple central intervention techniques to explore the underlying mechanisms are warranted. Trial registration The study protocol was registered for the clinical trial in China (registration number: ChiCTR2100045618)
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Affiliation(s)
- Peijun Gui
- Department of Rehabilitation Medicine, Beijing Friendship Hospital, Capital Medical University, 95 Yongan Road, Beijing, 100050, China
| | - Lin Wang
- Department of Rehabilitation Medicine, Beijing Friendship Hospital, Capital Medical University, 95 Yongan Road, Beijing, 100050, China
| | - Liya Guo
- Department of Rehabilitation Medicine, Beijing Friendship Hospital, Capital Medical University, 95 Yongan Road, Beijing, 100050, China
| | - Chunwei Wu
- Department of Rehabilitation Medicine, Beijing Friendship Hospital, Capital Medical University, 95 Yongan Road, Beijing, 100050, China
| | - Bo Zhang
- Department of Rehabilitation Medicine, Beijing Friendship Hospital, Capital Medical University, 95 Yongan Road, Beijing, 100050, China
| | - Chen Chen
- Department of Rehabilitation Medicine, Beijing Friendship Hospital, Capital Medical University, 95 Yongan Road, Beijing, 100050, China
| | - Ying Xie
- Department of Rehabilitation Medicine, Beijing Friendship Hospital, Capital Medical University, 95 Yongan Road, Beijing, 100050, China.
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De Ridder D, Vanneste S, Smith M, Adhia D. Pain and the Triple Network Model. Front Neurol 2022; 13:757241. [PMID: 35321511 PMCID: PMC8934778 DOI: 10.3389/fneur.2022.757241] [Citation(s) in RCA: 29] [Impact Index Per Article: 14.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/11/2021] [Accepted: 01/28/2022] [Indexed: 12/15/2022] Open
Abstract
Acute pain is a physiological response that causes an unpleasant sensory and emotional experience in the presence of actual or potential tissue injury. Anatomically and symptomatically, chronic pathological pain can be divided into three distinct but interconnected pathways, a lateral “painfulness” pathway, a medial “suffering” pathway and a descending pain inhibitory circuit. Pain (fullness) can exist without suffering and suffering can exist without pain (fullness). The triple network model is offering a generic unifying framework that may be used to understand a variety of neuropsychiatric illnesses. It claims that brain disorders are caused by aberrant interactions within and between three cardinal brain networks: the self-representational default mode network, the behavioral relevance encoding salience network and the goal oriented central executive network. A painful stimulus usually leads to a negative cognitive, emotional, and autonomic response, phenomenologically expressed as pain related suffering, processed by the medial pathway. This anatomically overlaps with the salience network, which encodes behavioral relevance of the painful stimuli and the central sympathetic control network. When pain lasts longer than the healing time and becomes chronic, the pain- associated somatosensory cortex activity may become functionally connected to the self-representational default mode network, i.e., it becomes an intrinsic part of the self-percept. This is most likely an evolutionary adaptation to save energy, by separating pain from sympathetic energy-consuming action. By interacting with the frontoparietal central executive network, this can eventually lead to functional impairment. In conclusion, the three well-known pain pathways can be combined into the triple network model explaining the whole range of pain related co-morbidities. This paves the path for the creation of new customized and personalized treatment methods.
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Affiliation(s)
- Dirk De Ridder
- Section of Neurosurgery, Department of Surgical Sciences, Dunedin School of Medicine, University of Otago, Dunedin, New Zealand
- *Correspondence: Dirk De Ridder
| | - Sven Vanneste
- School of Psychology, Global Brain Health Institute, Institute of Neuroscience, Trinity College Dublin, Dublin, Ireland
| | - Mark Smith
- Neurofeedbackservices of New York, New York, NY, United States
| | - Divya Adhia
- Section of Neurosurgery, Department of Surgical Sciences, Dunedin School of Medicine, University of Otago, Dunedin, New Zealand
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11
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Villiger D. How Psychedelic-Assisted Treatment Works in the Bayesian Brain. Front Psychiatry 2022; 13:812180. [PMID: 35360137 PMCID: PMC8963812 DOI: 10.3389/fpsyt.2022.812180] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/09/2021] [Accepted: 02/11/2022] [Indexed: 11/25/2022] Open
Abstract
Psychedelics are experiencing a renaissance in clinical research. In recent years, an increasing number of studies on psychedelic-assisted treatment have been conducted. So far, the results are promising, suggesting that this new (or rather, rediscovered) form of therapy has great potential. One particular reason for that appears to be the synergistic combination of the pharmacological and psychotherapeutic interventions in psychedelic-assisted treatment. But how exactly do these two interventions complement each other? This paper provides the first account of the interaction between pharmacological and psychological effects in psychedelic-assisted treatment. Building on the relaxed beliefs under psychedelics (REBUS) hypothesis of Carhart-Harris and Friston and the contextual model of Wampold, it argues that psychedelics amplify the common factors and thereby the remedial effects of psychotherapy. More precisely, psychedelics are assumed to attenuate the precision of high-level predictions, making them more revisable by bottom-up input. Psychotherapy constitutes an important source of such input. At best, it signalizes a safe and supportive environment (cf. setting) and induces remedial expectations (cf. set). During treatment, these signals should become incorporated when high-level predictions are revised: a process that is hypothesized to occur as a matter of course in psychotherapy but to get reinforced and accelerated under psychedelics. Ultimately, these revisions should lead to a relief of symptoms.
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Affiliation(s)
- Daniel Villiger
- Department of Psychosomatics and Psychotherapy, Psychiatric University Hospital Basel, University of Basel, Basel, Switzerland.,Institute of Philosophy, University of Zurich, Zurich, Switzerland
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Abstract
A placebo is an inert substance normally used in clinical trials for comparison with an active substance. However, a placebo has been shown to have an effect on its own; commonly known as the placebo effect. A placebo is an essential component in the design of conclusive clinical trials but has itself become the focus of intense research. The placebo effect is partly the result of positive expectations of the recipient on the state of health. Conversely, a nocebo effect is when negative expectations from a substance lead to poor treatment outcomes and/or adverse events. Randomized controlled trials in functional urology have demonstrated the importance of the placebo and nocebo effects across different diseases such as overactive bladder, urinary incontinence, lower urinary tract symptoms and interstitial cystitis/painful bladder syndrome, as well as male and female sexual dysfunction. Understanding the true nature of the placebo-nocebo complex and the scope of its effect in functional urology could help urologists to maximize the positive effects of this phenomenon while minimizing its potentially negative effects.
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13
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Shi Y, Zhan H, Zeng Y, Huang S, Cai G, Yang J, Wu W. Sex Differences in the Blood Oxygen Level-Dependent Signal to Placebo Analgesia and Nocebo Hyperalgesia in Experimental Pain: A Functional MRI Study. Front Behav Neurosci 2021; 15:657517. [PMID: 34497495 PMCID: PMC8419258 DOI: 10.3389/fnbeh.2021.657517] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/23/2021] [Accepted: 07/19/2021] [Indexed: 01/10/2023] Open
Abstract
Objective Placebo as well as nocebo responses are widely found in scientific research and clinical practice. Growing evidence suggests sex differences in placebo as well as nocebo responses. However, data concerning this question are still insufficient. This study examined whether the BOLD signals of two responses, as measured with functional MRI (fMRI), differ by sex under conditions of equivalent experimental pain perception. Method Thirty-one healthy volunteers (14 female) underwent two fMRI scans, once during a placebo intervention and once during a nocebo intervention, pseudorandomly ordered, in an acute lower back pain (ALBP) model. We collected visual analog scale (VAS) data after each scanning. fMRI data from different sex groups were subjected to functional connectivity (FC) analysis and behavioral correlation analysis (BCA). Results The results showed statistical differences in VAS scores between male and female participants, in both placebo and nocebo responses. Both groups also showed reduced FC in the pain-associated network of the placebo response and elevated FC in the pain-related network of the nocebo response. However, in the placebo condition, male participants displayed increased FC in the ventromedial prefrontal cortex, parahippocampal gyrus (PHP), and posterior cingulate cortex (PCC), while female participants showed increased FC in the dorsolateral prefrontal cortex, hippocampal gyrus (HP), and insular cortex (IC). In the nocebo condition, male participants showed decreased FC in the PCC and HP, while female participants displayed decreased FC in the mid-cingulate cortex, thalamus (THS), and HP. The BCA results of the two groups were also different. Conclusion We found that the endogenous opioid system and reward circuit play a key role in sex differences of placebo response and that anxiety and its secondary reactions may cause the sex differences of nocebo response.
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Affiliation(s)
- Yu Shi
- Department of Rehabilitation, Zhujiang Hospital, Southern Medical University, Guangzhou, China.,Rehabilitation Medical School, Southern Medical University, Guangzhou, China
| | - Hongrui Zhan
- Department of Rehabilitation, Zhujiang Hospital, Southern Medical University, Guangzhou, China.,Department of Rehabilitation, The Fifth Affiliated Hospital of Sun Yat-sen University, Zhuhai, China
| | - Yanyan Zeng
- Department of Rehabilitation, Zhujiang Hospital, Southern Medical University, Guangzhou, China.,Rehabilitation Medical School, Southern Medical University, Guangzhou, China
| | - Shimin Huang
- Department of Rehabilitation, Zhujiang Hospital, Southern Medical University, Guangzhou, China.,Rehabilitation Medical School, Southern Medical University, Guangzhou, China
| | - Guiyuan Cai
- Department of Rehabilitation, Zhujiang Hospital, Southern Medical University, Guangzhou, China.,Rehabilitation Medical School, Southern Medical University, Guangzhou, China
| | - Jianming Yang
- Department of Radiology, Zhujiang Hospital, Southern Medical University, Guangzhou, China
| | - Wen Wu
- Department of Rehabilitation, Zhujiang Hospital, Southern Medical University, Guangzhou, China.,Rehabilitation Medical School, Southern Medical University, Guangzhou, China
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14
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Shi Y, Cui S, Zeng Y, Huang S, Cai G, Yang J, Wu W. Brain Network to Placebo and Nocebo Responses in Acute Experimental Lower Back Pain: A Multivariate Granger Causality Analysis of fMRI Data. Front Behav Neurosci 2021; 15:696577. [PMID: 34566591 PMCID: PMC8458622 DOI: 10.3389/fnbeh.2021.696577] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/07/2021] [Accepted: 08/06/2021] [Indexed: 01/10/2023] Open
Abstract
Background and Objective: Placebo and nocebo responses are widely observed. Herein, we investigated the nocebo hyperalgesia and placebo analgesia responses in brain network in acute lower back pain (ALBP) model using multivariate Granger causality analysis (GCA). This approach analyses functional magnetic resonance imaging (fMRI) data for lagged-temporal correlation between different brain areas. Method: After completing the ALBP model, 20 healthy subjects were given two interventions, once during a placebo intervention and once during a nocebo intervention, pseudo-randomly ordered. fMRI scans were performed synchronously during each intervention, and visual analog scale (VAS) scores were collected at the end of each intervention. The fMRI data were then analyzed using multivariate GCA. Results: Our results found statistically significant differences in VAS scores from baseline (pain status) for both placebo and nocebo interventions, as well as between placebo and nocebo interventions. In placebo network, we found a negative lagged-temporal correlation between multiple brain areas, including the dorsolateral prefrontal cortex (DLPFC), secondary somatosensory cortex area, anterior cingulate cortex (ACC), and insular cortex (IC); and a positive lagged-temporal correlation between multiple brain areas, including IC, thalamus, ACC, as well as the supplementary motor area (SMA). In the nocebo network, we also found a positive lagged-temporal correlation between multiple brain areas, including the primary somatosensory cortex area, caudate, DLPFC and SMA. Conclusion: The results of this study suggest that both pain-related network and reward system are involved in placebo and nocebo responses. The placebo response mainly works by activating the reward system and inhibiting pain-related network, while the nocebo response is the opposite. Placebo network also involves the activation of opioid-mediated analgesia system (OMAS) and emotion pathway, while nocebo network involves the deactivation of emotional control. At the same time, through the construction of the GC network, we verified our hypothesis that nocebo and placebo networks share part of the same brain regions, but the two networks also have their own unique structural features.
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Affiliation(s)
- Yu Shi
- Department of Rehabilitation, Zhujiang Hospital, Southern Medical University, Guangzhou, China
| | - Shaoye Cui
- Department of Intensive Care Unit, Zhujiang Hospital, Southern Medical University, Guangzhou, China
| | - Yanyan Zeng
- Department of Rehabilitation, Zhujiang Hospital, Southern Medical University, Guangzhou, China
| | - Shimin Huang
- Department of Rehabilitation, Zhujiang Hospital, Southern Medical University, Guangzhou, China
| | - Guiyuan Cai
- Department of Rehabilitation, Zhujiang Hospital, Southern Medical University, Guangzhou, China
| | - Jianming Yang
- Department of Radiology, Zhujiang Hospital, Southern Medical University, Guangzhou, China
| | - Wen Wu
- Department of Rehabilitation, Zhujiang Hospital, Southern Medical University, Guangzhou, China
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15
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Hartmann H, Riva F, Rütgen M, Lamm C. Placebo Analgesia Does Not Reduce Empathy for Naturalistic Depictions of Others' Pain in a Somatosensory Specific Way. Cereb Cortex Commun 2021; 2:tgab039. [PMID: 34296184 PMCID: PMC8276832 DOI: 10.1093/texcom/tgab039] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/18/2021] [Revised: 05/18/2021] [Accepted: 05/26/2021] [Indexed: 01/10/2023] Open
Abstract
The shared representations account postulates that sharing another's pain recruits underlying brain functions also engaged during first-hand pain. Critically, direct causal evidence for this was mainly shown for affective pain processing, while the contribution of somatosensory processes to empathy remains controversial. This controversy may be explained, however, by experimental paradigms that did not direct attention towards a specific body part, or that did not employ naturalistic depictions of others' pain. In this preregistered functional magnetic resonance imaging study, we aimed to test whether causal manipulation of first-hand pain affects empathy for naturalistic depictions of pain in a somatosensory-matched manner. Forty-five participants underwent a placebo analgesia induction in their right hand and observed pictures of other people's right and left hands in pain. We found neither behavioral nor neural evidence for somatosensory-specific modulation of pain empathy. However, exploratory analyses revealed a general effect of the placebo on empathy, and higher brain activity in bilateral anterior insula when viewing others' right hands in pain (i.e., corresponding to one's own placebo hand). These results refine our knowledge regarding the neural mechanisms of pain empathy, and imply that the sharing of somatosensory representations seems to play less of a causal role than the one of affective representations.
