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Khatib L, Dean JG, Oliva V, Riegner G, Gonzalez NE, Birenbaum J, Cruanes GF, Miller J, Patterson M, Kim HC, Chakravarthy K, Zeidan F. The role of endogenous opioids in mindfulness and sham mindfulness-meditation for the direct alleviation of evoked chronic low back pain: a randomized clinical trial. Neuropsychopharmacology 2024; 49:1069-1077. [PMID: 37985872 PMCID: PMC11109232 DOI: 10.1038/s41386-023-01766-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/21/2023] [Revised: 10/26/2023] [Accepted: 11/02/2023] [Indexed: 11/22/2023]
Abstract
Chronic low back pain (cLBP) is the most prevalent chronic pain condition. There are no treatments that haven been found to directly assuage evoked cLBP. To this extent, mindfulness-meditation is a promising pain therapy. Yet, it is unclear if meditation can be utilized to directly attenuate evoked chronic pain through endogenous opioids. A double-blind, randomized, and placebo-controlled clinical trial with a drug crossover design examined if mindfulness-meditation, as compared to sham mindfulness-meditation, attenuated straight leg-raise test evoked chronic pain during intravenous (0.15 mg/kg bolus + 0.15 mg/kg/hour maintenance) naloxone (opioid antagonist) and placebo-saline infusion. Fifty-nine individuals with cLBP (mean age = 46 years; 30 females) completed all study procedures. After the pre-intervention pain testing session, patients were randomized to a four-session (20-min/session) mindfulness (n = 30) or sham mindfulness-meditation (n = 29) intervention. After the interventions, mindfulness and sham mindfulness-meditation were associated with significant reductions in back pain during saline and naloxone infusion when compared to rest (non-meditation) in response to the cLBP-evoking straight leg-raise test. These results indicate that meditation directly reduces evoked chronic pain through non-opioidergic processes. Importantly, after the interventions, the mindfulness group reported significantly lower straight leg-raise induced pain than the sham mindfulness-meditation group during rest (non-meditation) and meditation. Mindfulness and sham mindfulness-meditation training was also associated with significantly lower Brief Pain Inventory severity and interference scores. The pain-relieving effects of mindfulness meditation were more pronounced than a robust sham-mindfulness meditation intervention, suggesting that non-reactive appraisal processes may be uniquely associated with improvements in chronic low-back pain.Trial Registration: ClinicalTrials.gov identifier: NCT04034004.
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Affiliation(s)
- Lora Khatib
- Department of Anesthesiology, University of California San Diego, La Jolla, CA, USA
| | - Jon G Dean
- Department of Anesthesiology, University of California San Diego, La Jolla, CA, USA
| | - Valeria Oliva
- Department of Anesthesiology, University of California San Diego, La Jolla, CA, USA
| | - Gabriel Riegner
- Department of Anesthesiology, University of California San Diego, La Jolla, CA, USA
| | - Nailea E Gonzalez
- Department of Anesthesiology, University of California San Diego, La Jolla, CA, USA
| | - Julia Birenbaum
- Department of Anesthesiology, University of California San Diego, La Jolla, CA, USA
| | - Gael F Cruanes
- Department of Anesthesiology, University of California San Diego, La Jolla, CA, USA
| | - Jennifer Miller
- Department of Anesthesiology, University of California San Diego, La Jolla, CA, USA
| | - Marta Patterson
- Department of Anesthesiology, University of California San Diego, La Jolla, CA, USA
| | - Hyun-Chung Kim
- Department of Anesthesiology, University of California San Diego, La Jolla, CA, USA
| | | | - Fadel Zeidan
- Department of Anesthesiology, University of California San Diego, La Jolla, CA, USA.
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2
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Picard ME, Kunz M, Chen JI, Coll MP, Vachon-Presseau É, Wager TD, Rainville P. A distributed brain response predicting the facial expression of acute nociceptive pain. BIORXIV : THE PREPRINT SERVER FOR BIOLOGY 2024:2023.07.26.550504. [PMID: 37547018 PMCID: PMC10402001 DOI: 10.1101/2023.07.26.550504] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 08/08/2023]
Abstract
Pain is a private experience observable through various verbal and non-verbal behavioural manifestations, each of which may relate to different pain-related functions. Despite the importance of understanding the cerebral mechanisms underlying those manifestations, there is currently limited knowledge on the neural correlates of the facial expression of pain. In this functional magnetic resonance imaging (fMRI) study, noxious heat stimulation was applied in healthy volunteers and we tested if previously published brain signatures of pain were sensitive to pain expression. We then applied a multivariate pattern analysis to the fMRI data to predict the facial expression of pain. Results revealed the inability of previously developed pain neurosignatures to predict the facial expression of pain. We thus propose a Facial Expression of Pain Signature (FEPS) conveying distinctive information about the brain response to nociceptive stimulations with minimal or no overlap with other pain-relevant brain signatures associated with nociception, pain ratings, thermal pain aversiveness, or pain valuation. The FEPS may provide a distinctive functional characterization of the distributed cerebral response to nociceptive pain associated with the socio-communicative role of non-verbal pain expression. This underscores the complexity of pain phenomenology by reinforcing the view that neurosignatures conceived as biomarkers must be interpreted in relation to the specific pain manifestation(s) predicted and their underlying function(s). Future studies should explore other pain-relevant manifestations and assess the specificity of the FEPS against simulated pain expressions and other types of aversive or emotional states.
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Affiliation(s)
- Marie-Eve Picard
- Department of psychology, Université de Montréal, Montreal, Quebec, Canada
- Centre de recherche de l’institut universitaire de gériatrie de Montréal, Montreal, Quebec, Canada
| | - Miriam Kunz
- Department of medical psychology and sociology, Medical faculty, University of Augsburg, Augsburg, Germany
| | - Jen-I Chen
- Department of psychology, Université de Montréal, Montreal, Quebec, Canada
- Centre de recherche de l’institut universitaire de gériatrie de Montréal, Montreal, Quebec, Canada
| | | | - Étienne Vachon-Presseau
- Faculty of Dentistry, McGill University, Montreal, Quebec, Canada
- Department of Anesthesia, McGill University, Montreal, Quebec, Canada
- Alan Edwards Centre for Research on Pain, McGill University, Montreal, Quebec, Canada
| | - Tor D. Wager
- Department of psychological and brain sciences, Dartmouth College, Hanover, New Hampshire, United States
| | - Pierre Rainville
- Centre de recherche de l’institut universitaire de gériatrie de Montréal, Montreal, Quebec, Canada
- Stomatology department, Faculté de médecine dentaire, Université de Montréal, Montreal, Quebec, Canada
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3
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Raghuraman N, White JN, Watson L, Belleï-Rodriguez CÉ, Shafir R, Wang Y, Colloca L. Neuropsychological mechanisms of observational learning in human placebo effects. Psychopharmacology (Berl) 2024:10.1007/s00213-024-06608-7. [PMID: 38743108 DOI: 10.1007/s00213-024-06608-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/04/2023] [Accepted: 05/02/2024] [Indexed: 05/16/2024]
Abstract
Scientific evidence indicates that placebo effects are psychoneurobiological events involving the contribution of distinct central nervous systems and peripheral physiological mechanisms that influence pain perception and other symptoms. Placebo effects can occur without formal conditioning and direct prior experience because crucial information can be acquired through observational learning. Observation of benefits in another person results in placebo effects of a magnitude like those induced by directly experiencing an analgesic benefit. Understanding the psychological mechanisms of observationally induced placebo effects is a complex and multifaceted endeavor. While previous reviews have highlighted various frameworks and models to understand these phenomena, the underlying biological mechanisms have been overlooked. We summarize critically current understanding of its behavioral and neural mechanisms. Understanding the neural mechanisms of hypoalgesia driven by observation can serve as a foundation for future development of novel theoretical and methodological approaches and ultimately, applications.