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Affiliation(s)
- Helena Hartmann
- Social, Cognitive and Affective Neuroscience Unit, Department of Cognition, Emotion, and Methods in Psychology, Faculty of Psychology, University of Vienna, 1010 Vienna, Austria
| | - Federica Riva
- Social, Cognitive and Affective Neuroscience Unit, Department of Cognition, Emotion, and Methods in Psychology, Faculty of Psychology, University of Vienna, 1010 Vienna, Austria
| | - Markus Rütgen
- Social, Cognitive and Affective Neuroscience Unit, Department of Cognition, Emotion, and Methods in Psychology, Faculty of Psychology, University of Vienna, 1010 Vienna, Austria
| | - Claus Lamm
- Social, Cognitive and Affective Neuroscience Unit, Department of Cognition, Emotion, and Methods in Psychology, Faculty of Psychology, University of Vienna, 1010 Vienna, Austria
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16
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Manipulating placebo analgesia and nocebo hyperalgesia by changing brain excitability. Proc Natl Acad Sci U S A 2021; 118:2101273118. [PMID: 33941677 DOI: 10.1073/pnas.2101273118] [Citation(s) in RCA: 16] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/13/2022] Open
Abstract
Harnessing placebo and nocebo effects has significant implications for research and medical practice. Placebo analgesia and nocebo hyperalgesia, the most well-studied placebo and nocebo effects, are thought to initiate from the dorsal lateral prefrontal cortex (DLPFC) and then trigger the brain's descending pain modulatory system and other pain regulation pathways. Combining repeated transcranial direct current stimulation (tDCS), an expectancy manipulation model, and functional MRI, we investigated the modulatory effects of anodal and cathodal tDCS at the right DLPFC on placebo analgesia and nocebo hyperalgesia using a randomized, double-blind and sham-controlled design. We found that compared with sham tDCS, active tDCS could 1) boost placebo and blunt nocebo effects and 2) modulate brain activity and connectivity associated with placebo analgesia and nocebo hyperalgesia. These results provide a basis for mechanistic manipulation of placebo and nocebo effects and may lead to improved clinical outcomes in medical practice.
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17
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Abstract
Biological sex differences in brain function and structure are reliably associated with several cortico-subcortical brain regions. While sexual orientation (hetero- versus homosexuality) has been similarly linked to functional differences in several phylogenetically-old brain areas, the research on morphological brain phenotypes associated with sexual orientation is far from conclusive. We examined potential cerebral structural differences linked to sexual orientation in a group of 74 participants, including 37 men (21 homosexual) and 37 women (19 homosexual) using voxel-based morphometry (VBM). Gray matter volumes (GMV) were compared with respect to sexual orientation and biological sex across the entire sample using full factorial designs controlling for total intracranial volume, age, handedness, and education. We observed a significant effect of sexual orientation for the thalamus and precentral gyrus, with more GMV in heterosexual versus homosexual individuals, and for the putamen, with more GMV in homosexual + than heterosexual individuals. We found significant interactions between biological sex and sexual orientation, indicating that the significant effect for the putamen cluster was driven by homosexual women, whereas heterosexual women had increased precentral gyrus GMV. Heterosexual men exhibited more GMV in the thalamus than homosexual men. This study shows that sexual orientation is reflected in brain structure characteristics and that these differ between the sexes. The results emphasize the need to include or control for potential effects of participants' sexual orientation in neuroimaging studies. Furthermore, our findings provide important new insights into the brain morphology underlying sexual orientation and likely have important implications for understanding brain functions and behavior.
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18
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Zunhammer M, Spisák T, Wager TD, Bingel U. Meta-analysis of neural systems underlying placebo analgesia from individual participant fMRI data. Nat Commun 2021; 12:1391. [PMID: 33654105 PMCID: PMC7925520 DOI: 10.1038/s41467-021-21179-3] [Citation(s) in RCA: 62] [Impact Index Per Article: 20.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/19/2020] [Accepted: 01/04/2021] [Indexed: 12/13/2022] Open
Abstract
The brain systems underlying placebo analgesia are insufficiently understood. Here we performed a systematic, participant-level meta-analysis of experimental functional neuroimaging studies of evoked pain under stimulus-intensity-matched placebo and control conditions, encompassing 603 healthy participants from 20 (out of 28 eligible) studies. We find that placebo vs. control treatments induce small, widespread reductions in pain-related activity, particularly in regions belonging to ventral attention (including mid-insula) and somatomotor networks (including posterior insula). Behavioral placebo analgesia correlates with reduced pain-related activity in these networks and the thalamus, habenula, mid-cingulate, and supplementary motor area. Placebo-associated activity increases occur mainly in frontoparietal regions, with high between-study heterogeneity. We conclude that placebo treatments affect pain-related activity in multiple brain areas, which may reflect changes in nociception and/or other affective and decision-making processes surrounding pain. Between-study heterogeneity suggests that placebo analgesia is a multi-faceted phenomenon involving multiple cerebral mechanisms that differ across studies.
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Affiliation(s)
- Matthias Zunhammer
- Center for Translational Neuro- and Behavioral Sciences, Dept. of Neurology, University Hospital Essen, Essen, Germany
| | - Tamás Spisák
- Center for Translational Neuro- and Behavioral Sciences, Dept. of Neurology, University Hospital Essen, Essen, Germany
| | - Tor D Wager
- Cognitive and Affective Neuroscience Laboratory, Department of Psychological and Brain Sciences, Dartmouth College, Hanover, NH, USA.
| | - Ulrike Bingel
- Center for Translational Neuro- and Behavioral Sciences, Dept. of Neurology, University Hospital Essen, Essen, Germany.
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19
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Lee IS, Jung WM, Lee YS, Wallraven C, Chae Y. Operant and classical learning principles underlying mind-body interaction in pain modulation: a pilot fMRI study. Sci Rep 2021; 11:1663. [PMID: 33462278 PMCID: PMC7813884 DOI: 10.1038/s41598-021-81134-6] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/30/2020] [Accepted: 01/04/2021] [Indexed: 11/09/2022] Open
Abstract
The operant conditioning has been less studied than the classical conditioning as a mechanism of placebo-like effect, and two distinct learning mechanisms have never been compared to each other in terms of their neural activities. Twenty-one participants completed cue-learning based pain rating tasks while their brain responses were measured using functional magnetic resonance imaging. After choosing (instrumental) or viewing (classical) one of three predictive cues (low- and high-pain cues with different level of certainty), they received painful stimuli according to the selected cues. Participants completed the same task during the test session, except that they received only a high pain stimulus regardless of the selected cues to identify the effects of two learning paradigms. While receiving a high pain stimulation, low-pain cue significantly reduced pain ratings compared to high-pain cue, and the overall ratings were significantly lower under operant than under classical conditioning. Operant behavior activated the temporoparietal junction significantly more than the passive behavior did, and neural activity in the primary somatosensory cortex was significantly reduced during pain in instrumental as compared with classical conditioning trials. The results suggest that pain modulation can be induced by classical and operant conditioning, and mechanisms of attention and context change are involved in instrumental learning.
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Affiliation(s)
- In-Seon Lee
- Acupuncture and Meridian Science Research Center, College of Korean Medicine, Kyung Hee University, 1 Hoegi-dong, Dongdaemun-gu, Seoul, 02447, Republic of Korea
| | - Won-Mo Jung
- Acupuncture and Meridian Science Research Center, College of Korean Medicine, Kyung Hee University, 1 Hoegi-dong, Dongdaemun-gu, Seoul, 02447, Republic of Korea
| | - Ye-Seul Lee
- Department of Anatomy and Acupoint, College of Korean Medicine, Gachon University, Seongnam, Republic of Korea
| | - Christian Wallraven
- Department of Artificial Intelligence, Department of Brain Cognitive Engineering, Korea University, Seoul, Republic of Korea
| | - Younbyoung Chae
- Acupuncture and Meridian Science Research Center, College of Korean Medicine, Kyung Hee University, 1 Hoegi-dong, Dongdaemun-gu, Seoul, 02447, Republic of Korea.
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20
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Geers AL, Faasse K, Guevarra DA, Clemens KS, Helfer SG, Colagiuri B. Affect and emotions in placebo and nocebo effects: What do we know so far? SOCIAL AND PERSONALITY PSYCHOLOGY COMPASS 2020. [DOI: 10.1111/spc3.12575] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/20/2022]
Affiliation(s)
- Andrew L. Geers
- Department of Psychology University of Toledo Toledo Ohio USA
| | - Kate Faasse
- School of Psychology University of New South Wales Sydney New South Wales Australia
| | - Darwin A. Guevarra
- Department of Psychology Michigan State University East Lansing Michigan USA
| | | | | | - Ben Colagiuri
- School of Psychology University of Sydney Sydney New South Wales Australia
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21
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Amanzio M, Howick J, Bartoli M, Cipriani GE, Kong J. How Do Nocebo Phenomena Provide a Theoretical Framework for the COVID-19 Pandemic? Front Psychol 2020; 11:589884. [PMID: 33192929 PMCID: PMC7661580 DOI: 10.3389/fpsyg.2020.589884] [Citation(s) in RCA: 24] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/31/2020] [Accepted: 09/24/2020] [Indexed: 12/12/2022] Open
Abstract
The COVID-19 pandemic is a major health issue, which leads to psychological and behavioural changes. In particular, among various negative feelings, fear seems to be one of the main emotional reactions that can be as contagious as the virus itself. The actual pandemic is likely to function as an important stressor, especially in terms of chronic anxiety and lack of control over the succession of unforeseeable environmental events. In this direction, the psychological impact of previous quarantine measures showed important negative psychological effects, including post-traumatic stress symptoms (PTTS) with long-lasting effects. The presence of psychological discomfort and disturbances due to negative contextual factors can be studied using the nocebo phenomenon as a possible theoretical explanatory framework. Although in the absence of studies linking nocebo to Covid-19 and data-driven evidence, the context of the actual pandemic may be seen as a fertile ground for amplified discomfort and anxiety. The media provide dramatic and negative descriptions and often present conflicting sources of information, which can lead to physical and mental health problems, diminishing response to treatment. This can be worse when supported by conspiracy theories or misinformation. The aim of this perspective review is to propose a new theoretical framework for the COVID-19 pandemic, which should be supported by future empirical studies. In particular, the negative contextual factors, which can predispose individuals to psychological distress and the onset of the nocebo phenomena will be presented here, in order to suggest possible guidelines to mitigate the devastating effects of COVID-19.
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Affiliation(s)
- Martina Amanzio
- Department of Psychology, University of Turin, Turin, Italy.,European Innovation Partnership on Active and Healthy Ageing (EIP-AHA), Brussels, Belgium
| | - Jeremy Howick
- Faculty of Philosophy, University of Oxford, Oxford, United Kingdom
| | | | | | - Jian Kong
- Department of Psychiatry, Massachusetts General Hospital, Harvard Medical School, Charlestown, MA, United States
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22
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Shi Y, Huang S, Zhan H, Wang Y, Zeng Y, Cai G, Yang J, Wu W. Personality Differences of Brain Networks in Placebo Analgesia and Nocebo Hyperalgesia: A Psychophysiological Interaction (PPI) Approach in fMRI. Neural Plast 2020; 2020:8820443. [PMID: 33133178 PMCID: PMC7591942 DOI: 10.1155/2020/8820443] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/28/2020] [Revised: 09/28/2020] [Accepted: 09/30/2020] [Indexed: 11/18/2022] Open
Abstract
It is generally believed that the placebo response can elicit an analgesic effect, whilst the nocebo response can elicit a hyperalgesia effect in pain. Placebo analgesia and nocebo hyperalgesia effects are increasing concerns for researchers. Growing evidence suggests personality differences have an impact on both placebo and nocebo effects. However, previous studies have not reached a unified conclusion. We designed this study to explore the personality differences of functional magnetic resonance imaging (fMRI) signals in placebo response and nocebo response by using psychophysiological interaction (PPI) analysis. 30 healthy subjects underwent conditioning induction training to establish expectations of placebo effect and nocebo effect, and then, all subjects completed the following experimental procedures: (1) baseline scanning, (2) acute pain model establishment, (3) pain status scanning, and (4) pseudorandom scanning of block design of placebo response or nocebo response. Behavioral data were collected after each scan. The results of this study showed that (1) there were significant differences of VAS placebo intervention between the extrovert group and the introvert group (p = 0.004); (2) there were significant differences of VAS nocebo intervention between the extrovert group and the introvert group (p = 0.011); (3) there were significant differences between the VAS placebo intervention and VAS pain status (baseline) in both the extrovert group (p < 0.001) and the introvert group (p = 0.001); (4) there were significant differences between the VAS nocebo intervention and VAS pain status (baseline) in both the extrovert group (p = 0.008) and the introvert group (p < 0.001). Moreover, there were significant differences in the brain network for placebo and nocebo responses between different personalities. We found that (1) deactivation differences of the pain-related network and limbic system play an important role in personality differences associated with placebo analgesia and (2) differences of control of anxiety and activation of dorsolateral prefrontal cortex may cause the personality differences observed in nocebo hyperalgesia.
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Affiliation(s)
- Yu Shi
- Department of Rehabilitation, Zhujiang Hospital, Southern Medical University, Guangzhou 510282, China
| | - Shimin Huang
- Department of Rehabilitation, Zhujiang Hospital, Southern Medical University, Guangzhou 510282, China
| | - Hongrui Zhan
- Department of Rehabilitation, Zhujiang Hospital, Southern Medical University, Guangzhou 510282, China
- Department of Physical Medicine and Rehabilitation, The Fifth Affiliated Hospital of Sun Yat-sen University, Zhuhai 519000, China
| | - Yaping Wang
- Department of Rehabilitation, Zhujiang Hospital, Southern Medical University, Guangzhou 510282, China
| | - Yanyan Zeng
- Department of Rehabilitation, Zhujiang Hospital, Southern Medical University, Guangzhou 510282, China
| | - Guiyuan Cai
- Department of Rehabilitation, Zhujiang Hospital, Southern Medical University, Guangzhou 510282, China
| | - Jianming Yang
- Department of Radiology, Zhujiang Hospital, Southern Medical University, Guangzhou 510282, China
| | - Wen Wu
- Department of Rehabilitation, Zhujiang Hospital, Southern Medical University, Guangzhou 510282, China
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23
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Ellingsen DM, Isenburg K, Jung C, Lee J, Gerber J, Mawla I, Sclocco R, Jensen KB, Edwards RR, Kelley JM, Kirsch I, Kaptchuk TJ, Napadow V. Dynamic brain-to-brain concordance and behavioral mirroring as a mechanism of the patient-clinician interaction. SCIENCE ADVANCES 2020; 6:eabc1304. [PMID: 33087365 PMCID: PMC7577722 DOI: 10.1126/sciadv.abc1304] [Citation(s) in RCA: 41] [Impact Index Per Article: 10.3] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/08/2020] [Accepted: 08/25/2020] [Indexed: 06/02/2023]
Abstract
The patient-clinician interaction can powerfully shape treatment outcomes such as pain but is often considered an intangible "art of medicine" and has largely eluded scientific inquiry. Although brain correlates of social processes such as empathy and theory of mind have been studied using single-subject designs, specific behavioral and neural mechanisms underpinning the patient-clinician interaction are unknown. Using a two-person interactive design, we simultaneously recorded functional magnetic resonance imaging (hyperscanning) in patient-clinician dyads, who interacted via live video, while clinicians treated evoked pain in patients with chronic pain. Our results show that patient analgesia is mediated by patient-clinician nonverbal behavioral mirroring and brain-to-brain concordance in circuitry implicated in theory of mind and social mirroring. Dyad-based analyses showed extensive dynamic coupling of these brain nodes with the partners' brain activity, yet only in dyads with pre-established clinical rapport. These findings introduce a putatively key brain-behavioral mechanism for therapeutic alliance and psychosocial analgesia.
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Affiliation(s)
- Dan-Mikael Ellingsen
- Department of Psychology, University of Oslo, Oslo, Norway.
- Norwegian Centre for Mental Disorders Research (NORMENT), Division of Mental Health and Addiction, Oslo University Hospital, Oslo, Norway
- Athinoula A. Martinos Center for Biomedical Imaging, Massachusetts General Hospital, Charlestown, MA, USA
| | - Kylie Isenburg
- Athinoula A. Martinos Center for Biomedical Imaging, Massachusetts General Hospital, Charlestown, MA, USA
| | - Changjin Jung
- Athinoula A. Martinos Center for Biomedical Imaging, Massachusetts General Hospital, Charlestown, MA, USA
- KM Fundamental Research Division, Korea Institute of Oriental Medicine, Daejeon, The Republic of Korea
| | - Jeungchan Lee
- Athinoula A. Martinos Center for Biomedical Imaging, Massachusetts General Hospital, Charlestown, MA, USA
| | - Jessica Gerber
- Athinoula A. Martinos Center for Biomedical Imaging, Massachusetts General Hospital, Charlestown, MA, USA
| | - Ishtiaq Mawla
- Athinoula A. Martinos Center for Biomedical Imaging, Massachusetts General Hospital, Charlestown, MA, USA
| | - Roberta Sclocco
- Athinoula A. Martinos Center for Biomedical Imaging, Massachusetts General Hospital, Charlestown, MA, USA
- Department of Radiology, Logan University, Chesterfield, MO, USA
| | - Karin B Jensen
- Department of Clinical Neuroscience, Karolinska Institute, Stockholm, Sweden
| | - Robert R Edwards
- Department of Anesthesiology, Brigham and Women's Hospital, Boston, MA, USA
| | - John M Kelley
- Endicott College, Beverly, MA, USA
- Program in Placebo Studies and Therapeutic Encounter (PiPS), Harvard Medical School, Boston, MA, USA
| | - Irving Kirsch
- Program in Placebo Studies and Therapeutic Encounter (PiPS), Harvard Medical School, Boston, MA, USA
| | - Ted J Kaptchuk
- Program in Placebo Studies and Therapeutic Encounter (PiPS), Harvard Medical School, Boston, MA, USA
| | - Vitaly Napadow
- Athinoula A. Martinos Center for Biomedical Imaging, Massachusetts General Hospital, Charlestown, MA, USA
- Department of Radiology, Logan University, Chesterfield, MO, USA
- Department of Anesthesiology, Brigham and Women's Hospital, Boston, MA, USA
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24
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Lindheimer JB, Szabo A, Raglin JS, Beedie C. Advancing the understanding of placebo effects in psychological outcomes of exercise: Lessons learned and future directions. Eur J Sport Sci 2020; 20:326-337. [PMID: 31215360 PMCID: PMC6949426 DOI: 10.1080/17461391.2019.1632937] [Citation(s) in RCA: 27] [Impact Index Per Article: 6.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/30/2023]
Abstract
Despite the apparent strength of scientific evidence suggesting that psychological benefits result from both acute and chronic exercise, concerns remain regarding the extent to which these benefits are explained by placebo effects. Addressing these concerns is methodologically and at times conceptually challenging. However, developments in the conceptualisation and study of placebo effects from the fields of psychology, neuroscience, pharmacology, and human performance offer guidance for advancing the understanding of placebo effects in psychological responses to exercise. In clinical trials, expectations can be measured and experimentally manipulated to better understand the influence of placebo effects on treatment responses. Further, compelling evidence has shown that the contribution of placebo effects and their underlying neurobiological mechanisms to treatment effects can be measured without administering a traditional placebo (e.g. inert substance) by leveraging psychological factors such as expectations and conditioning. Hence, the purpose of this focused review is to integrate lessons such as these with the current body of literature on placebo effects in psychological responses to exercise and provide recommendations for future research directions.
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Affiliation(s)
- Jacob B Lindheimer
- Department of Veterans Affairs, William S. Middleton Veterans Memorial Hospital, Madison, WI, USA
- Department of Kinesiology, University of Wisconsin-Madison, Madison, WI, USA
| | - Attila Szabo
- Institute of Health Promotion and Sport Sciences, ELTE Eötvös Loránd University, Budapest Hungary
| | - John S Raglin
- Department of Kinesiology, Indiana University, Bloomington, IN, USA
| | - Chris Beedie
- School of Psychology, University of Kent, Canterbury, UK
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Tu Y, Zeng F, Lan L, Li Z, Maleki N, Liu B, Chen J, Wang C, Park J, Lang C, Yujie G, Liu M, Fu Z, Zhang Z, Liang F, Kong J. An fMRI-based neural marker for migraine without aura. Neurology 2020; 94:e741-e751. [PMID: 31964691 PMCID: PMC7176301 DOI: 10.1212/wnl.0000000000008962] [Citation(s) in RCA: 63] [Impact Index Per Article: 15.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/25/2019] [Accepted: 08/29/2019] [Indexed: 12/28/2022] Open
Abstract
OBJECTIVE To identify and validate an fMRI-based neural marker for migraine without aura (MwoA) and to examine its association with treatment response. METHODS We conducted cross-sectional studies with resting-state fMRI data from 230 participants and machine learning analyses. In studies 1 through 3, we identified, cross-validated, independently validated, and cross-sectionally validated an fMRI-based neural marker for MwoA. In study 4, we assessed the relationship between the neural marker and treatment responses in migraineurs who received a 4-week real or sham acupuncture treatment, or were waitlisted, in a registered clinical trial. RESULTS In study 1 (n = 116), we identified a neural marker with abnormal functional connectivity within the visual, default mode, sensorimotor, and frontal-parietal networks that could discriminate migraineurs from healthy controls (HCs) with 93% sensitivity and 89% specificity. In study 2 (n = 38), we investigated the generalizability of the marker by applying it to an independent cohort of migraineurs and HCs and achieved 84% sensitivity and specificity. In study 3 (n = 76), we verified the specificity of the marker with new datasets of migraineurs and patients with other chronic pain disorders (chronic low back pain and fibromyalgia) and demonstrated 78% sensitivity and 76% specificity for discriminating migraineurs from nonmigraineurs. In study 4 (n = 116), we found that the changes in the marker responses showed significant correlation with the changes in headache frequency in response to real acupuncture. CONCLUSION We identified an fMRI-based neural marker that captures distinct characteristics of MwoA and can link disease pattern changes to brain changes.
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Affiliation(s)
- Yiheng Tu
- From the Department of Psychiatry (Y.T., N.M., J.P., C.L., J.K.), Massachusetts General Hospital and Harvard Medical School, Charlestown; The Third Teaching Hospital (F.Z., L.L., Z.L., F.L.), Chengdu University of Traditional Chinese Medicine, Sichuan; Department of Radiology (B.L., J.C.), Guangdong Provincial Hospital of Chinese Medicine, Guangzhou, China; Center for Complementary and Integrative Medicine (C.W.), Division of Rheumatology, Tufts Medical Center, Boston, MA; Traditional Chinese Medicine School (G.Y), Ningxia Medical University, Yinchuan; The Acupuncture and Tuina School (M.L.), Hunan University of Traditional Chinese Medicine, Changsha, China; The Mind Research Network (Z.F.), Albuquerque, NM; and School of Biomedical Engineering (Z.Z.), Health Science Center, Shenzhen University, China
| | - Fang Zeng
- From the Department of Psychiatry (Y.T., N.M., J.P., C.L., J.K.), Massachusetts General Hospital and Harvard Medical School, Charlestown; The Third Teaching Hospital (F.Z., L.L., Z.L., F.L.), Chengdu University of Traditional Chinese Medicine, Sichuan; Department of Radiology (B.L., J.C.), Guangdong Provincial Hospital of Chinese Medicine, Guangzhou, China; Center for Complementary and Integrative Medicine (C.W.), Division of Rheumatology, Tufts Medical Center, Boston, MA; Traditional Chinese Medicine School (G.Y), Ningxia Medical University, Yinchuan; The Acupuncture and Tuina School (M.L.), Hunan University of Traditional Chinese Medicine, Changsha, China; The Mind Research Network (Z.F.), Albuquerque, NM; and School of Biomedical Engineering (Z.Z.), Health Science Center, Shenzhen University, China
| | - Lei Lan
- From the Department of Psychiatry (Y.T., N.M., J.P., C.L., J.K.), Massachusetts General Hospital and Harvard Medical School, Charlestown; The Third Teaching Hospital (F.Z., L.L., Z.L., F.L.), Chengdu University of Traditional Chinese Medicine, Sichuan; Department of Radiology (B.L., J.C.), Guangdong Provincial Hospital of Chinese Medicine, Guangzhou, China; Center for Complementary and Integrative Medicine (C.W.), Division of Rheumatology, Tufts Medical Center, Boston, MA; Traditional Chinese Medicine School (G.Y), Ningxia Medical University, Yinchuan; The Acupuncture and Tuina School (M.L.), Hunan University of Traditional Chinese Medicine, Changsha, China; The Mind Research Network (Z.F.), Albuquerque, NM; and School of Biomedical Engineering (Z.Z.), Health Science Center, Shenzhen University, China
| | - Zhengjie Li
- From the Department of Psychiatry (Y.T., N.M., J.P., C.L., J.K.), Massachusetts General Hospital and Harvard Medical School, Charlestown; The Third Teaching Hospital (F.Z., L.L., Z.L., F.L.), Chengdu University of Traditional Chinese Medicine, Sichuan; Department of Radiology (B.L., J.C.), Guangdong Provincial Hospital of Chinese Medicine, Guangzhou, China; Center for Complementary and Integrative Medicine (C.W.), Division of Rheumatology, Tufts Medical Center, Boston, MA; Traditional Chinese Medicine School (G.Y), Ningxia Medical University, Yinchuan; The Acupuncture and Tuina School (M.L.), Hunan University of Traditional Chinese Medicine, Changsha, China; The Mind Research Network (Z.F.), Albuquerque, NM; and School of Biomedical Engineering (Z.Z.), Health Science Center, Shenzhen University, China
| | - Nasim Maleki
- From the Department of Psychiatry (Y.T., N.M., J.P., C.L., J.K.), Massachusetts General Hospital and Harvard Medical School, Charlestown; The Third Teaching Hospital (F.Z., L.L., Z.L., F.L.), Chengdu University of Traditional Chinese Medicine, Sichuan; Department of Radiology (B.L., J.C.), Guangdong Provincial Hospital of Chinese Medicine, Guangzhou, China; Center for Complementary and Integrative Medicine (C.W.), Division of Rheumatology, Tufts Medical Center, Boston, MA; Traditional Chinese Medicine School (G.Y), Ningxia Medical University, Yinchuan; The Acupuncture and Tuina School (M.L.), Hunan University of Traditional Chinese Medicine, Changsha, China; The Mind Research Network (Z.F.), Albuquerque, NM; and School of Biomedical Engineering (Z.Z.), Health Science Center, Shenzhen University, China
| | - Bo Liu
- From the Department of Psychiatry (Y.T., N.M., J.P., C.L., J.K.), Massachusetts General Hospital and Harvard Medical School, Charlestown; The Third Teaching Hospital (F.Z., L.L., Z.L., F.L.), Chengdu University of Traditional Chinese Medicine, Sichuan; Department of Radiology (B.L., J.C.), Guangdong Provincial Hospital of Chinese Medicine, Guangzhou, China; Center for Complementary and Integrative Medicine (C.W.), Division of Rheumatology, Tufts Medical Center, Boston, MA; Traditional Chinese Medicine School (G.Y), Ningxia Medical University, Yinchuan; The Acupuncture and Tuina School (M.L.), Hunan University of Traditional Chinese Medicine, Changsha, China; The Mind Research Network (Z.F.), Albuquerque, NM; and School of Biomedical Engineering (Z.Z.), Health Science Center, Shenzhen University, China
| | - Jun Chen