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Affiliation(s)
- Nandini Raghuraman
- Department of Pain and Translational Symptom Science, University of Maryland School of Nursing, Baltimore, MD, USA
- Graduate Program in Life Sciences, Program in Epidemiology and Human Genetics, University of Maryland School of Medicine, Baltimore, MD, USA
- Placebo Beyond Opinions Center, University of Maryland School of Nursing, Baltimore, USA
| | - Jewel N White
- Department of Pain and Translational Symptom Science, University of Maryland School of Nursing, Baltimore, MD, USA
- Placebo Beyond Opinions Center, University of Maryland School of Nursing, Baltimore, USA
- Graduate Program in Life Sciences, Program in Neuroscience, University of Maryland School of Medicine, Baltimore, USA
| | - Lakota Watson
- Department of Pain and Translational Symptom Science, University of Maryland School of Nursing, Baltimore, MD, USA
- Graduate Program in Life Sciences, Program in Neuroscience, University of Maryland School of Medicine, Baltimore, USA
| | | | - Roni Shafir
- Department of Pain and Translational Symptom Science, University of Maryland School of Nursing, Baltimore, MD, USA
- Placebo Beyond Opinions Center, University of Maryland School of Nursing, Baltimore, USA
| | - Yang Wang
- Department of Pain and Translational Symptom Science, University of Maryland School of Nursing, Baltimore, MD, USA
- Placebo Beyond Opinions Center, University of Maryland School of Nursing, Baltimore, USA
- Center to Advance Chronic Pain Research, University of Maryland, Baltimore, USA
| | - Luana Colloca
- Department of Pain and Translational Symptom Science, University of Maryland School of Nursing, Baltimore, MD, USA.
- Placebo Beyond Opinions Center, University of Maryland School of Nursing, Baltimore, USA.
- Center to Advance Chronic Pain Research, University of Maryland, Baltimore, USA.
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4
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Harp NR, Wager TD, Kober H. Neuromarkers in addiction: definitions, development strategies, and recent advances. J Neural Transm (Vienna) 2024; 131:509-523. [PMID: 38630190 DOI: 10.1007/s00702-024-02766-2] [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: 11/21/2023] [Accepted: 03/12/2024] [Indexed: 04/28/2024]
Abstract
Substance use disorders (SUDs) are the most costly and prevalent psychiatric conditions. Recent calls emphasize a need for biomarkers-measurable, stable indicators of normal and abnormal processes and response to treatment or environmental agents-and, in particular, brain-based neuromarkers that will advance understanding of the neurobiological basis of SUDs and clinical practice. To develop neuromarkers, researchers must be grounded in evidence that a putative marker (i) is sensitive and specific to the psychological phenomenon of interest, (ii) constitutes a predictive model, and (iii) generalizes to novel observations (e.g., through internal cross-validation and external application to novel data). These neuromarkers may be used to index risk of developing SUDs (susceptibility), classify individuals with SUDs (diagnostic), assess risk for progression to more severe pathology (prognostic) or index current severity of pathology (monitoring), detect response to treatment (response), and predict individualized treatment outcomes (predictive). Here, we outline guidelines for developing and assessing neuromarkers, we then review recent advances toward neuromarkers in addiction neuroscience centering our discussion around neuromarkers of craving-a core feature of SUDs. In doing so, we specifically focus on the Neurobiological Craving Signature (NCS), which show great promise for meeting the demand of neuromarkers.
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Affiliation(s)
- Nicholas R Harp
- Department of Psychiatry, Yale University, New Haven, CT, USA
| | - Tor D Wager
- Department of Psychological & Brain Sciences, Dartmouth College, Hanover, NH, USA
| | - Hedy Kober
- Department of Psychiatry, Yale University, New Haven, CT, USA.
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5
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Bi S, Guan Y, Tian L. Prediction of individual brain age using movie and resting-state fMRI. Cereb Cortex 2024; 34:bhad407. [PMID: 37885127 DOI: 10.1093/cercor/bhad407] [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: 08/28/2023] [Revised: 10/07/2023] [Accepted: 10/09/2023] [Indexed: 10/28/2023] Open
Abstract
Brain age is a promising biomarker for predicting chronological age based on brain imaging data. Although movie and resting-state functional MRI techniques have attracted much research interest for the investigation of brain function, whether the 2 different imaging paradigms show similarities and differences in terms of their capabilities and properties for predicting brain age remains largely unexplored. Here, we used movie and resting-state functional MRI data from 528 participants aged from 18 to 87 years old in the Cambridge Centre for Ageing and Neuroscience data set for functional network construction and further used elastic net for age prediction model building. The connectivity properties of movie and resting-state functional MRI were evaluated based on the connections supporting predictive model building. We found comparable predictive abilities of movie and resting-state connectivity in estimating brain age of individuals, as evidenced by correlation coefficients of 0.868 and 0.862 between actual and predicted age, respectively. Despite some similarities, notable differences in connectivity properties were observed between the predictive models using movie and resting-state functional MRI data, primarily involving components of the default mode network. Our results highlight that both movie and resting-state functional MRI are effective and promising techniques for predicting brain age. Leveraging its data acquisition advantages, such as improved child and patient compliance resulting in reduced motion artifacts, movie functional MRI is emerging as an important paradigm for studying brain function in pediatric and clinical populations.
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Affiliation(s)
- Suyu Bi
- School of International Journalism and Communication, Beijing Foreign Studies University, Beijing 100081, China
| | - Yun Guan
- School of Computer and Information Technology, Beijing Jiaotong University, Beijing 100044, China
- Beijing Key Laboratory of Traffic Data Analysis and Mining, Beijing Jiaotong University, Beijing 100044, China
| | - Lixia Tian
- School of Computer and Information Technology, Beijing Jiaotong University, Beijing 100044, China
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Milde C, Brinskelle LS, Glombiewski JA. Does Active Inference Provide a Comprehensive Theory of Placebo Analgesia? BIOLOGICAL PSYCHIATRY. COGNITIVE NEUROSCIENCE AND NEUROIMAGING 2024; 9:10-20. [PMID: 37678710 DOI: 10.1016/j.bpsc.2023.08.007] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/22/2023] [Revised: 08/21/2023] [Accepted: 08/28/2023] [Indexed: 09/09/2023]
Abstract
Placebo interventions generate mismatches between expected pain and sensory signals from which pain states are inferred. Because we lack direct access to bodily states, we can only infer whether nociceptive activity indicates tissue damage or results from noise in sensory channels. Predictive processing models propose to make optimal inferences using prior knowledge given noisy sensory data. However, these models do not provide a satisfactory explanation of how pain relief expectations are translated into physiological manifestations of placebo responses. Furthermore, they do not account for individual differences in the ability to endogenously regulate nociceptive activity in predicting placebo analgesia. The brain not only passively integrates prior pain expectations with nociceptive activity to infer pain states (perceptual inference) but also initiates various types of actions to ensure that sensory data are consistent with prior pain expectations (active inference). We argue that depending on whether the brain interprets conflicting sensory data (prediction errors) as a signal to learn from or noise to be attenuated, the brain initiates opposing types of action to facilitate learning from sensory data or, conversely, to enhance the biasing influence of prior pain expectations on pain perception. Furthermore, we discuss the role of stress, anxiety, and unpredictability of pain in influencing the weighting of prior pain expectations and sensory data and how they relate to the individual ability to regulate nociceptive activity (endogenous pain modulation). Finally, we provide suggestions for future studies to test the implications of the active inference model of placebo analgesia.