- From the Department of Psychiatry (Y.T., N.M., J.P., C.L., J.K.), Massachusetts General Hospital and Harvard Medical School, Charlestown; The Third Teaching Hospital (F.Z., L.L., Z.L., F.L.), Chengdu University of Traditional Chinese Medicine, Sichuan; Department of Radiology (B.L., J.C.), Guangdong Provincial Hospital of Chinese Medicine, Guangzhou, China; Center for Complementary and Integrative Medicine (C.W.), Division of Rheumatology, Tufts Medical Center, Boston, MA; Traditional Chinese Medicine School (G.Y), Ningxia Medical University, Yinchuan; The Acupuncture and Tuina School (M.L.), Hunan University of Traditional Chinese Medicine, Changsha, China; The Mind Research Network (Z.F.), Albuquerque, NM; and School of Biomedical Engineering (Z.Z.), Health Science Center, Shenzhen University, China
| | - Chenchen Wang
- From the Department of Psychiatry (Y.T., N.M., J.P., C.L., J.K.), Massachusetts General Hospital and Harvard Medical School, Charlestown; The Third Teaching Hospital (F.Z., L.L., Z.L., F.L.), Chengdu University of Traditional Chinese Medicine, Sichuan; Department of Radiology (B.L., J.C.), Guangdong Provincial Hospital of Chinese Medicine, Guangzhou, China; Center for Complementary and Integrative Medicine (C.W.), Division of Rheumatology, Tufts Medical Center, Boston, MA; Traditional Chinese Medicine School (G.Y), Ningxia Medical University, Yinchuan; The Acupuncture and Tuina School (M.L.), Hunan University of Traditional Chinese Medicine, Changsha, China; The Mind Research Network (Z.F.), Albuquerque, NM; and School of Biomedical Engineering (Z.Z.), Health Science Center, Shenzhen University, China
| | - Joel Park
- From the Department of Psychiatry (Y.T., N.M., J.P., C.L., J.K.), Massachusetts General Hospital and Harvard Medical School, Charlestown; The Third Teaching Hospital (F.Z., L.L., Z.L., F.L.), Chengdu University of Traditional Chinese Medicine, Sichuan; Department of Radiology (B.L., J.C.), Guangdong Provincial Hospital of Chinese Medicine, Guangzhou, China; Center for Complementary and Integrative Medicine (C.W.), Division of Rheumatology, Tufts Medical Center, Boston, MA; Traditional Chinese Medicine School (G.Y), Ningxia Medical University, Yinchuan; The Acupuncture and Tuina School (M.L.), Hunan University of Traditional Chinese Medicine, Changsha, China; The Mind Research Network (Z.F.), Albuquerque, NM; and School of Biomedical Engineering (Z.Z.), Health Science Center, Shenzhen University, China
| | - Courtney Lang
- From the Department of Psychiatry (Y.T., N.M., J.P., C.L., J.K.), Massachusetts General Hospital and Harvard Medical School, Charlestown; The Third Teaching Hospital (F.Z., L.L., Z.L., F.L.), Chengdu University of Traditional Chinese Medicine, Sichuan; Department of Radiology (B.L., J.C.), Guangdong Provincial Hospital of Chinese Medicine, Guangzhou, China; Center for Complementary and Integrative Medicine (C.W.), Division of Rheumatology, Tufts Medical Center, Boston, MA; Traditional Chinese Medicine School (G.Y), Ningxia Medical University, Yinchuan; The Acupuncture and Tuina School (M.L.), Hunan University of Traditional Chinese Medicine, Changsha, China; The Mind Research Network (Z.F.), Albuquerque, NM; and School of Biomedical Engineering (Z.Z.), Health Science Center, Shenzhen University, China
| | - Gao Yujie
- From the Department of Psychiatry (Y.T., N.M., J.P., C.L., J.K.), Massachusetts General Hospital and Harvard Medical School, Charlestown; The Third Teaching Hospital (F.Z., L.L., Z.L., F.L.), Chengdu University of Traditional Chinese Medicine, Sichuan; Department of Radiology (B.L., J.C.), Guangdong Provincial Hospital of Chinese Medicine, Guangzhou, China; Center for Complementary and Integrative Medicine (C.W.), Division of Rheumatology, Tufts Medical Center, Boston, MA; Traditional Chinese Medicine School (G.Y), Ningxia Medical University, Yinchuan; The Acupuncture and Tuina School (M.L.), Hunan University of Traditional Chinese Medicine, Changsha, China; The Mind Research Network (Z.F.), Albuquerque, NM; and School of Biomedical Engineering (Z.Z.), Health Science Center, Shenzhen University, China
| | - Mailan Liu
- From the Department of Psychiatry (Y.T., N.M., J.P., C.L., J.K.), Massachusetts General Hospital and Harvard Medical School, Charlestown; The Third Teaching Hospital (F.Z., L.L., Z.L., F.L.), Chengdu University of Traditional Chinese Medicine, Sichuan; Department of Radiology (B.L., J.C.), Guangdong Provincial Hospital of Chinese Medicine, Guangzhou, China; Center for Complementary and Integrative Medicine (C.W.), Division of Rheumatology, Tufts Medical Center, Boston, MA; Traditional Chinese Medicine School (G.Y), Ningxia Medical University, Yinchuan; The Acupuncture and Tuina School (M.L.), Hunan University of Traditional Chinese Medicine, Changsha, China; The Mind Research Network (Z.F.), Albuquerque, NM; and School of Biomedical Engineering (Z.Z.), Health Science Center, Shenzhen University, China
| | - Zening Fu
- From the Department of Psychiatry (Y.T., N.M., J.P., C.L., J.K.), Massachusetts General Hospital and Harvard Medical School, Charlestown; The Third Teaching Hospital (F.Z., L.L., Z.L., F.L.), Chengdu University of Traditional Chinese Medicine, Sichuan; Department of Radiology (B.L., J.C.), Guangdong Provincial Hospital of Chinese Medicine, Guangzhou, China; Center for Complementary and Integrative Medicine (C.W.), Division of Rheumatology, Tufts Medical Center, Boston, MA; Traditional Chinese Medicine School (G.Y), Ningxia Medical University, Yinchuan; The Acupuncture and Tuina School (M.L.), Hunan University of Traditional Chinese Medicine, Changsha, China; The Mind Research Network (Z.F.), Albuquerque, NM; and School of Biomedical Engineering (Z.Z.), Health Science Center, Shenzhen University, China
| | - Zhiguo Zhang
- From the Department of Psychiatry (Y.T., N.M., J.P., C.L., J.K.), Massachusetts General Hospital and Harvard Medical School, Charlestown; The Third Teaching Hospital (F.Z., L.L., Z.L., F.L.), Chengdu University of Traditional Chinese Medicine, Sichuan; Department of Radiology (B.L., J.C.), Guangdong Provincial Hospital of Chinese Medicine, Guangzhou, China; Center for Complementary and Integrative Medicine (C.W.), Division of Rheumatology, Tufts Medical Center, Boston, MA; Traditional Chinese Medicine School (G.Y), Ningxia Medical University, Yinchuan; The Acupuncture and Tuina School (M.L.), Hunan University of Traditional Chinese Medicine, Changsha, China; The Mind Research Network (Z.F.), Albuquerque, NM; and School of Biomedical Engineering (Z.Z.), Health Science Center, Shenzhen University, China
| | - Fanrong Liang
- From the Department of Psychiatry (Y.T., N.M., J.P., C.L., J.K.), Massachusetts General Hospital and Harvard Medical School, Charlestown; The Third Teaching Hospital (F.Z., L.L., Z.L., F.L.), Chengdu University of Traditional Chinese Medicine, Sichuan; Department of Radiology (B.L., J.C.), Guangdong Provincial Hospital of Chinese Medicine, Guangzhou, China; Center for Complementary and Integrative Medicine (C.W.), Division of Rheumatology, Tufts Medical Center, Boston, MA; Traditional Chinese Medicine School (G.Y), Ningxia Medical University, Yinchuan; The Acupuncture and Tuina School (M.L.), Hunan University of Traditional Chinese Medicine, Changsha, China; The Mind Research Network (Z.F.), Albuquerque, NM; and School of Biomedical Engineering (Z.Z.), Health Science Center, Shenzhen University, China
| | - Jian Kong
- From the Department of Psychiatry (Y.T., N.M., J.P., C.L., J.K.), Massachusetts General Hospital and Harvard Medical School, Charlestown; The Third Teaching Hospital (F.Z., L.L., Z.L., F.L.), Chengdu University of Traditional Chinese Medicine, Sichuan; Department of Radiology (B.L., J.C.), Guangdong Provincial Hospital of Chinese Medicine, Guangzhou, China; Center for Complementary and Integrative Medicine (C.W.), Division of Rheumatology, Tufts Medical Center, Boston, MA; Traditional Chinese Medicine School (G.Y), Ningxia Medical University, Yinchuan; The Acupuncture and Tuina School (M.L.), Hunan University of Traditional Chinese Medicine, Changsha, China; The Mind Research Network (Z.F.), Albuquerque, NM; and School of Biomedical Engineering (Z.Z.), Health Science Center, Shenzhen University, China.
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Druart L, Graham Longsworth S, Rolland C, Dolgopoloff M, Terrisse H, Bosson JL, Pinsault N. Can an Open-Label Placebo Be as Effective as a Deceptive Placebo? Methodological Considerations of a Study Protocol. MEDICINES (BASEL, SWITZERLAND) 2020; 7:medicines7010003. [PMID: 31906435 PMCID: PMC7168289 DOI: 10.3390/medicines7010003] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/06/2019] [Revised: 12/19/2019] [Accepted: 12/30/2019] [Indexed: 06/02/2023]
Abstract
Background: Placebo has been studied for many years and is ever-present in healthcare. In clinical practice, its use is limited by ethical issues raised by the deception entailed by its administration. Objective: To investigate whether, when given detailed information about pain and underlying placebo mechanisms, subjects will have a response similar to that of those subjected to a procedure in which they receive a conventional placebo treatment. Methods: The study is designed as a non-inferiority randomized, parallel with a nested crossover trial. In addition, 126 subjects without any known pathology will be included. They will be randomized into two groups. Each subject will undergo three Cold Pressor Tests (CPT): calibration, condition of interest (deceptive placebo or educated placebo), and control. Our main judgment criterion will be the comparison in pain intensity experienced on the visual analog scale between the two CPTs with placebo conditions. Results: This study will allow us to rule on the non-inferiority of an "educated" placebo compared to a deceptive placebo in the context of an acute painful stimulation. It is another step towards the understanding of open-label placebo and its use in clinical practice. Conclusions: This study has been approved by the ethics committee in France (2017-A01643-50) and registered on ClinicalTrials.gov (NCT03934138).
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Affiliation(s)
- Leo Druart
- Physiotherapy Department, University Grenoble Alpes, 38000 Grenoble, France
- Techniques pour l’Évaluation et la Modélisation des Actions de Santé (ThEMAS), Techniques de l’Ingénierie Médicale et de la Complexité (TIMC), Unité Mixte de Recherche (UMR), Centre National de la Recherche Scientifique (CNRS) 5525, Université Grenoble-Alpes, 38000 Grenoble, France
| | - SaraEve Graham Longsworth
- Techniques pour l’Évaluation et la Modélisation des Actions de Santé (ThEMAS), Techniques de l’Ingénierie Médicale et de la Complexité (TIMC), Unité Mixte de Recherche (UMR), Centre National de la Recherche Scientifique (CNRS) 5525, Université Grenoble-Alpes, 38000 Grenoble, France
| | - Carole Rolland
- Techniques pour l’Évaluation et la Modélisation des Actions de Santé (ThEMAS), Techniques de l’Ingénierie Médicale et de la Complexité (TIMC), Unité Mixte de Recherche (UMR), Centre National de la Recherche Scientifique (CNRS) 5525, Université Grenoble-Alpes, 38000 Grenoble, France
| | - Maïa Dolgopoloff
- Physiotherapy Department, University Grenoble Alpes, 38000 Grenoble, France
| | - Hugo Terrisse
- Techniques pour l’Évaluation et la Modélisation des Actions de Santé (ThEMAS), Techniques de l’Ingénierie Médicale et de la Complexité (TIMC), Unité Mixte de Recherche (UMR), Centre National de la Recherche Scientifique (CNRS) 5525, Université Grenoble-Alpes, 38000 Grenoble, France
| | - Jean-Luc Bosson
- Techniques pour l’Évaluation et la Modélisation des Actions de Santé (ThEMAS), Techniques de l’Ingénierie Médicale et de la Complexité (TIMC), Unité Mixte de Recherche (UMR), Centre National de la Recherche Scientifique (CNRS) 5525, Université Grenoble-Alpes, 38000 Grenoble, France
| | - Nicolas Pinsault
- Physiotherapy Department, University Grenoble Alpes, 38000 Grenoble, France
- Techniques pour l’Évaluation et la Modélisation des Actions de Santé (ThEMAS), Techniques de l’Ingénierie Médicale et de la Complexité (TIMC), Unité Mixte de Recherche (UMR), Centre National de la Recherche Scientifique (CNRS) 5525, Université Grenoble-Alpes, 38000 Grenoble, France
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Schenk LA, Colloca L. The neural processes of acquiring placebo effects through observation. Neuroimage 2019; 209:116510. [PMID: 31899287 DOI: 10.1016/j.neuroimage.2019.116510] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/30/2019] [Revised: 12/20/2019] [Accepted: 12/26/2019] [Indexed: 12/16/2022] Open
Abstract
Learning through social observation is critical for humans. The present study investigates the neural processes underlying the acquisition of placebo effects through observational learning. We created a new functional magnetic resonance imaging (fMRI) paradigm where participants (n = 38, healthy, both sexes) observed a demonstrator experiencing pain relief by a placebo treatment cream and experiencing pain without a treatment (control cream), and subsequently performed the same procedure themselves. Participants demonstrated placebo hypoalgesia while they performed the procedure themselves, confirming that observational learning can lead to placebo effects. During the observational learning phase, fMRI analysis showed a modulation of the amygdalae, periaqueductal grey, temporoparietal junctions (TPJ), and dorsolateral prefrontal cortex (DLPFC). Connectivity between the DLPFC and TPJ during the observational learning task was modulated by the placebo treatment and predicted subsequent placebo effects. Mediation analysis further confirmed that the DLPFC-TPJ connectivity formally mediated the effect of the observed treatment condition on subsequent placebo effects. Additionally, pre-recorded resting state connectivity between the DLPFC and TPJ also predicted observationally-learned placebo effects. Our findings provide an understanding of the neural processes during the acquisition of placebo effects through observation and indicate a critical role for DLPFC-TPJ integration processes during observational learning of therapeutic outcomes.
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Affiliation(s)
- Lieven A Schenk
- Department of Pain and Translational Symptom Science, School of Nursing, University of Maryland, Baltimore, USA.
| | - Luana Colloca
- Department of Pain and Translational Symptom Science, School of Nursing, University of Maryland, Baltimore, USA; Departments of Anesthesiology and Psychiatry, School of Medicine, University of Maryland, Baltimore, USA; Center to Advance Chronic Pain Research, University of Maryland, Baltimore, USA.
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28
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Egorova N, Benedetti F, Gollub RL, Kong J. Between placebo and nocebo: Response to control treatment is mediated by amygdala activity and connectivity. Eur J Pain 2019; 24:580-592. [PMID: 31770471 DOI: 10.1002/ejp.1510] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/17/2019] [Revised: 09/08/2019] [Accepted: 11/19/2019] [Indexed: 12/27/2022]
Abstract
BACKGROUND In experimental placebo and nocebo studies, neutral control treatments are often administered for comparison with active treatments, but are of little interest, as, on average, they result in little change. Yet, when considered at an individual level, they fluctuate between baseline and subsequent measurements and may reveal important information about participants' placebo/nocebo responding tendencies. METHODS In a paradigm involving application of creams paired with positive, negative and neutral expectations, some subjects rated identical stimuli in the neutral condition as more painful while others as less painful after treatment with inert cream. We divided subjects into two groups based on the median split in these pre-post responses in the neutral control condition, and investigated (a) fMRI signal differences (post minus pre) between the two groups in neutral condition, and (b) seed-based resting state connectivity of the bilateral amygdala, known to be involved in emotional self-regulation, as well as ambiguous stimulus processing and aversive learning. RESULTS The results suggested that subjects who rated the same pain stimuli after treatment with explicitly neutral cream as more painful showed stronger fMRI activation of the amygdala during the experiment and had higher connectivity between the left amygdala and the striatum at rest. Neutral pre-post changes predicted behavioural placebo/nocebo response in this and two independent datasets. CONCLUSION These findings suggest that measuring pre-post change in the neutral control condition might provide important information about subjects' individual differences in placebo/nocebo response. SIGNIFICANCE Pre-post changes in pain ratings in neutral conditions are modulated by amygdala activity and connectivity and can be used to predict placebo/nocebo responses.
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Affiliation(s)
- Natalia Egorova
- Department of Psychiatry, Massachusetts General Hospital/Harvard Medical School, Charlestown, MA, USA.,The Florey Institute of Neuroscience and Mental Health, Melbourne, Vic., Australia.,Melbourne School of Psychological Sciences, University of Melbourne, Melbourne, Vic., Australia
| | - Fabrizio Benedetti
- University of Turin, Turin, Italy.,Plateau Rosà Labs, Plateau Rosà, Switzerland
| | - Randy L Gollub
- Department of Psychiatry, Massachusetts General Hospital/Harvard Medical School, Charlestown, MA, USA
| | - Jian Kong
- Department of Psychiatry, Massachusetts General Hospital/Harvard Medical School, Charlestown, MA, USA
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Vase L, Wartolowska K. Pain, placebo, and test of treatment efficacy: a narrative review. Br J Anaesth 2019; 123:e254-e262. [PMID: 30915982 PMCID: PMC6676016 DOI: 10.1016/j.bja.2019.01.040] [Citation(s) in RCA: 68] [Impact Index Per Article: 13.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/11/2018] [Revised: 01/22/2019] [Accepted: 01/28/2019] [Indexed: 01/09/2023] Open
Abstract
Over the past decade, the mechanisms underlying placebo effects have begun to be identified. At the same time, the placebo response appears to have increased in pharmacological trials and marked placebo effects are found in neurostimulation and surgical trials, thereby posing the question whether non-pharmacological interventions should be placebo-controlled to a greater extent. In this narrative review we discuss how the knowledge of placebo mechanisms may help to improve placebo control in pharmacological and non-pharmacological trials. We review the psychological, neurobiological, and genetic mechanisms underlying placebo analgesia and outline the current problems and potential solutions to the challenges with placebo control in trials on pharmacological, neurostimulation, and surgical interventions. We particularly focus on how patients' perception of the therapeutic intervention, and their expectations towards treatment efficacy may help develop more precise placebo controls and blinding procedures and account for the contribution of placebo factors to the efficacy of active treatments. Finally, we discuss how systematic investigations into placebo mechanisms across various pain conditions and types of treatment are needed in order to 'personalise' the placebo control to the specific pathophysiology and interventions, which may ultimately lead to identification of more effective treatment for pain patients. In conclusion this review shows that it is important to understand how patients' perception and expectations influence the efficacy of active and placebo treatments in order to improve the test of new treatments. Importantly, this applies not only to assessment of drug efficacy but also to non-pharmacological trials on surgeries and stimulation procedures.
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Affiliation(s)
- Lene Vase
- Department of Psychology and Behavioural Sciences, School of Business and Social Sciences, Aarhus University, Aarhus, Denmark.
| | - Karolina Wartolowska
- Nuffield Department of Primary Care Health Services, University of Oxford, Oxford, UK.
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30
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Davis AJ, Hettinga F, Beedie C. You don't need to administer a placebo to elicit a placebo effect: Social factors trigger neurobiological pathways to enhance sports performance. Eur J Sport Sci 2019; 20:302-312. [DOI: 10.1080/17461391.2019.1635212] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/02/2023]
Affiliation(s)
- Arran J. Davis
- Institute of Cognitive & Evolutionary Anthropology, University of Oxford, UK
| | - Florentina Hettinga
- Department of Sport, Rehabilitation, and Exercise, Northumbria University, England, UK
| | - Chris Beedie
- School of Psychology, University of Kent, Canterbury, UK
- CHX Performance, London, UK
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Becker S, Bräscher AK, Bannister S, Bensafi M, Calma-Birling D, Chan RCK, Eerola T, Ellingsen DM, Ferdenzi C, Hanson JL, Joffily M, Lidhar NK, Lowe LJ, Martin LJ, Musser ED, Noll-Hussong M, Olino TM, Pintos Lobo R, Wang Y. The role of hedonics in the Human Affectome. Neurosci Biobehav Rev 2019; 102:221-241. [PMID: 31071361 PMCID: PMC6931259 DOI: 10.1016/j.neubiorev.2019.05.003] [Citation(s) in RCA: 29] [Impact Index Per Article: 5.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/31/2018] [Revised: 03/25/2019] [Accepted: 05/03/2019] [Indexed: 01/06/2023]
Abstract
Experiencing pleasure and displeasure is a fundamental part of life. Hedonics guide behavior, affect decision-making, induce learning, and much more. As the positive and negative valence of feelings, hedonics are core processes that accompany emotion, motivation, and bodily states. Here, the affective neuroscience of pleasure and displeasure that has largely focused on the investigation of reward and pain processing, is reviewed. We describe the neurobiological systems of hedonics and factors that modulate hedonic experiences (e.g., cognition, learning, sensory input). Further, we review maladaptive and adaptive pleasure and displeasure functions in mental disorders and well-being, as well as the experience of aesthetics. As a centerpiece of the Human Affectome Project, language used to express pleasure and displeasure was also analyzed, and showed that most of these analyzed words overlap with expressions of emotions, actions, and bodily states. Our review shows that hedonics are typically investigated as processes that accompany other functions, but the mechanisms of hedonics (as core processes) have not been fully elucidated.
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Affiliation(s)
- Susanne Becker
- Department of Cognitive and Clinical Neuroscience, Central Institute of Mental Health, Medical Faculty Mannheim, Heidelberg University, J5, 68159 Mannheim, Germany.
| | - Anne-Kathrin Bräscher
- Department of Clinical Psychology, Psychotherapy and Experimental Psychopathology, University of Mainz, Wallstr. 3, 55122 Mainz, Germany.
| | | | - Moustafa Bensafi
- Research Center in Neurosciences of Lyon, CNRS UMR5292, INSERM U1028, Claude Bernard University Lyon 1, Lyon, Centre Hospitalier Le Vinatier, 95 bd Pinel, 69675 Bron Cedex, France.
| | - Destany Calma-Birling
- Department of Psychology, University of Wisconsin-Oshkosh, 800 Algoma, Blvd., Clow F011, Oshkosh, WI 54901, USA.
| | - Raymond C K Chan
- Neuropsychology and Applied Cognitive Neuroscience Laboratory, CAS Key Laboratory of Mental Health, Institute of Psychology, Chinese Academy of Sciences, Beijing 100101, China.
| | - Tuomas Eerola
- Durham University, Palace Green, DH1 RL3, Durham, UK.
| | - Dan-Mikael Ellingsen
- Martinos Center for Biomedical Imaging, Massachusetts General Hospital, Harvard Medical School, CNY149-2301, 13th St, Charlestown, MA 02129, USA.
| | - Camille Ferdenzi
- Research Center in Neurosciences of Lyon, CNRS UMR5292, INSERM U1028, Claude Bernard University Lyon 1, Lyon, Centre Hospitalier Le Vinatier, 95 bd Pinel, 69675 Bron Cedex, France.
| | - Jamie L Hanson
- University of Pittsburgh, Department of Psychology, 3939 O'Hara Street, Rm. 715, Pittsburgh, PA 15206, USA.
| | - Mateus Joffily
- Groupe d'Analyse et de Théorie Economique (GATE), 93 Chemin des Mouilles, 69130, Écully, France.
| | - Navdeep K Lidhar
- Department of Psychology, University of Toronto Mississauga, Mississauga, ON L5L 1C6, Canada.
| | - Leroy J Lowe
- Neuroqualia (NGO), 36 Arthur Street, Truro, NS, B2N 1X5, Canada.
| | - Loren J Martin
- Department of Psychology, University of Toronto Mississauga, Mississauga, ON L5L 1C6, Canada.
| | - Erica D Musser
- Department of Psychology, Center for Childen and Families, Florida International University, 11200 SW 8th St., Miami, FL 33199, USA.
| | - Michael Noll-Hussong
- Clinic for Psychiatry and Psychotherapy, Division of Psychosomatic Medicine and Psychotherapy, Saarland University Medical Centre, Kirrberger Strasse 100, D-66421 Homburg, Germany.
| | - Thomas M Olino
- Temple University, Department of Psychology, 1701N. 13th St, Philadelphia, PA 19010, USA.
| | - Rosario Pintos Lobo
- Department of Psychology, Center for Childen and Families, Florida International University, 11200 SW 8th St., Miami, FL 33199, USA.
| | - Yi Wang
- Neuropsychology and Applied Cognitive Neuroscience Laboratory, CAS Key Laboratory of Mental Health, Institute of Psychology, Chinese Academy of Sciences, Beijing 100101, China.
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Case LK, Laubacher CM, Richards EA, Grossman M, Atlas LY, Parker S, Bushnell MC. Is placebo analgesia for heat pain a sensory effect? An exploratory study on minimizing the influence of response bias. NEUROBIOLOGY OF PAIN 2019; 5. [PMID: 31080912 PMCID: PMC6505707 DOI: 10.1016/j.ynpai.2018.09.001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
We explored whether placebo analgesia alters afferent nociceptive processing. Healthy adult participants received a standard heat placebo induction procedure. Placebo manipulation was modified to reduce experimenter demand. A novel inter-arm sensory discrimination task was administered. Only placebo responders showed changes in discriminative ability.
We explored the ongoing question of whether placebo analgesia alters afferent nociceptive processing in a novel paradigm designed to minimize the role of response bias in placebo measurement. First, healthy adult participants received a standard heat placebo induction and conditioning procedure using a topical “analgesic” cream applied to one arm. During a subsequent placebo testing procedure, participants rated stimuli on the placebo-treated arm and untreated arm, using a task that minimized subjects’ ability to guess the expected response, thus reducing experimenter demand. Retrospectively participants reported moderate analgesia effectiveness (mean = 5.3/10), but for individual temperature ratings, only 2 subjects exhibited a perceptual placebo response >5 points. Next, these subjects completed a novel, exploratory task designed to measure changes in inter-arm in discriminative accuracy that would be expected from changes in afferent nociception. Both placebo responders (but no non-responders) showed reduced discriminative ability when the hotter stimulus occurred on the placebo arm, an effect consistent with alterations in nociceptive afferent flow and unlikely to be caused by response bias.
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Affiliation(s)
- Laura K Case
- National Center for Complementary and Integrative Health, NIH, Bethesda, MD, United State
| | - Claire M Laubacher
- National Center for Complementary and Integrative Health, NIH, Bethesda, MD, United State
| | - Emily A Richards
- National Center for Complementary and Integrative Health, NIH, Bethesda, MD, United State
| | - Matthew Grossman
- National Center for Complementary and Integrative Health, NIH, Bethesda, MD, United State
| | - Lauren Y Atlas
- National Center for Complementary and Integrative Health, NIH, Bethesda, MD, United State.,National Institutes on Drug Abuse, NIH, Baltimore, MD, United States
| | - Scott Parker
- National Center for Complementary and Integrative Health, NIH, Bethesda, MD, United State.,Department of Psychology, American University, United States
| | - M Catherine Bushnell
- National Center for Complementary and Integrative Health, NIH, Bethesda, MD, United State
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Burke MJ, Kaptchuk TJ, Pascual-Leone A. Challenges of differential placebo effects in contemporary medicine: The example of brain stimulation. Ann Neurol 2019; 85:12-20. [PMID: 30521083 DOI: 10.1002/ana.25387] [Citation(s) in RCA: 49] [Impact Index Per Article: 9.8] [Reference Citation Analysis] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/10/2018] [Revised: 10/04/2018] [Accepted: 11/25/2018] [Indexed: 01/09/2023]
Affiliation(s)
- Matthew J Burke
- Berenson-Allen Center for Noninvasive Brain Stimulation and Division of Cognitive Neurology, Department of Neurology, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, MA
| | - Ted J Kaptchuk
- Program in Placebo Studies, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, MA
| | - Alvaro Pascual-Leone
- Berenson-Allen Center for Noninvasive Brain Stimulation and Division of Cognitive Neurology, Department of Neurology, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, MA
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Santarcangelo EL, Consoli S. Complex Role of Hypnotizability in the Cognitive Control of Pain. Front Psychol 2018; 9:2272. [PMID: 30515125 PMCID: PMC6256013 DOI: 10.3389/fpsyg.2018.02272] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/01/2018] [Accepted: 11/01/2018] [Indexed: 12/12/2022] Open
Affiliation(s)
- Enrica L. Santarcangelo
- Department of Translational Research and New Technologies in Medicine and Surgery University of Pisa, Pisa, Italy
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35
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Ahmed S, Plazier M, Ost J, Stassijns G, Deleye S, Ceyssens S, Dupont P, Stroobants S, Staelens S, De Ridder D, Vanneste S. The effect of occipital nerve field stimulation on the descending pain pathway in patients with fibromyalgia: a water PET and EEG imaging study. BMC Neurol 2018; 18:191. [PMID: 30419855 PMCID: PMC6233518 DOI: 10.1186/s12883-018-1190-5] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/05/2017] [Accepted: 10/28/2018] [Indexed: 12/26/2022] Open
Abstract
Background Fibromyalgia is a chronic disorder characterized by widespread musculoskeletal pain accompanied by fatigue, sleep, memory, and mood problems. Recently, occipital nerve field stimulation (ONS) has been proposed as an effective potential treatment for fibromyalgia-related pain. The aim of this study is to unravel the neural mechanism behind occipital nerve stimulation’s ability to suppress pain in fibromyalgia patients. Materials and methods Seven patients implanted with subcutaneous electrodes in the C2 dermatoma were enrolled for a Positron Emission Tomography (PET) H215O activation study. These seven patients were selected from a cohort of 40 patients who were part of a double blind, placebo-controlled study followed by an open label follow up at six months. The H215O PET scans were taken during both the “ON” (active stimulation) and “OFF” (stimulating device turned off) conditions. Electroencephalogram (EEG) data were also recorded for the implanted fibromyalgia patients during both the “ON” and “OFF” conditions. Results Relative to the “OFF” condition, ONS stimulation resulted in activation in the dorsal lateral prefrontal cortex, comprising the medial pain pathway, the ventral medial prefrontal cortex, and the bilateral anterior cingulate cortex as well as parahippocampal area, the latter two of which comprise the descending pain pathway. Relative deactivation was observed in the left somatosensory cortex, constituting the lateral pain pathway as well as other sensory areas such as the visual and auditory cortex. The EEG results also showed increased activity in the descending pain pathway. The pregenual anterior cingulate cortex extending into the ventral medial prefrontal cortex displayed this increase in the theta, alpha1, alpha2, beta1, and beta2 frequency bands. Conclusion PET shows that ONS exerts its effect via activation of the descending pain inhibitory pathway and the lateral pain pathway in fibromyalgia, while EEG shows activation of those cortical areas that could be responsible for descending inhibition system recruitment. Trial Registration This study is registered with ClinicalTrials.gov, number NCT00917176 (June 10, 2009).