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Affiliation(s)
- Christopher Milde
- Department of Psychology, Rheinland-Pfälzische Technische Universität Kaiserslautern-Landau, Landau, Germany.
| | - Laura S Brinskelle
- Department of Psychology, Rheinland-Pfälzische Technische Universität Kaiserslautern-Landau, Landau, Germany
| | - Julia A Glombiewski
- Department of Psychology, Rheinland-Pfälzische Technische Universität Kaiserslautern-Landau, Landau, Germany
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7
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Huang Y, Yan R, Zhang Y, Wang X, Sun H, Zhou H, Zou H, Xia Y, Yao Z, Shi J, Lu Q. Abnormal fractional amplitude of low-frequency fluctuations and regional homogeneity in major depressive disorder with non-suicidal self-injury. Clin Neurophysiol 2024; 157:120-129. [PMID: 38101296 DOI: 10.1016/j.clinph.2023.11.016] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/26/2022] [Revised: 09/18/2023] [Accepted: 11/25/2023] [Indexed: 12/17/2023]
Abstract
OBJECTIVE We conducted this resting-state functional magnetic resonance imaging (rsfMRI) study to characterize changes in regional homogeneity (ReHo) or fractional amplitude of low-frequency fluctuations (fALFF) in young adult patients with major depressive disorder (MDD), with or without non-suicidal self-injury (NSSI). METHODS We recruited 54 MDD patients with NSSI (MDD/NSSI), 68 MDD patients without NSSI, which is referred to as simple MDD (sMDD), and 66 matched healthy controls (HCs). A combination of fALFF and ReHo analyses was conducted. The effects of NSSI on the brain and their relationship to clinical variables were examined in this study. RESULTS MDD/NSSI patients have decreased fALFF in the right superior frontal gyrus (SFG) and the right inferior parietal lobe (IPL), decreased ReHo in the right SFG and the right middle temporal gyrus (MTG) and the left middle occipital gyrus (MOG). fALFF and ReHo values of the right SFG are positively correlated. The ReHo values of the right SFG and the number of recent self-injuries are positively correlated; the fALFF values of the right SFG are negatively correlated with NSSI severity. CONCLUSIONS There is a difference in brain activity between MDD/NSSI and sMDD, which may serve as an important physiological marker to determine the risk of self-injury and suicide. SIGNIFICANCE Abnormal brain activity in patients with NSSI may provide new perspectives and significant implications on the severity of MDD patients and the prevention of self-injury and suicide.
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Affiliation(s)
- Yinghong Huang
- Department of Psychiatry, The Affiliated Brain Hospital of Nanjing Medical University, Nanjing 210029, China; Nanjing Brain Hospital, Clinical Teaching Hospital of Medical School, Nanjing University, Nanjing, China
| | - Rui Yan
- Department of Psychiatry, The Affiliated Brain Hospital of Nanjing Medical University, Nanjing 210029, China; Nanjing Brain Hospital, Clinical Teaching Hospital of Medical School, Nanjing University, Nanjing, China
| | - Yu Zhang
- Department of Psychiatry, The Affiliated Brain Hospital of Nanjing Medical University, Nanjing 210029, China; Department of Clinical Psychology, The Affiliated Hangzhou First People's Hospital of Zhejiang University School of Medicine, Hangzhou 310006, China
| | - Xiaoqin Wang
- Department of Psychiatry, The Affiliated Brain Hospital of Nanjing Medical University, Nanjing 210029, China
| | - Hao Sun
- Department of Psychiatry, The Affiliated Brain Hospital of Nanjing Medical University, Nanjing 210029, China; Nanjing Brain Hospital, Clinical Teaching Hospital of Medical School, Nanjing University, Nanjing, China
| | - Hongliang Zhou
- Department of Psychiatry, The Affiliated Brain Hospital of Nanjing Medical University, Nanjing 210029, China
| | - Haowen Zou
- Department of Psychiatry, The Affiliated Brain Hospital of Nanjing Medical University, Nanjing 210029, China; Nanjing Brain Hospital, Clinical Teaching Hospital of Medical School, Nanjing University, Nanjing, China
| | - Yi Xia
- Department of Psychiatry, The Affiliated Brain Hospital of Nanjing Medical University, Nanjing 210029, China
| | - Zhijian Yao
- Department of Psychiatry, The Affiliated Brain Hospital of Nanjing Medical University, Nanjing 210029, China; Nanjing Brain Hospital, Clinical Teaching Hospital of Medical School, Nanjing University, Nanjing, China; School of Biological Sciences and Medical Engineering, Southeast University, 2 Sipailou, Nanjing 210096, China.
| | - Jiabo Shi
- Department of Psychiatry, The Affiliated Brain Hospital of Nanjing Medical University, Nanjing 210029, China.
| | - Qing Lu
- School of Biological Sciences and Medical Engineering, Southeast University, 2 Sipailou, Nanjing 210096, China; Child Development and Learning Science, Key Laboratory of Ministry of Education, Nanjing 210096, China.
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Reddan M, Ong D, Wager T, Mattek S, Kahhale I, Zaki J. Neural signatures of emotional inference and experience align during social consensus. RESEARCH SQUARE 2023:rs.3.rs-3487248. [PMID: 38014230 PMCID: PMC10680919 DOI: 10.21203/rs.3.rs-3487248/v1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/29/2023]
Abstract
Humans seamlessly transform dynamic social signals into inferences about the internal states of the people around them. To understand the neural processes that sustain this transformation, we collected fMRI data from participants (N = 100) while they rated the emotional intensity of people (targets) describing significant life events. Targets rated themselves on the same scale to indicate the intended "ground truth" emotional intensity of their videos. Next, we developed two multivariate models of observer brain activity- the first predicted the "ground truth" (r = 0.50, p < 0.0001) and the second predicted observer inferences (r = 0.53, p < 0.0001). When individuals make more accurate inferences, there is greater moment-by-moment concordance between these two models, suggesting that an observer's brain activity contains latent representations of other people's emotional states. Using naturalistic socioemotional stimuli and machine learning, we developed reliable brain signatures that predict what an observer thinks about a target, what the target thinks about themselves, and the correspondence between them. These signatures can be applied in clinical data to better our understanding of socioemotional dysfunction.
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Liu T, Yu CP. How Do Expectations Modulate Pain? A Motivational Perspective. PERSPECTIVES ON PSYCHOLOGICAL SCIENCE 2023; 18:1508-1519. [PMID: 37369088 DOI: 10.1177/17456916231178701] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/29/2023]
Abstract
Expectations can profoundly modulate pain experience, during which the periaqueductal gray (PAG) plays a pivotal role. In this article, we focus on motivationally evoked neural activations in cortical and brainstem regions both before and during stimulus administration, as has been demonstrated by experimental studies on pain-modulatory effects of expectations, in the hope of unraveling how the PAG is involved in descending and ascending nociceptive processes. This motivational perspective on expectancy effects on the perception of noxious stimuli sheds new light on psychological and neuronal substrates of pain and its modulation, thus having important research and clinical implications.
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Affiliation(s)
- Tao Liu
- The Second Teaching Hospital, University of Jilin
| | - Cui-Ping Yu
- Department of Basic Medicine, Changchun Medical College
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10
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Hird EJ, Diederen K, Leucht S, Jensen KB, McGuire P. The Placebo Effect in Psychosis: Why It Matters and How to Measure It. BIOLOGICAL PSYCHIATRY GLOBAL OPEN SCIENCE 2023; 3:605-613. [PMID: 37881581 PMCID: PMC10593894 DOI: 10.1016/j.bpsgos.2023.02.008] [Citation(s) in RCA: 5] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/18/2022] [Revised: 12/04/2022] [Accepted: 02/20/2023] [Indexed: 03/07/2023] Open
Abstract
Psychosis is characterized by unusual percepts and beliefs in the form of hallucinations and delusions. Antipsychotic medication, the primary treatment for psychosis, is often ineffective and accompanied by severe side effects, but research has not identified an effective alternative in several decades. One reason that clinical trials fail is that patients with psychosis tend to show a significant therapeutic response to inert control treatments, known as the placebo effect, which makes it difficult to distinguish drug effects from placebo effects. Conversely, in clinical practice, a strong placebo effect may be useful because it could enhance the overall treatment response. Identifying factors that predict large placebo effects could improve the future outlook of psychosis treatment. Biomarkers of the placebo effect have already been suggested in pain and depression, but not in psychosis. Quantifying markers of the placebo effect would have the potential to predict placebo effects in psychosis clinical trials. Furthermore, the placebo effect and psychosis may represent a shared neurocognitive mechanism in which prior beliefs are weighted against new sensory information to make inferences about reality. Examining this overlap could reveal new insights into the mechanisms underlying psychosis and indicate novel treatment targets. We provide a narrative review of the importance of the placebo effect in psychosis and propose a novel method to assess it.
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Affiliation(s)
- Emily J. Hird
- Institute of Psychiatry, Psychology and Neuroscience, King’s College London, London, England
| | - Kelly Diederen
- Institute of Psychiatry, Psychology and Neuroscience, King’s College London, London, England
| | - Stefan Leucht
- Department of Psychiatry and Psychotherapy, Technical University of Munich, Munich, Germany
| | - Karin B. Jensen
- Department of Clinical Neuroscience, Karolinska Institute, Stockholm, Sweden
| | - Philip McGuire
- Institute of Psychiatry, Psychology and Neuroscience, King’s College London, London, England
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11
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Krecké J, Dierolf AM, Rischer KM, Anton F, van der Meulen M. Baseline heart rate variability predicts placebo hypoalgesia in men, but not women. FRONTIERS IN PAIN RESEARCH 2023; 4:1213848. [PMID: 37799824 PMCID: PMC10547887 DOI: 10.3389/fpain.2023.1213848] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/28/2023] [Accepted: 08/31/2023] [Indexed: 10/07/2023] Open
Abstract
Introduction Placebo hypoalgesic effects vary greatly across individuals, making them challenging to control for in clinical trials and difficult to use in treatment. We investigated the potential of resting vagally-mediated heart rate variability (vmHRV) to help predict the magnitude of placebo responsiveness. Methods In two independent studies (total N = 77), we administered a placebo paradigm after measuring baseline HRV. In Study I, we delivered heat pain to the forearm, on skin patches treated with "real" and "control" cream (identical inactive creams). In Study II, electrical pulses to the forearm were modulated by sham transcutaneous electrical nerve stimulation. We combined data from both studies to evaluate the relationship between vagally-mediated HRV (vmHRV) parameters and the placebo response size, while also assessing sex differences in this relationship. Results and Discussion This revealed a positive association between vmHRV and the degree of pain relief, and this effect was driven by men. These results not only reveal new insights into the (sex-specific) mechanisms of placebo hypoalgesia, but also suggest that measuring vmHRV may be helpful in predicting placebo responsiveness. Given that placebo hypoalgesic effects contribute substantially to treatment outcomes, such a non-invasive and easily obtained predictor would be valuable in the context of personalized medicine.
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Affiliation(s)
- Joy Krecké
- Department of Behavioural and Cognitive Sciences, University of Luxembourg, Esch-sur-Alzette, Luxembourg
| | | | | | | | - Marian van der Meulen
- Department of Behavioural and Cognitive Sciences, University of Luxembourg, Esch-sur-Alzette, Luxembourg
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12
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Rossettini G, Campaci F, Bialosky J, Huysmans E, Vase L, Carlino E. The Biology of Placebo and Nocebo Effects on Experimental and Chronic Pain: State of the Art. J Clin Med 2023; 12:4113. [PMID: 37373806 DOI: 10.3390/jcm12124113] [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: 05/22/2023] [Revised: 06/13/2023] [Accepted: 06/15/2023] [Indexed: 06/29/2023] Open
Abstract
(1) Background: In recent years, placebo and nocebo effects have been extensively documented in different medical conditions, including pain. The scientific literature has provided strong evidence of how the psychosocial context accompanying the treatment administration can influence the therapeutic outcome positively (placebo effects) or negatively (nocebo effects). (2) Methods: This state-of-the-art paper aims to provide an updated overview of placebo and nocebo effects on pain. (3) Results: The most common study designs, the psychological mechanisms, and neurobiological/genetic determinants of these phenomena are discussed, focusing on the differences between positive and negative context effects on pain in experimental settings on healthy volunteers and in clinical settings on chronic pain patients. Finally, the last section describes the implications for clinical and research practice to maximize the medical and scientific routine and correctly interpret the results of research studies on placebo and nocebo effects. (4) Conclusions: While studies on healthy participants seem consistent and provide a clear picture of how the brain reacts to the context, there are no unique results of the occurrence and magnitude of placebo and nocebo effects in chronic pain patients, mainly due to the heterogeneity of pain. This opens up the need for future studies on the topic.