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Affiliation(s)
- Shaheen Ahmed
- School of Behavioral and Brain Sciences, The University of Texas at Dallas, Richardson, Texas, USA
| | - Mark Plazier
- Department of Neurosurgery, University Hospital Antwerp, Antwerp, Belgium
| | | | - Gaetane Stassijns
- Department of physical health hand rehabilitation, University Hospital Antwerp, Edegem, Belgium
| | - Steven Deleye
- Department of Cognitive Neurology, UZ Leuven, Leuven, Belgium
| | - Sarah Ceyssens
- Department of Cognitive Neurology, UZ Leuven, Leuven, Belgium
| | - Patrick Dupont
- Department of Cognitive Neurology, UZ Leuven, Leuven, Belgium
| | - Sigrid Stroobants
- Department of nuclear medicine, University Hospital Antwerp, Edegem, Belgium
| | - Steven Staelens
- Molecular Imaging Centre, University of Antwerp, Edegem, Belgium
| | - Dirk De Ridder
- Department of Surgical Sciences, Dunedin School of Medicine, University of Otago, Dunedin, New Zealand
| | - Sven Vanneste
- School of Behavioral and Brain Sciences, The University of Texas at Dallas, Richardson, Texas, USA.
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36
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Brain and psychological determinants of placebo pill response in chronic pain patients. Nat Commun 2018; 9:3397. [PMID: 30209286 PMCID: PMC6135815 DOI: 10.1038/s41467-018-05859-1] [Citation(s) in RCA: 72] [Impact Index Per Article: 12.0] [Reference Citation Analysis] [Abstract] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/14/2017] [Accepted: 07/12/2018] [Indexed: 12/18/2022] Open
Abstract
The placebo response is universally observed in clinical trials of pain treatments, yet the individual characteristics rendering a patient a ‘placebo responder’ remain unclear. Here, in chronic back pain patients, we demonstrate using MRI and fMRI that the response to placebo ‘analgesic’ pills depends on brain structure and function. Subcortical limbic volume asymmetry, sensorimotor cortical thickness, and functional coupling of prefrontal regions, anterior cingulate, and periaqueductal gray were predictive of response. These neural traits were present before exposure to the pill and most remained stable across treatment and washout periods. Further, psychological traits, including interoceptive awareness and openness, were also predictive of the magnitude of response. These results shed light on psychological, neuroanatomical, and neurophysiological principles determining placebo response in RCTs in chronic pain patients, and they suggest that the long-term beneficial effects of placebo, as observed in clinical settings, are partially predictable. People vary in the extent to which they feel better after taking an inert, placebo, treatment, but the basis for individual placebo response is unclear. Here, the authors show how brain structural and functional variables, as well as personality traits, predict placebo response in those with chronic back pain.
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Liu J, Mu J, Chen T, Zhang M, Tian J. White matter tract microstructure of the mPFC-amygdala predicts interindividual differences in placebo response related to treatment in migraine patients. Hum Brain Mapp 2018; 40:284-292. [PMID: 30256491 DOI: 10.1002/hbm.24372] [Citation(s) in RCA: 23] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/09/2018] [Revised: 08/13/2018] [Accepted: 08/13/2018] [Indexed: 01/15/2023] Open
Abstract
To investigate whether interindividual variability of white matter (WM) tract microstructure of the medial prefrontal cortex (mPFC)-amygdala circuit could predict 8-week placebo treatment outcomes in patients with migraine without aura (MO) using diffusion tensor imaging (DTI) with a tractography atlas-based analysis algorithm and a linear support vector machine algorithm. This study received institutional review board approval, and all subjects gave informed consent. One hundred and twenty-four MO had an 8-week sham acupuncture treatment. Patients were subdivided into recovering (MOr, >50% improvement in migraine attack frequency after treatment) and persisting (MOp, <50% reduction in number of migraine days). Neuroimaging was collected via magnetic resonance imaging (MRI) in all subjects. Patients were imaged during the interictal phase of migraine (at least 72 hr after, and not within 24 hr of a migraine) before the treatment. WM microstructures were quantified along the selected fiber pathway and were used to evaluate the discrimination performance for classifying MOr and MOp. The combined features of diffusion measures from vertices along the pathways of the mPFC-amygdala accurately discriminated MOr from MOp migraineurs with an accuracy of 84.0% (p < .005, permutation test). The most discriminative WM features that contributed to the classification were located in the external capsule and ACC/mPFC. Our findings suggested that the variability of placebo treatment outcomes in migraineurs could be predicted from priori diffusion measures along the fiber pathways of the mPFC-amygdala, which may demonstrate a potential of WM neuroimaging features as imaging markers for identifying placebo responders in migraine patients.
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Affiliation(s)
- Jixin Liu
- Center for Brain Imaging, School of Life Science and Technology, Xidian University, Xi'an, Peoples Republic of China.,Engineering Research Center of Molecular and Neuro Imaging, Ministry of Education, Xi'an, Peoples Repubilc of China
| | - Junya Mu
- Center for Brain Imaging, School of Life Science and Technology, Xidian University, Xi'an, Peoples Republic of China.,Engineering Research Center of Molecular and Neuro Imaging, Ministry of Education, Xi'an, Peoples Repubilc of China
| | - Tao Chen
- Center for Brain Imaging, School of Life Science and Technology, Xidian University, Xi'an, Peoples Republic of China.,Engineering Research Center of Molecular and Neuro Imaging, Ministry of Education, Xi'an, Peoples Repubilc of China
| | - Ming Zhang
- Department of Medical Imaging, First Affiliated Hospital of Xi'an Jiaotong University, Xi'an, Peoples Republic of China
| | - Jie Tian
- Center for Brain Imaging, School of Life Science and Technology, Xidian University, Xi'an, Peoples Republic of China.,Engineering Research Center of Molecular and Neuro Imaging, Ministry of Education, Xi'an, Peoples Repubilc of China
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38
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Coleshill MJ, Sharpe L, Colloca L, Zachariae R, Colagiuri B. Placebo and Active Treatment Additivity in Placebo Analgesia: Research to Date and Future Directions. INTERNATIONAL REVIEW OF NEUROBIOLOGY 2018; 139:407-441. [PMID: 30146056 PMCID: PMC6179351 DOI: 10.1016/bs.irn.2018.07.021] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/17/2022]
Abstract
Placebo analgesia is a robust experimental and clinical phenomenon. While our understanding of the mechanisms of placebo analgesia has developed rapidly, some central questions remain unanswered. Among the important questions is how placebo analgesia interacts with active analgesic effects. It is an assumption underlying double-blind randomized placebo-controlled trials (RCTs) that the true effect of a treatment can be determined by examining the effect of the active treatment arm and subtracting the response in the placebo group ("the assumption of additivity"). However, despite the importance of this assumption for the interpretation of RCTs, it has rarely been formally examined. This article reviews the assumption of additivity in placebo analgesia by examining studies employing factorial designs manipulating both the receipt of an active analgesic and instructions about the treatment being delivered. In reviewing the literature, we identified seven studies that allowed a test of additivity. Of these, four found evidence against additivity, while the remaining three studies found results consistent with additivity. While the limited available data are somewhat mixed, the evidence suggests that at least under some conditions the assumption of additivity does not hold in placebo analgesia. The concordance between mechanisms of the active analgesic and placebo analgesia may influence whether additivity occurs or not. However, more research using factorial designs is needed to disentangle the relationship between placebo analgesia and the active effect of analgesic treatments.
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Affiliation(s)
- Matthew J Coleshill
- School of Psychology, University of Sydney, Sydney, NSW, Australia; St Vincent's Clinical School, St Vincent's Hospital, University of New South Wales, Sydney, NSW, Australia; Department of Clinical Pharmacology and Toxicology, St Vincent's Hospital, Sydney, NSW, Australia.
| | - Louise Sharpe
- School of Psychology, University of Sydney, Sydney, NSW, Australia
| | - Luana Colloca
- Center to Advance Chronic Pain Research, University of Maryland, Baltimore, MD, United States; School of Nursing, University of Maryland, Baltimore, MD, United States; School of Medicine, University of Maryland, Baltimore, MD, United States
| | - Robert Zachariae
- Aarhus University Hospital and Department of Psychology and Behavioural Science, Aarhus University, Aarhus, Denmark
| | - Ben Colagiuri
- School of Psychology, University of Sydney, Sydney, NSW, Australia
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39
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Koban L, Jepma M, Geuter S, Wager TD. What's in a word? How instructions, suggestions, and social information change pain and emotion. Neurosci Biobehav Rev 2018; 81:29-42. [PMID: 29173508 DOI: 10.1016/j.neubiorev.2017.02.014] [Citation(s) in RCA: 66] [Impact Index Per Article: 11.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/08/2016] [Revised: 02/06/2017] [Accepted: 02/14/2017] [Indexed: 01/10/2023]
Abstract
Instructions, suggestions, and other types of social information can have powerful effects on pain and emotion. Prominent examples include observational learning, social influence, placebo, and hypnosis. These different phenomena and their underlying brain mechanisms have been studied in partially separate literatures, which we discuss, compare, and integrate in this review. Converging findings from these literatures suggest that (1) instructions and social information affect brain systems associated with the generation of pain and emotion, and with reinforcement learning, and that (2) these changes are mediated by alterations in prefrontal systems responsible for top-down control and the generation of affective meaning. We argue that changes in expectation and appraisal, a process of assessing personal meaning and implications for wellbeing, are two potential key mediators of the effects of instructions and social information on affective experience. Finally, we propose a tentative model of how prefrontal regions, especially dorsolateral and ventromedial prefrontal cortex may regulate affective processing based on instructions and socially transmitted expectations more broadly.
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Affiliation(s)
- Leonie Koban
- Institute of Cognitive Science, University of Colorado Boulder, United States; Department of Psychology and Neuroscience, University of Colorado Boulder, United States.
| | - Marieke Jepma
- Cognitive Psychology Unit, Institute of Psychology, Leiden University, The Netherlands; Leiden Institute for Brain and Cognition, Leiden University, The Netherlands
| | - Stephan Geuter
- Institute of Cognitive Science, University of Colorado Boulder, United States; Department of Psychology and Neuroscience, University of Colorado Boulder, United States
| | - Tor D Wager
- Institute of Cognitive Science, University of Colorado Boulder, United States; Department of Psychology and Neuroscience, University of Colorado Boulder, United States
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40
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Alhazmi FH, Beaton D, Abdi H. Semantically defined subdomains of functional neuroimaging literature and their corresponding brain regions. Hum Brain Mapp 2018; 39:2764-2776. [PMID: 29575246 PMCID: PMC6866474 DOI: 10.1002/hbm.24038] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/14/2017] [Revised: 02/17/2018] [Accepted: 03/04/2018] [Indexed: 11/10/2022] Open
Abstract
The functional neuroimaging literature has become increasingly complex and thus difficult to navigate. This complexity arises from the rate at which new studies are published and from the terminology that varies widely from study-to-study and even more so from discipline-to-discipline. One way to investigate and manage this problem is to build a "semantic space" that maps the different vocabulary used in functional neuroimaging literature. Such a semantic space will also help identify the primary research domains of neuroimaging and their most commonly reported brain regions. In this work, we analyzed the multivariate semantic structure of abstracts in Neurosynth and found that there are six primary domains of the functional neuroimaging literature, each with their own preferred reported brain regions. Our analyses also highlight possible semantic sources of reported brain regions within and across domains because some research topics (e.g., memory disorders, substance use disorder) use heterogeneous terminology. Furthermore, we highlight the growth and decline of the primary domains over time. Finally, we note that our techniques and results form the basis of a "recommendation engine" that could help readers better navigate the neuroimaging literature.
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Affiliation(s)
- Fahd H. Alhazmi
- School of Behavioral and Brain SciencesThe University of Texas at Dallas, MS: GR4.1, 800 West Campbell RdRichardsonTexas75080
| | - Derek Beaton
- Rotman Research Institute, Baycrest Health Sciences, 3560 Bathurst StreetTorontoOntarioM6A 2E1Canada
| | - Hervé Abdi
- School of Behavioral and Brain SciencesThe University of Texas at Dallas, MS: GR4.1, 800 West Campbell RdRichardsonTexas75080
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41
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van der Meulen M, Kamping S, Anton F. The role of cognitive reappraisal in placebo analgesia: an fMRI study. Soc Cogn Affect Neurosci 2018; 12:1128-1137. [PMID: 28338955 PMCID: PMC5490670 DOI: 10.1093/scan/nsx033] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/22/2016] [Accepted: 03/06/2017] [Indexed: 12/19/2022] Open
Abstract
Placebo analgesia (PA) depends crucially on the prefrontal cortex (PFC), which is assumed to be responsible for initiating the analgesic response. Surprisingly little research has focused on the psychological mechanisms mediated by the PFC and underlying PA. One increasingly accepted theory is that cognitive reappraisal—the reinterpretation of the meaning of adverse events—plays an important role, but no study has yet addressed the possible functional relationship with PA. We studied the influence of individual differences in reappraisal ability on PA and its prefrontal mediation. Participants completed a cognitive reappraisal ability task, which compared negative affect evoked by pictures in a reappraise versus a control condition. In a subsequent fMRI session, PA was induced using thermal noxious stimuli and an inert skin cream. We found a region in the left dorsolateral PFC, which showed a positive correlation between placebo-induced activation and (i) the reduction in participants’ pain intensity ratings; and (ii) cognitive reappraisal ability scores. Moreover, this region showed increased placebo-induced functional connectivity with the periaqueductal grey, indicating its involvement in descending nociceptive control. These initial findings thus suggest that cognitive reappraisal mechanisms mediated by the dorsolateral PFC may play a role in initiating pain inhibition in PA.