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Affiliation(s)
| | - Francesco Campaci
- Department of Neuroscience "Rita Levi Montalcini", University of Turin, 10124 Turin, Italy
| | - Joel Bialosky
- Department of Physical Therapy, University of Florida, Gainesville, FL 32611, USA
- Clinical Research Center, Brooks Rehabilitation, Jacksonville, FL 32211, USA
| | - Eva Huysmans
- Pain in Motion Research Group (PAIN), Department of Physiotherapy, Human Physiology and Anatomy, Faculty of Physical Education & Physiotherapy, Vrije Universiteit Brussel, Laarbeeklaan 103, 1090 Brussels, Belgium
- Department of Physical Medicine and Physiotherapy, Universitair Ziekenhuis Brussel, Laarbeeklaan 101, 1090 Brussels, Belgium
| | - Lene Vase
- Department of Psychology and Behavioural Sciences, School of Business and Social Sciences, Aarhus University, 8000 Aarhus, Denmark
| | - Elisa Carlino
- Department of Neuroscience "Rita Levi Montalcini", University of Turin, 10124 Turin, Italy
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13
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Motzkin JC, Kanungo I, D’Esposito M, Shirvalkar P. Network targets for therapeutic brain stimulation: towards personalized therapy for pain. FRONTIERS IN PAIN RESEARCH 2023; 4:1156108. [PMID: 37363755 PMCID: PMC10286871 DOI: 10.3389/fpain.2023.1156108] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/01/2023] [Accepted: 05/19/2023] [Indexed: 06/28/2023] Open
Abstract
Precision neuromodulation of central brain circuits is a promising emerging therapeutic modality for a variety of neuropsychiatric disorders. Reliably identifying in whom, where, and in what context to provide brain stimulation for optimal pain relief are fundamental challenges limiting the widespread implementation of central neuromodulation treatments for chronic pain. Current approaches to brain stimulation target empirically derived regions of interest to the disorder or targets with strong connections to these regions. However, complex, multidimensional experiences like chronic pain are more closely linked to patterns of coordinated activity across distributed large-scale functional networks. Recent advances in precision network neuroscience indicate that these networks are highly variable in their neuroanatomical organization across individuals. Here we review accumulating evidence that variable central representations of pain will likely pose a major barrier to implementation of population-derived analgesic brain stimulation targets. We propose network-level estimates as a more valid, robust, and reliable way to stratify personalized candidate regions. Finally, we review key background, methods, and implications for developing network topology-informed brain stimulation targets for chronic pain.
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Affiliation(s)
- Julian C. Motzkin
- Departments of Neurology and Anesthesia and Perioperative Care (Pain Management), University of California, San Francisco, San Francisco, CA, United States
| | - Ishan Kanungo
- Department of Neurological Surgery, University of California, San Francisco, San Francisco, CA, United States
| | - Mark D’Esposito
- Department of Psychology, University of California, Berkeley, Berkeley, CA, United States
| | - Prasad Shirvalkar
- Departments of Neurology and Anesthesia and Perioperative Care (Pain Management), University of California, San Francisco, San Francisco, CA, United States
- Department of Neurological Surgery, University of California, San Francisco, San Francisco, CA, United States
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14
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Branco P, Berger S, Abdullah T, Vachon-Presseau E, Cecchi G, Apkarian AV. Predicting placebo analgesia in patients with chronic pain using natural language processing: a preliminary validation study. Pain 2023; 164:1078-1086. [PMID: 36524810 PMCID: PMC10106359 DOI: 10.1097/j.pain.0000000000002808] [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: 02/25/2022] [Accepted: 10/05/2022] [Indexed: 12/23/2022]
Abstract
ABSTRACT Patients with chronic pain show large placebo effects in clinical trials, and inert pills can lead to clinically meaningful analgesia that can last from days to weeks. Whether the placebo response can be predicted reliably, and how to best predict it, is still unknown. We have shown previously that placebo responders can be identified through the language content of patients because they speak about their life, and their pain, after a placebo treatment. In this study, we examine whether these language properties are present before placebo treatment and are thus predictive of placebo response and whether a placebo prediction model can also dissociate between placebo and drug responders. We report the fine-tuning of a language model built based on a longitudinal treatment study where patients with chronic back pain received a placebo (study 1) and its validation on an independent study where patients received a placebo or drug (study 2). A model built on language features from an exit interview from study 1 was able to predict, a priori, the placebo response of patients in study 2 (area under the curve = 0.71). Furthermore, the model predicted as placebo responders exhibited an average of 30% pain relief from an inert pill, compared with 3% for those predicted as nonresponders. The model was not able to predict who responded to naproxen nor spontaneous recovery in a no-treatment arm, suggesting specificity of the prediction to placebo. Taken together, our initial findings suggest that placebo response is predictable using ecological and quick measures such as language use.
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Affiliation(s)
- Paulo Branco
- Department of Neuroscience, Northwestern University Feinberg School of Medicine, Chicago, IL, United States
- Center for Translational Pain Research, Northwestern University Feinberg School of Medicine, Chicago, IL, United States
| | - Sara Berger
- Responsible and Inclusive Technology (Exploratory Sciences Division), IBM Research, Yorktown Heights, NY, United States
- Computational Psychiatry and Digital Health (Impact Science Division), IBM Research, Yorktown Heights, NY, United States
| | - Taha Abdullah
- Department of Neuroscience, Northwestern University Feinberg School of Medicine, Chicago, IL, United States
- Center for Translational Pain Research, Northwestern University Feinberg School of Medicine, Chicago, IL, United States
| | - Etienne Vachon-Presseau
- Faculty of Dentistry and Department of Anesthesia, McGill University, Montréal, QC, Canada
- Alan Edwards Center for Research on Pain (AECRP), McGill University, Montréal, QC, Canada
| | - Guillermo Cecchi
- Computational Psychiatry and Digital Health (Impact Science Division), IBM Research, Yorktown Heights, NY, United States
| | - A Vania Apkarian
- Department of Neuroscience, Northwestern University Feinberg School of Medicine, Chicago, IL, United States
- Center for Translational Pain Research, Northwestern University Feinberg School of Medicine, Chicago, IL, United States
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15
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Anderson SR, Gianola M, Medina NA, Perry JM, Wager TD, Losin EAR. Doctor trustworthiness influences pain and its neural correlates in virtual medical interactions. Cereb Cortex 2023; 33:3421-3436. [PMID: 36001114 PMCID: PMC10068271 DOI: 10.1093/cercor/bhac281] [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: 01/07/2022] [Revised: 06/24/2022] [Accepted: 06/25/2022] [Indexed: 11/13/2022] Open
Abstract
Trust is an important component of the doctor-patient relationship and is associated with improved patient satisfaction and health outcomes. Previously, we reported that patient feelings of trust and similarity toward their clinician predicted reductions in evoked pain in response to painful heat stimulations. In the present study, we investigated the brain mechanisms underlying this effect. We used face stimuli previously developed using a data-driven computational modeling approach that differ in perceived trustworthiness and superimposed them on bodies dressed in doctors' attire. During functional magnetic resonance imaging, participants (n = 42) underwent a series of virtual medical interactions with these doctors during which they received painful heat stimulation as an analogue of a painful diagnostic procedure. Participants reported increased pain when receiving painful heat stimulations from low-trust doctors, which was accompanied by increased activity in pain-related brain regions and a multivariate pain-predictive neuromarker. Findings suggest that patient trust in their doctor may have tangible impacts on pain and point to a potential brain basis for trust-related reductions in pain through the modulation of brain circuitry associated with the sensory-discriminative and affective-motivational dimensions of pain.
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Affiliation(s)
- Steven R Anderson
- Department of Psychology, University of Miami, 5665 Ponce de Leon Boulevard, Coral Gables, FL 33146-0751, USA
| | - Morgan Gianola
- Department of Psychology, University of Miami, 5665 Ponce de Leon Boulevard, Coral Gables, FL 33146-0751, USA
| | - Natalia A Medina
- Department of Psychology, University of Miami, 5665 Ponce de Leon Boulevard, Coral Gables, FL 33146-0751, USA
| | - Jenna M Perry
- Department of Psychology, University of Miami, 5665 Ponce de Leon Boulevard, Coral Gables, FL 33146-0751, USA
| | - Tor D Wager
- Department of Psychological and Brain Sciences, Dartmouth College, 3 Maynard St, Hanover, NH 03755-3565, USA
| | - Elizabeth A Reynolds Losin
- Department of Psychology, University of Miami, 5665 Ponce de Leon Boulevard, Coral Gables, FL 33146-0751, USA
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16
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Speer SPH, Keysers C, Barrios JC, Teurlings CJS, Smidts A, Boksem MAS, Wager TD, Gazzola V. A multivariate brain signature for reward. Neuroimage 2023; 271:119990. [PMID: 36878456 DOI: 10.1016/j.neuroimage.2023.119990] [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: 07/15/2022] [Revised: 02/20/2023] [Accepted: 02/25/2023] [Indexed: 03/07/2023] Open
Abstract
The processing of reinforcers and punishers is crucial to adapt to an ever changing environment and its dysregulation is prevalent in mental health and substance use disorders. While many human brain measures related to reward have been based on activity in individual brain regions, recent studies indicate that many affective and motivational processes are encoded in distributed systems that span multiple regions. Consequently, decoding these processes using individual regions yields small effect sizes and limited reliability, whereas predictive models based on distributed patterns yield larger effect sizes and excellent reliability. To create such a predictive model for the processes of rewards and losses, termed the Brain Reward Signature (BRS), we trained a model to predict the signed magnitude of monetary rewards on the Monetary Incentive Delay task (MID; N = 39) and achieved a highly significant decoding performance (92% for decoding rewards versus losses). We subsequently demonstrate the generalizability of our signature on another version of the MID in a different sample (92% decoding accuracy; N = 12) and on a gambling task from a large sample (73% decoding accuracy, N = 1084). We further provided preliminary data to characterize the specificity of the signature by illustrating that the signature map generates estimates that significantly differ between rewarding and negative feedback (92% decoding accuracy) but do not differ for conditions that differ in disgust rather than reward in a novel Disgust-Delay Task (N = 39). Finally, we show that passively viewing positive and negatively valenced facial expressions loads positively on our signature, in line with previous studies on morbid curiosity. We thus created a BRS that can accurately predict brain responses to rewards and losses in active decision making tasks, and that possibly relates to information seeking in passive observational tasks.
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Affiliation(s)
- Sebastian P H Speer
- Social Brain Lab, Netherlands Institute for Neuroscience, Amsterdam, The Netherlands; Princeton Neuroscience Institute, Princeton University, Princeton, NJ 08544, USA
| | - Christian Keysers
- Social Brain Lab, Netherlands Institute for Neuroscience, Amsterdam, The Netherlands; Brain and Cognition, Department of Psychology, University of Amsterdam, The Netherlands
| | | | - Cas J S Teurlings
- Social Brain Lab, Netherlands Institute for Neuroscience, Amsterdam, The Netherlands
| | - Ale Smidts
- Rotterdam School of Management, Erasmus University, 3062 PA Rotterdam, The Netherlands
| | - Maarten A S Boksem
- Rotterdam School of Management, Erasmus University, 3062 PA Rotterdam, The Netherlands
| | - Tor D Wager
- Department of Psychological and Brain Sciences, Dartmouth College, Hanover, NH 03755, USA
| | - Valeria Gazzola
- Social Brain Lab, Netherlands Institute for Neuroscience, Amsterdam, The Netherlands.
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17
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Koban L, Lee S, Schelski DS, Simon MC, Lerman C, Weber B, Kable JW, Plassmann H. An fMRI-Based Brain Marker of Individual Differences in Delay Discounting. J Neurosci 2023; 43:1600-1613. [PMID: 36657973 PMCID: PMC10008056 DOI: 10.1523/jneurosci.1343-22.2022] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/08/2022] [Revised: 12/02/2022] [Accepted: 12/07/2022] [Indexed: 01/20/2023] Open
Abstract
Individual differences in delay discounting-how much we discount future compared to immediate rewards-are associated with general life outcomes, psychopathology, and obesity. Here, we use machine learning on fMRI activity during an intertemporal choice task to develop a functional brain marker of these individual differences in human adults. Training and cross-validating the marker in one dataset (Study 1, N = 110 male adults) resulted in a significant prediction-outcome correlation (r = 0.49), generalized to predict individual differences in a completely independent dataset (Study 2: N = 145 male and female adults, r = 0.45), and predicted discounting several weeks later. Out-of-sample responses of the functional brain marker, but not discounting behavior itself, differed significantly between overweight and lean individuals in both studies, and predicted fasting-state blood levels of insulin, c-peptide, and leptin in Study 1. Significant predictive weights of the marker were found in cingulate, insula, and frontoparietal areas, among others, suggesting an interplay among regions associated with valuation, conflict processing, and cognitive control. This new functional brain marker is a step toward a generalizable brain model of individual differences in delay discounting. Future studies can evaluate it as a potential transdiagnostic marker of altered decision-making in different clinical and developmental populations.SIGNIFICANCE STATEMENT People differ substantially in how much they prefer smaller sooner rewards or larger later rewards such as spending money now versus saving it for retirement. These individual differences are generally stable over time and have been related to differences in mental and bodily health. What is their neurobiological basis? We applied machine learning to brain-imaging data to identify a novel brain activity pattern that accurately predicts how much people prefer sooner versus later rewards, and which can be used as a new brain-based measure of intertemporal decision-making in future studies. The resulting functional brain marker also predicts overweight and metabolism-related blood markers, providing new insight into the possible links between metabolism and the cognitive and brain processes involved in intertemporal decision-making.
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Affiliation(s)
- Leonie Koban
- Marketing Area, INSEAD, F-77300 Fontainebleau, France
- Control-Interoception-Attention Team, Paris Brain Institute (ICM), INSERM U1127, CNRS UMR7225, Sorbonne University, 75013 Paris, France
- CNRS, INSERM, Centre de Recherche en Neurosciences de Lyon CRNL U1028 UMR5292, Université Claude Bernard Lyon 1, 69500 Bron, France
| | - Sangil Lee
- Department of Psychology, University of Pennsylvania, Philadelphia, Pennsylvania 19104-6018
| | - Daniela S Schelski
- Center for Economics and Neuroscience, University of Bonn, 53113 Bonn, Germany
- Institute of Experimental Epileptology and Cognition Research, University of Bonn Medical Center, 53113 Bonn, Germany
| | - Marie-Christine Simon
- Institute for Nutrition and Food Science, Nutrition and Microbiota, University of Bonn, 53113 Bonn, Germany
| | - Caryn Lerman
- Norris Comprehensive Cancer Center, University of Southern California, Los Angeles, California 90033
| | - Bernd Weber
- Center for Economics and Neuroscience, University of Bonn, 53113 Bonn, Germany
- Institute of Experimental Epileptology and Cognition Research, University of Bonn Medical Center, 53113 Bonn, Germany
| | - Joseph W Kable
- Department of Psychology, University of Pennsylvania, Philadelphia, Pennsylvania 19104-6018
| | - Hilke Plassmann
- Marketing Area, INSEAD, F-77300 Fontainebleau, France
- Control-Interoception-Attention Team, Paris Brain Institute (ICM), INSERM U1127, CNRS UMR7225, Sorbonne University, 75013 Paris, France
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18
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Koban L, Wager TD, Kober H. A neuromarker for drug and food craving distinguishes drug users from non-users. Nat Neurosci 2023; 26:316-325. [PMID: 36536243 DOI: 10.1038/s41593-022-01228-w] [Citation(s) in RCA: 35] [Impact Index Per Article: 35.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/26/2021] [Accepted: 11/01/2022] [Indexed: 12/24/2022]
Abstract
Craving is a core feature of substance use disorders. It is a strong predictor of substance use and relapse and is linked to overeating, gambling, and other maladaptive behaviors. Craving is measured via self-report, which is limited by introspective access and sociocultural contexts. Neurobiological markers of craving are both needed and lacking, and it remains unclear whether craving for drugs and food involve similar mechanisms. Across three functional magnetic resonance imaging studies (n = 99), we used machine learning to identify a cross-validated neuromarker that predicts self-reported intensity of cue-induced drug and food craving (P < 0.0002). This pattern, which we term the Neurobiological Craving Signature (NCS), includes ventromedial prefrontal and cingulate cortices, ventral striatum, temporal/parietal association areas, mediodorsal thalamus and cerebellum. Importantly, NCS responses to drug versus food cues discriminate drug users versus non-users with 82% accuracy. The NCS is also modulated by a self-regulation strategy. Transfer between separate neuromarkers for drug and food craving suggests shared neurobiological mechanisms. Future studies can assess the discriminant and convergent validity of the NCS and test whether it responds to clinical interventions and predicts long-term clinical outcomes.