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Affiliation(s)
- Marian van der Meulen
- Institute for Health and Behaviour, University of Luxembourg, Campus Belval, Maison des Sciences Humaines, 11, Porte des Sciences, L-4366, Esch-sur-Alzette, Luxembourg
| | - Sandra Kamping
- Section Pain Medicine and Pain Psychology, Department of Anesthesiology, University Medical Center Hamburg-Eppendorf, Martinistrasse 52, 20246 Hamburg, Germany
| | - Fernand Anton
- Institute for Health and Behaviour, University of Luxembourg, Campus Belval, Maison des Sciences Humaines, 11, Porte des Sciences, L-4366, Esch-sur-Alzette, Luxembourg
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42
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Moayedi M, Salomons TV, Atlas LY. Pain Neuroimaging in Humans: A Primer for Beginners and Non-Imagers. THE JOURNAL OF PAIN 2018; 19:961.e1-961.e21. [PMID: 29608974 PMCID: PMC6192705 DOI: 10.1016/j.jpain.2018.03.011] [Citation(s) in RCA: 20] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 12/15/2017] [Revised: 02/22/2018] [Accepted: 03/19/2018] [Indexed: 01/06/2023]
Abstract
Human pain neuroimaging has exploded in the past 2 decades. During this time, the broader neuroimaging community has continued to investigate and refine methods. Another key to progress is exchange with clinicians and pain scientists working with other model systems and approaches. These collaborative efforts require that non-imagers be able to evaluate and assess the evidence provided in these reports. Likewise, new trainees must design rigorous and reliable pain imaging experiments. In this article we provide a guideline for designing, reading, evaluating, analyzing, and reporting results of a pain neuroimaging experiment, with a focus on functional and structural magnetic resonance imaging. We focus in particular on considerations that are unique to neuroimaging studies of pain in humans, including study design and analysis, inferences that can be drawn from these studies, and the strengths and limitations of the approach.
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Affiliation(s)
- Massieh Moayedi
- Faculty of Dentistry, University of Toronto, Toronto, Ontario, Canada; University of Toronto Centre for the Study of Pain, University of Toronto, Toronto, Ontario, Canada; Department of Dentistry, Mount Sinai Hospital, Toronto, Ontario, Canada.
| | - Tim V Salomons
- School of Psychology and Clinical Language Science, University of Reading, Reading, UK; Centre for Integrated Neuroscience and Neurodynamics, University of Reading, Reading, UK
| | - Lauren Y Atlas
- National Center for Complementary and Integrative Health, National Institutes of Health, Bethesda, Maryland; National Institute on Drug Abuse, National Institutes of Health, Bethesda, Maryland
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Enhancing treatment of osteoarthritis knee pain by boosting expectancy: A functional neuroimaging study. NEUROIMAGE-CLINICAL 2018; 18:325-334. [PMID: 29868449 PMCID: PMC5984593 DOI: 10.1016/j.nicl.2018.01.021] [Citation(s) in RCA: 47] [Impact Index Per Article: 7.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 09/13/2017] [Revised: 12/08/2017] [Accepted: 01/18/2018] [Indexed: 12/25/2022]
Abstract
Objectives Expectation can significantly modulate pain and treatment effects. This study aims to investigate if boosting patients' expectancy can enhance the treatment of knee osteoarthritis (KOA), and its underlying brain mechanism. Methods Seventy-four KOA patients were recruited and randomized to three groups: boosted acupuncture (with a manipulation to enhance expectation), standard acupuncture, or treatment as usual (TAU). Each patient underwent six treatments before being debriefed, and four additional treatments after being debriefed. The fMRI scans were applied during the first and sixth treatment sessions. Results We found significantly decreased knee pain in the boosted acupuncture group compared to the standard acupuncture or TAU groups after both six and ten treatments. Resting state functional connectivity (rsFC) analyses using the nucleus accumbens (NAc) as the seed showed rsFC increases between the NAc and the medial prefrontal cortex (MPFC)/rostral anterior cingulate cortex (rACC) and dorsolateral prefrontal cortex in the boosted group as compared to the standard acupuncture group after multiple treatments. Expectancy scores after the first treatment were significantly associated with increased NAc-rACC/MPFC rsFC and decreased knee pain following treatment. Conclusions Our study provides a novel method and mechanism for boosting the treatment of pain in patients with KOA. Our findings may shed light on enhancing outcomes of pharmacological and integrative medicines in clinical settings. Acupuncture with enhanced expectancy produced greater pain relief in KOA patients. NAc – ACC/MPFC rsFC increased after acupuncture with enhanced expectancy. NAc – ACC/MPFC rsFC increases are associated with clinical improvements. Our findings provide a novel method for boosting the treatment of chronic pain.
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44
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Tétreault P, Baliki MN, Baria AT, Bauer WR, Schnitzer TJ, Apkarian AV. Inferring distinct mechanisms in the absence of subjective differences: Placebo and centrally acting analgesic underlie unique brain adaptations. Hum Brain Mapp 2018; 39:2210-2223. [PMID: 29417694 DOI: 10.1002/hbm.23999] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/27/2017] [Revised: 01/22/2018] [Accepted: 01/30/2018] [Indexed: 12/31/2022] Open
Abstract
Development and maintenance of chronic pain is associated with structural and functional brain reorganization. However, few studies have explored the impact of drug treatments on such changes. The extent to which long-term analgesia is related to brain adaptations and its effects on the reversibility of brain reorganization remain unclear. In a randomized placebo-controlled clinical trial, we contrasted pain relief (3-month treatment period), and anatomical (gray matter density [GMD], assessed by voxel-based morphometry) and functional connectivity (resting state fMRI nodal degree count [DC]) adaptations, in 39 knee osteoarthritis (OA) patients (22 females), randomized to duloxetine (DLX, 60 mg once daily) or placebo. Pain relief was equivalent between treatment types. However, distinct circuitry (GMD and DC) could explain pain relief in each group: up to 85% of variance for placebo analgesia and 49% of variance for DLX analgesia. No behavioral measures (collected at entry into the study) could independently explain observed analgesia. Identified circuitry were outside of nociceptive circuitry and minimally overlapped with OA-abnormal or placebo response predictive brain regions. Mediation analysis revealed that changes in GMD and DC can influence each other across remote brain regions to explain observed analgesia. Therefore, we can conclude that distinct brain mechanisms underlie DLX and placebo analgesia in OA. The results demonstrate that even in the absence of differences in subjective pain relief, pharmacological treatments can be differentiated from placebo based on objective brain biomarkers. This is a crucial step to untangling mechanisms and advancing personalized therapy approaches for chronic pain.
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Affiliation(s)
- Pascal Tétreault
- Department of Physiology, Feinberg School of Medicine, Chicago, Illinois, 60611
| | - Marwan N Baliki
- Department of Physical Medicine and Rehabilitation, Feinberg School of Medicine, Chicago, Illinois, 60611.,Shirley Ryan AbilityLab, Chicago, Illinois, 60611
| | - Alexis T Baria
- Department of Physiology, Feinberg School of Medicine, Chicago, Illinois, 60611
| | - William R Bauer
- Department of Neuroscience, University of Toledo, Toledo, Ohio, 43614-2598
| | - Thomas J Schnitzer
- Department of Rheumatology, Feinberg School of Medicine, Chicago, Illinois, 60611
| | - A Vania Apkarian
- Department of Physiology, Feinberg School of Medicine, Chicago, Illinois, 60611.,Anesthesiology Northwestern University, Feinberg School of Medicine, Chicago, Illinois, 60611
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45
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Rossettini G, Carlino E, Testa M. Clinical relevance of contextual factors as triggers of placebo and nocebo effects in musculoskeletal pain. BMC Musculoskelet Disord 2018; 19:27. [PMID: 29357856 PMCID: PMC5778801 DOI: 10.1186/s12891-018-1943-8] [Citation(s) in RCA: 130] [Impact Index Per Article: 21.7] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/03/2017] [Accepted: 01/15/2018] [Indexed: 12/18/2022] Open
Abstract
Placebo and nocebo effects are embodied psycho-neurobiological responses capable of modulating pain and producing changes at different neurobiological, body at perceptual and cognitive levels. These modifications are triggered by different contextual factors (CFs) presented in the therapeutic encounter between patient and healthcare providers, such as healing rituals and signs. The CFs directly impact on the quality of the therapeutic outcome: a positive context, that is a context characterized by the presence of positive CFs, can reduce pain by producing placebo effects, while a negative context, characterized by the presence of negative CFs, can aggravate pain by creating nocebo effects. Despite the increasing interest about this topic; the detailed study of CFs as triggers of placebo and nocebo effects is still lacked in the management of musculoskeletal pain. Increasing evidence suggest a relevant role of CFs in musculoskeletal pain management. CFs are a complex sets of internal, external or relational elements encompassing: patient’s expectation, history, baseline characteristics; clinician’s behavior, belief, verbal suggestions and therapeutic touch; positive therapeutic encounter, patient-centered approach and social learning; overt therapy, posology of intervention, modality of treatment administration; marketing features of treatment and health care setting. Different explanatory models such as classical conditioning and expectancy can explain how CFs trigger placebo and nocebo effects. CFs act through specific neural networks and neurotransmitters that were described as mediators of placebo and nocebo effects. Available findings suggest a relevant clinical role and impact of CFs. They should be integrated in the clinical reasoning to increase the number of treatment solutions, boosts their efficacy and improve the quality of the decision-making. From a clinical perspective, the mindful manipulation of CFs represents a useful opportunity to enrich a well-established therapy in therapeutic setting within the ethical border. From a translational perspective, there is a strong need of research studies on CFs close to routine and real-world clinical practice in order to underline the uncertainty of therapy action and help clinicians to implement knowledge in daily practice.
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Affiliation(s)
- Giacomo Rossettini
- Department of Neuroscience, Rehabilitation, Ophthalmology, Genetics, Maternal and Child Health, University of Genova, Campus of Savona. Via Magliotto, 2, 17100, Savona, Italy
| | - Elisa Carlino
- Department of Neuroscience, University of Turin Medical School, Turin, Italy
| | - Marco Testa
- Department of Neuroscience, Rehabilitation, Ophthalmology, Genetics, Maternal and Child Health, University of Genova, Campus of Savona. Via Magliotto, 2, 17100, Savona, Italy.
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46
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Gollub RL, Kirsch I, Maleki N, Wasan AD, Edwards RR, Tu Y, Kaptchuk TJ, Kong J. A Functional Neuroimaging Study of Expectancy Effects on Pain Response in Patients With Knee Osteoarthritis. THE JOURNAL OF PAIN 2018; 19:515-527. [PMID: 29325883 DOI: 10.1016/j.jpain.2017.12.260] [Citation(s) in RCA: 42] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/15/2017] [Revised: 12/01/2017] [Accepted: 12/13/2017] [Indexed: 12/18/2022]
Abstract
Placebo treatments and healing rituals share much in common, such as the effects of expectancy, and have been used since the beginning of human history to treat pain. Previous mechanistic neuroimaging studies investigating the effects of expectancy on placebo analgesia have used young, healthy volunteers. Using functional magnetic resonance imaging (fMRI), we aimed to investigate the neural mechanisms by which expectancy evokes analgesia in older adults living with a chronic pain disorder and determine whether there are interactions with active treatment. In this fMRI study, we investigated the brain networks underlying expectancy in participants with chronic pain due to knee osteoarthritis (OA) after verum (genuine) and sham electroacupuncture treatment before and after experiencing calibrated experimental heat pain using a well tested expectancy manipulation model. We found that expectancy significantly and similarly modulates the pain experience in knee OA patients in both verum (n = 21, 11 female; mean ± SD age 57 ± 7 years) and sham (n = 22, 15 female; mean ± SD age 59 ± 7 years) acupuncture treatment groups. However, there were different patterns of changes in fMRI indices of brain activity associated with verum and sham treatment modalities specifically in the lateral prefrontal cortex. We also found that continuous electroacupuncture in knee OA patients can evoke significant regional coherence decreases in pain associated brain regions. Our results suggest that expectancy modulates the experience of pain in knee OA patients but may work through different pathways depending on the treatment modality and, we speculate, on pathophysiological states of the participants. PERSPECTIVE To investigate the neural mechanisms underlying pain modulation, we used an expectancy manipulation model and fMRI to study response to heat pain stimuli before and after verum or sham acupuncture treatment in chronic pain patients. Both relieve pain and each is each associated with a distinct pattern of brain activation.