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Affiliation(s)
- Leonie Koban
- Paris Brain Institute (ICM), Inserm, CNRS, Sorbonne Université, Paris, France.
- Centre de Recherche en Neurosciences de Lyon (CRNL), CNRS, INSERM, Université Claude Bernard Lyon 1, Bron, France.
| | - Tor D Wager
- Department of Psychological and Brain Sciences, Dartmouth College, Hanover, NH, USA.
| | - Hedy Kober
- Department of Psychiatry and Psychology, Yale University, New Haven, CT, USA.
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19
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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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20
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Lee S, Parthasarathi T, Cooper N, Zauberman G, Lerman C, Kable JW. A neural signature of the vividness of prospective thought is modulated by temporal proximity during intertemporal decision making. Proc Natl Acad Sci U S A 2022; 119:e2214072119. [PMID: 36279433 PMCID: PMC9636959 DOI: 10.1073/pnas.2214072119] [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: 08/19/2022] [Accepted: 09/27/2022] [Indexed: 11/18/2022] Open
Abstract
Why do people discount future rewards? Multiple theories in psychology argue that one reason is that future events are imagined less vividly than immediate events, thereby diminishing their perceived value. Here we provide neuroscientific evidence for this proposal. First, we construct a neural signature of the vividness of prospective thought, using an fMRI dataset where the vividness of imagined future events is orthogonal to their valence by design. Then, we apply this neural signature in two additional fMRI datasets, each using a different delay-discounting task, to show that neural measures of vividness decline as rewards are delayed farther into the future.
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Affiliation(s)
- Sangil Lee
- Department of Psychology, University of Pennsylvania, Philadelphia, PA 19104
| | | | - Nicole Cooper
- Annenberg School for Communication, University of Pennsylvania, Philadelphia, PA 19104
| | - Gal Zauberman
- Yale School of Management, Yale University, New Haven, CT 06511
| | - Caryn Lerman
- University of Southern California Norris Comprehensive Cancer Center, University of Southern California, Los Angeles, CA 90033
| | - Joseph W. Kable
- Department of Psychology, University of Pennsylvania, Philadelphia, PA 19104
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21
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Parong J, Seitz AR, Jaeggi SM, Green CS. Expectation effects in working memory training. Proc Natl Acad Sci U S A 2022; 119:e2209308119. [PMID: 36067292 PMCID: PMC9477404 DOI: 10.1073/pnas.2209308119] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/30/2022] [Accepted: 08/03/2022] [Indexed: 11/24/2022] Open
Abstract
There is a growing body of research focused on developing and evaluating behavioral training paradigms meant to induce enhancements in cognitive function. It has recently been proposed that one mechanism through which such performance gains could be induced involves participants' expectations of improvement. However, no work to date has evaluated whether it is possible to cause changes in cognitive function in a long-term behavioral training study by manipulating expectations. In this study, positive or negative expectations about cognitive training were both explicitly and associatively induced before either a working memory training intervention or a control intervention. Consistent with previous work, a main effect of the training condition was found, with individuals trained on the working memory task showing larger gains in cognitive function than those trained on the control task. Interestingly, a main effect of expectation was also found, with individuals given positive expectations showing larger cognitive gains than those who were given negative expectations (regardless of training condition). No interaction effect between training and expectations was found. Exploratory analyses suggest that certain individual characteristics (e.g., personality, motivation) moderate the size of the expectation effect. These results highlight aspects of methodology that can inform future behavioral interventions and suggest that participant expectations could be capitalized on to maximize training outcomes.
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Affiliation(s)
- Jocelyn Parong
- Department of Psychology, University of Wisconsin–Madison, Madison, WI 53706
| | - Aaron R. Seitz
- Department of Psychology, University of California, Riverside, CA 92521
| | | | - C. Shawn Green
- Department of Psychology, University of Wisconsin–Madison, Madison, WI 53706
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22
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Merritt CR, Cisneros IE, Covarrubias-Zambrano O, Stutz SJ, Motamedi M, Bossmann SH, Cunningham KA. Liquid Biopsy-Based Biomarkers of Inflammatory Nociception Identified in Male Rats. Front Pharmacol 2022; 13:893828. [PMID: 35833018 PMCID: PMC9271856 DOI: 10.3389/fphar.2022.893828] [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: 03/10/2022] [Accepted: 05/18/2022] [Indexed: 11/13/2022] Open
Abstract
Physicians are challenged in treating pain patients due to the lack of quantifiable, objective methods of measuring pain in the clinic; pain sensation is multifaceted and subjective to each individual. There is a critical need for point-of-care quantification of accessible biomarkers to provide objective analyses beyond the subjective pain scales currently employed in clinical care settings. In the present study, we employed an animal model to test the hypothesis that circulating regulators of the inflammatory response directly associate with an objective behavioral response to inflammatory pain. Upon induction of localized paw inflammation, we measured the systemic protein expression of cytokines, and activity levels of matrix metalloproteinases (MMPs) that are known to participate in the inflammatory response at the site of injury and investigated their relationship to the behavioral response across a 24 h period. Intraplantar injection with 1% λ-carrageenan induced a significant increase in paw thickness across this timespan with maximal effects observed at the 8 h timepoint when locomotor activity was also impaired. Expression of the chemokines C-X-C motif chemokine ligand 1 (CXCL1) and C-C motif chemokine ligand 2 (CCL2) positively correlated with paw inflammation and negatively correlated with locomotor activity at 8 h. The ratio of MMP9 to MMP2 activity negatively correlated with paw inflammation at the 8 h timepoint. We postulate that the CXCL1 and CCL2 as well as the ratio of MMP9 to MMP2 activity may serve as predictive biomarkers for the timecourse of inflammation-associated locomotor impairment. These data define opportunities for the future development of a point-of-care device to objectively quantify biomarkers for inflammatory pain states.