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Affiliation(s)
- Randy L Gollub
- Psychiatric Neuroimaging, Department of Psychiatry, Massachusetts General Hospital, Harvard Medical School, Boston, Massachusetts; Athinoula A. Martinos Center for Biomedical Imaging, Massachusetts General Hospital, Charlestown, Massachusetts.
| | - Irving Kirsch
- Program in Placebo Studies and Therapeutic Encounter, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, Massachusetts
| | - Nasim Maleki
- Psychiatric Neuroimaging, Department of Psychiatry, Massachusetts General Hospital, Harvard Medical School, Boston, Massachusetts
| | - Ajay D Wasan
- Departments of Anesthesiology and Psychiatry, University of Pittsburgh School of Medicine, Pittsburgh, Pennsylvania
| | - Robert R Edwards
- Pain Management Center, Department of Anesthesiology, Perioperative and Pain Medicine, Brigham & Women's Hospital, Harvard Medical School, Boston, Massachusetts
| | - Yiheng Tu
- Psychiatric Neuroimaging, Department of Psychiatry, Massachusetts General Hospital, Harvard Medical School, Boston, Massachusetts
| | - Ted J Kaptchuk
- Program in Placebo Studies and Therapeutic Encounter, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, Massachusetts
| | - Jian Kong
- Psychiatric Neuroimaging, Department of Psychiatry, Massachusetts General Hospital, Harvard Medical School, Boston, Massachusetts; Athinoula A. Martinos Center for Biomedical Imaging, Massachusetts General Hospital, Charlestown, Massachusetts
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47
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Peng K, Yücel MA, Aasted CM, Steele SC, Boas DA, Borsook D, Becerra L. Using prerecorded hemodynamic response functions in detecting prefrontal pain response: a functional near-infrared spectroscopy study. NEUROPHOTONICS 2018; 5:011018. [PMID: 29057285 PMCID: PMC5641587 DOI: 10.1117/1.nph.5.1.011018] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/06/2017] [Accepted: 09/26/2017] [Indexed: 05/03/2023]
Abstract
Currently, there is no method for providing a nonverbal objective assessment of pain. Recent work using functional near-infrared spectroscopy (fNIRS) has revealed its potential for objective measures. We conducted two fNIRS scans separated by 30 min and measured the hemodynamic response to the electrical noxious and innocuous stimuli over the anterior prefrontal cortex (aPFC) in 14 subjects. Based on the estimated hemodynamic response functions (HRFs), we first evaluated the test-retest reliability of using fNIRS in measuring the pain response over the aPFC. We then proposed a general linear model (GLM)-based detection model that employs the subject-specific HRFs from the first scan to detect the pain response in the second scan. Our results indicate that fNIRS has a reasonable reliability in detecting the hemodynamic changes associated with noxious events, especially in the medial portion of the aPFC. Compared with a standard HRF with a fixed shape, including the subject-specific HRFs in the GLM allows for a significant improvement in the detection sensitivity of aPFC pain response. This study supports the potential application of individualized analysis in using fNIRS and provides a robust model to perform objective determination of pain perception.
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Affiliation(s)
- Ke Peng
- Harvard Medical School, Center for Pain and the Brain, Boston, Massachusetts, United States
- Boston Children’s Hospital and Harvard Medical School, Department of Anesthesiology, Perioperative and Pain Medicine, Boston, Massachusetts, United States
- Massachusetts General Hospital and Harvard Medical School, MGH/HST Athinoula A. Martinos Center for Biomedical Imaging, Department of Radiology, Charlestown, Massachusetts, United States
- Address all correspondence to: Ke Peng, E-mail: Ke.
| | - Meryem A. Yücel
- Massachusetts General Hospital and Harvard Medical School, MGH/HST Athinoula A. Martinos Center for Biomedical Imaging, Department of Radiology, Charlestown, Massachusetts, United States
| | - Christopher M. Aasted
- Harvard Medical School, Center for Pain and the Brain, Boston, Massachusetts, United States
- Boston Children’s Hospital and Harvard Medical School, Department of Anesthesiology, Perioperative and Pain Medicine, Boston, Massachusetts, United States
- Massachusetts General Hospital and Harvard Medical School, MGH/HST Athinoula A. Martinos Center for Biomedical Imaging, Department of Radiology, Charlestown, Massachusetts, United States
| | - Sarah C. Steele
- Harvard Medical School, Center for Pain and the Brain, Boston, Massachusetts, United States
- Boston Children’s Hospital and Harvard Medical School, Department of Anesthesiology, Perioperative and Pain Medicine, Boston, Massachusetts, United States
- Massachusetts General Hospital and Harvard Medical School, MGH/HST Athinoula A. Martinos Center for Biomedical Imaging, Department of Radiology, Charlestown, Massachusetts, United States
| | - David A. Boas
- Massachusetts General Hospital and Harvard Medical School, MGH/HST Athinoula A. Martinos Center for Biomedical Imaging, Department of Radiology, Charlestown, Massachusetts, United States
- Boston University, Boston University Neurophotonics Center, Boston, Massachusetts, United States
| | - David Borsook
- Harvard Medical School, Center for Pain and the Brain, Boston, Massachusetts, United States
- Boston Children’s Hospital and Harvard Medical School, Department of Anesthesiology, Perioperative and Pain Medicine, Boston, Massachusetts, United States
- Massachusetts General Hospital and Harvard Medical School, MGH/HST Athinoula A. Martinos Center for Biomedical Imaging, Department of Radiology, Charlestown, Massachusetts, United States
| | - Lino Becerra
- Harvard Medical School, Center for Pain and the Brain, Boston, Massachusetts, United States
- Boston Children’s Hospital and Harvard Medical School, Department of Anesthesiology, Perioperative and Pain Medicine, Boston, Massachusetts, United States
- Massachusetts General Hospital and Harvard Medical School, MGH/HST Athinoula A. Martinos Center for Biomedical Imaging, Department of Radiology, Charlestown, Massachusetts, United States
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48
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Peng K, Steele SC, Becerra L, Borsook D. Brodmann area 10: Collating, integrating and high level processing of nociception and pain. Prog Neurobiol 2017; 161:1-22. [PMID: 29199137 DOI: 10.1016/j.pneurobio.2017.11.004] [Citation(s) in RCA: 75] [Impact Index Per Article: 10.7] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/30/2017] [Revised: 11/16/2017] [Accepted: 11/28/2017] [Indexed: 02/08/2023]
Abstract
Multiple frontal cortical brain regions have emerged as being important in pain processing, whether it be integrative, sensory, cognitive, or emotional. One such region, Brodmann Area 10 (BA 10), is the largest frontal brain region that has been shown to be involved in a wide variety of functions including risk and decision making, odor evaluation, reward and conflict, pain, and working memory. BA 10, also known as the anterior prefrontal cortex, frontopolar prefrontal cortex or rostral prefrontal cortex, is comprised of at least two cytoarchitectonic sub-regions, medial and lateral. To date, the explicit role of BA 10 in the processing of pain hasn't been fully elucidated. In this paper, we first review the anatomical pathways and functional connectivity of BA 10. Numerous functional imaging studies of experimental or clinical pain have also reported brain activations and/or deactivations in BA 10 in response to painful events. The evidence suggests that BA 10 may play a critical role in the collation, integration and high-level processing of nociception and pain, but also reveals possible functional distinctions between the subregions of BA 10 in this process.
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Affiliation(s)
- Ke Peng
- Center for Pain and the Brain, Harvard Medical School, Boston, MA, United States; Department of Anesthesiology, Perioperative and Pain Medicine, Boston Children's Hospital, Boston, MA, United States; Department of Psychiatry and Radiology, Massachusetts General Hospital, Charlestown, MA, United States.
| | - Sarah C Steele
- Center for Pain and the Brain, Harvard Medical School, Boston, MA, United States; Department of Anesthesiology, Perioperative and Pain Medicine, Boston Children's Hospital, Boston, MA, United States; Department of Psychiatry and Radiology, Massachusetts General Hospital, Charlestown, MA, United States
| | - Lino Becerra
- Center for Pain and the Brain, Harvard Medical School, Boston, MA, United States; Department of Anesthesiology, Perioperative and Pain Medicine, Boston Children's Hospital, Boston, MA, United States; Department of Psychiatry and Radiology, Massachusetts General Hospital, Charlestown, MA, United States; Department of Psychiatry, Mclean Hospital, Belmont, MA, United States
| | - David Borsook
- Center for Pain and the Brain, Harvard Medical School, Boston, MA, United States; Department of Anesthesiology, Perioperative and Pain Medicine, Boston Children's Hospital, Boston, MA, United States; Department of Psychiatry and Radiology, Massachusetts General Hospital, Charlestown, MA, United States; Department of Psychiatry, Mclean Hospital, Belmont, MA, United States
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49
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Linnman C, Catana C, Petkov MP, Chonde DB, Becerra L, Hooker J, Borsook D. Molecular and functional PET-fMRI measures of placebo analgesia in episodic migraine: Preliminary findings. NEUROIMAGE-CLINICAL 2017; 17:680-690. [PMID: 29255671 PMCID: PMC5725156 DOI: 10.1016/j.nicl.2017.11.011] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 07/19/2017] [Revised: 10/03/2017] [Accepted: 11/13/2017] [Indexed: 12/18/2022]
Abstract
Pain interventions with no active ingredient, placebo, are sometimes effective in treating chronic pain conditions. Prior studies on the neurobiological underpinnings of placebo analgesia indicate endogenous opioid release and changes in brain responses and functional connectivity during pain anticipation and pain experience in healthy subjects. Here, we investigated placebo analgesia in healthy subjects and in interictal migraine patients (n = 9) and matched healthy controls (n = 9) using 11C-diprenoprhine Positron Emission Tomography (PET) and simultaneous functional Magnetic Resonance Imaging (fMRI). Intravenous saline injections (the placebo) led to lower pain ratings, but we did not find evidence for an altered placebo response in interictal migraine subjects as compared to healthy subjects.
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Affiliation(s)
- Clas Linnman
- Department of Anesthesiology, Perioperative and Pain Medicine, Boston Children's Hospital, Harvard Medical School, USA; Department of Psychiatry, Massachusetts General Hospital, Harvard Medical School, USA.
| | - Ciprian Catana
- Athinoula A Martinos Center for Biomedical Imaging, Department of Radiology, Massachusetts General Hospital, Harvard Medical School, Charlestown, MA, USA
| | - Mike P Petkov
- Department of Anesthesiology, Perioperative and Pain Medicine, Boston Children's Hospital, Harvard Medical School, USA; Center for Pain and the Brain, Boston Children's Hospital and Massachusetts General Hospital (MGH), Harvard Medical School, Boston, MA, USA
| | - Daniel Burje Chonde
- Athinoula A Martinos Center for Biomedical Imaging, Department of Radiology, Massachusetts General Hospital, Harvard Medical School, Charlestown, MA, USA
| | - Lino Becerra
- Department of Anesthesiology, Perioperative and Pain Medicine, Boston Children's Hospital, Harvard Medical School, USA; Department of Psychiatry, Massachusetts General Hospital, Harvard Medical School, USA; Athinoula A Martinos Center for Biomedical Imaging, Department of Radiology, Massachusetts General Hospital, Harvard Medical School, Charlestown, MA, USA.; Center for Pain and the Brain, Boston Children's Hospital and Massachusetts General Hospital (MGH), Harvard Medical School, Boston, MA, USA
| | - Jacob Hooker
- Athinoula A Martinos Center for Biomedical Imaging, Department of Radiology, Massachusetts General Hospital, Harvard Medical School, Charlestown, MA, USA
| | - David Borsook
- Department of Anesthesiology, Perioperative and Pain Medicine, Boston Children's Hospital, Harvard Medical School, USA; Department of Psychiatry, Massachusetts General Hospital, Harvard Medical School, USA; Athinoula A Martinos Center for Biomedical Imaging, Department of Radiology, Massachusetts General Hospital, Harvard Medical School, Charlestown, MA, USA.; Center for Pain and the Brain, Boston Children's Hospital and Massachusetts General Hospital (MGH), Harvard Medical School, Boston, MA, USA
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50
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Liu J, Ma S, Mu J, Chen T, Xu Q, Dun W, Tian J, Zhang M. Integration of white matter network is associated with interindividual differences in psychologically mediated placebo response in migraine patients. Hum Brain Mapp 2017; 38:5250-5259. [PMID: 28731567 DOI: 10.1002/hbm.23729] [Citation(s) in RCA: 21] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/22/2017] [Revised: 05/08/2017] [Accepted: 07/06/2017] [Indexed: 11/06/2022] Open
Abstract
Individual differences of brain changes of neural communication and integration in the modular architecture of the human brain network exist for the repeated migraine attack and physical or psychological stressors. However, whether the interindividual variability in the migraine brain connectome predicts placebo response to placebo treatment is still unclear. Using DTI and graph theory approaches, we systematically investigated the topological organization of white matter networks in 71 patients with migraine without aura (MO) and 50 matched healthy controls at three levels: global network measure, nodal efficiency, and nodal intramodule/intermodule efficiency. All patients participated in an 8-week sham acupuncture treatment to induce analgesia. In our results, 30% (n = 21) of patients had 50% change in migraine days from baseline after placebo treatment. At baseline, abnormal increased network integration was found in MO patients as compared with the HC group, and the increased global efficiency before starting clinical treatment was associated with their following placebo response. For nodal efficiency, significantly increased within-subnetwork nodal efficiency and intersubnetwork connectivity of the hippocampus and middle frontal gyrus in patients' white matter network were correlated with the responses of follow-up placebo treatment. Our findings suggested that the trait-like individual differences in pain-related maladaptive stress interfered with and diminished the capacity of chronic pain modulation differently, and the placebo response for treatment could be predicted from a prior white matter network modular structure in migraineurs. Hum Brain Mapp 38:5250-5259, 2017. © 2017 Wiley Periodicals, Inc.
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Affiliation(s)
- Jixin Liu
- Center for Brain Imaging, School of Life Science and Technology, Xidian University, Xi'an, 710126, People's Republic of China.,Engineering Research Center of Molecular and Neuro Imaging, Ministry of Education, Xi'an, 710126, People's Republic of China
| | - Shaohui Ma
- Department of Medical Imaging, First Affiliated Hospital of Xi'an Jiaotong University, Xi'an, 710061, People's Republic of China
| | - Junya Mu
- Center for Brain Imaging, School of Life Science and Technology, Xidian University, Xi'an, 710126, People's Republic of China.,Engineering Research Center of Molecular and Neuro Imaging, Ministry of Education, Xi'an, 710126, People's Republic of China
| | - Tao Chen
- Center for Brain Imaging, School of Life Science and Technology, Xidian University, Xi'an, 710126, People's Republic of China.,Engineering Research Center of Molecular and Neuro Imaging, Ministry of Education, Xi'an, 710126, People's Republic of China
| | - Qing Xu
- Center for Brain Imaging, School of Life Science and Technology, Xidian University, Xi'an, 710126, People's Republic of China.,Engineering Research Center of Molecular and Neuro Imaging, Ministry of Education, Xi'an, 710126, People's Republic of China
| | - Wanghuan Dun
- Department of Medical Imaging, First Affiliated Hospital of Xi'an Jiaotong University, Xi'an, 710061, People's Republic of China
| | - Jie Tian
- Center for Brain Imaging, School of Life Science and Technology, Xidian University, Xi'an, 710126, People's Republic of China.,Engineering Research Center of Molecular and Neuro Imaging, Ministry of Education, Xi'an, 710126, People's Republic of China
| | - Ming Zhang
- Department of Medical Imaging, First Affiliated Hospital of Xi'an Jiaotong University, Xi'an, 710061, People's Republic of China
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