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Affiliation(s)
- Christina R. Merritt
- Center for Addiction Research, University of Texas Medical Branch, Galveston, TX, United States
- Department of Pharmacology and Toxicology, University of Texas Medical Branch, Galveston, TX, United States
| | - Irma E. Cisneros
- Center for Addiction Research, University of Texas Medical Branch, Galveston, TX, United States
- Department of Pharmacology and Toxicology, University of Texas Medical Branch, Galveston, TX, United States
- Department of Pathology, University of Texas Medical Branch, Galveston, TX, United States
| | - Obdulia Covarrubias-Zambrano
- Department of Chemistry, Kansas State University, Manhattan, KS, United States
- Department of Cancer Biology, The University of Kansas Cancer Center, Kansas City, MO, United States
| | - Sonja J. Stutz
- Center for Addiction Research, University of Texas Medical Branch, Galveston, TX, United States
- Department of Pharmacology and Toxicology, University of Texas Medical Branch, Galveston, TX, United States
| | - Massoud Motamedi
- Center for Addiction Research, University of Texas Medical Branch, Galveston, TX, United States
- Department of Ophthalmology and Visual Sciences, University of Texas Medical Branch, Galveston, TX, United States
| | - Stefan H. Bossmann
- Department of Chemistry, Kansas State University, Manhattan, KS, United States
- Department of Cancer Biology, The University of Kansas Cancer Center, Kansas City, MO, United States
| | - Kathryn A. Cunningham
- Center for Addiction Research, University of Texas Medical Branch, Galveston, TX, United States
- Department of Pharmacology and Toxicology, University of Texas Medical Branch, Galveston, TX, United States
- *Correspondence: Kathryn A. Cunningham,
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23
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Li H, Li X, Wang J, Gao F, Wiech K, Hu L, Kong Y. Pain-related reorganization in the primary somatosensory cortex of patients with postherpetic neuralgia. Hum Brain Mapp 2022; 43:5167-5179. [PMID: 35751551 PMCID: PMC9812237 DOI: 10.1002/hbm.25992] [Citation(s) in RCA: 10] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/06/2022] [Revised: 06/05/2022] [Accepted: 06/10/2022] [Indexed: 01/15/2023] Open
Abstract
Studies on functional and structural changes in the primary somatosensory cortex (S1) have provided important insights into neural mechanisms underlying several chronic pain conditions. However, the role of S1 plasticity in postherpetic neuralgia (PHN) remains elusive. Combining psychophysics and magnetic resonance imaging (MRI), we investigated whether pain in PHN patients is linked to S1 reorganization as compared with healthy controls. Results from voxel-based morphometry showed no structural differences between groups. To characterize functional plasticity, we compared S1 responses to noxious laser stimuli of a fixed intensity between both groups and assessed the relationship between S1 activation and spontaneous pain in PHN patients. Although the intensity of evoked pain was comparable in both groups, PHN patients exhibited greater activation in S1 ipsilateral to the stimulated hand. Pain-related activity was identified in contralateral superior S1 (SS1) in controls as expected, but in bilateral inferior S1 (IS1) in PHN patients with no overlap between SS1 and IS1. Contralateral SS1 engaged during evoked pain in controls encoded spontaneous pain in patients, suggesting functional S1 reorganization in PHN. Resting-state fMRI data showed decreased functional connectivity between left and right SS1 in PHN patients, which scaled with the intensity of spontaneous pain. Finally, multivariate pattern analyses (MVPA) demonstrated that BOLD activity and resting-state functional connectivity of S1 predicted within-subject variations of evoked and spontaneous pain intensities across groups. In summary, functional reorganization in S1 might play a key role in chronic pain related to PHN and could be a potential treatment target in this patient group.
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Affiliation(s)
- Hong Li
- CAS Key Laboratory of Behavioral ScienceInstitute of PsychologyBeijingChina,Department of PsychologyUniversity of Chinese Academy of SciencesBeijingChina
| | - Xiaoyun Li
- Department of PsychologyUniversity of Chinese Academy of SciencesBeijingChina,CAS Key Laboratory of Mental HealthInstitute of PsychologyBeijingChina
| | - Jiyuan Wang
- CAS Key Laboratory of Behavioral ScienceInstitute of PsychologyBeijingChina,Department of PsychologyUniversity of Chinese Academy of SciencesBeijingChina
| | - Fei Gao
- Department of Pain MedicinePeking University People's HospitalBeijingChina
| | - Katja Wiech
- Wellcome Centre for Integrative Neuroimaging (WIN), Nuffield Department of Clinical NeurosciencesUniversity of Oxford, John Radcliffe HospitalOxfordUK
| | - Li Hu
- Department of PsychologyUniversity of Chinese Academy of SciencesBeijingChina,CAS Key Laboratory of Mental HealthInstitute of PsychologyBeijingChina
| | - Yazhuo Kong
- CAS Key Laboratory of Behavioral ScienceInstitute of PsychologyBeijingChina,Department of PsychologyUniversity of Chinese Academy of SciencesBeijingChina,Wellcome Centre for Integrative Neuroimaging (WIN), Nuffield Department of Clinical NeurosciencesUniversity of Oxford, John Radcliffe HospitalOxfordUK
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24
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Hoeppli ME, Nahman-Averbuch H, Hinkle WA, Leon E, Peugh J, Lopez-Sola M, King CD, Goldschneider KR, Coghill RC. Dissociation between individual differences in self-reported pain intensity and underlying fMRI brain activation. Nat Commun 2022; 13:3569. [PMID: 35732637 PMCID: PMC9218124 DOI: 10.1038/s41467-022-31039-3] [Citation(s) in RCA: 13] [Impact Index Per Article: 6.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/21/2021] [Accepted: 04/21/2022] [Indexed: 12/02/2022] Open
Abstract
Pain is an individual experience. Previous studies have highlighted changes in brain activation and morphology associated with within- and interindividual pain perception. In this study we sought to characterize brain mechanisms associated with between-individual differences in pain in a sample of healthy adolescent and adult participants (N = 101). Here we show that pain ratings varied widely across individuals and that individuals reported changes in pain evoked by small differences in stimulus intensity in a manner congruent with their pain sensitivity, further supporting the utility of subjective reporting as a measure of the true individual experience. Furthermore, brain activation related to interindividual differences in pain was not detected, despite clear sensitivity of the Blood Oxygenation Level-Dependent (BOLD) signal to small differences in noxious stimulus intensities within individuals. These findings suggest fMRI may not be a useful objective measure to infer reported pain intensity.
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Affiliation(s)
- M E Hoeppli
- Pediatric Pain Research Center (PPRC), Cincinnati Children's Hospital Medical Center, Cincinnati, OH, USA.
- Division of Behavioral Medicine and Clinical Psychology, Cincinnati Children's Hospital Medical Center, Cincinnati, OH, USA.
| | - H Nahman-Averbuch
- Pediatric Pain Research Center (PPRC), Cincinnati Children's Hospital Medical Center, Cincinnati, OH, USA
- Division of Behavioral Medicine and Clinical Psychology, Cincinnati Children's Hospital Medical Center, Cincinnati, OH, USA
- Division of Clinical and Translational Research and Washington University Pain Center, Department of Anesthesiology, Washington University School of Medicine, St Louis, MO, USA
| | - W A Hinkle
- Pediatric Pain Research Center (PPRC), Cincinnati Children's Hospital Medical Center, Cincinnati, OH, USA
| | - E Leon
- Pediatric Pain Research Center (PPRC), Cincinnati Children's Hospital Medical Center, Cincinnati, OH, USA
- Division of Behavioral Medicine and Clinical Psychology, Cincinnati Children's Hospital Medical Center, Cincinnati, OH, USA
| | - J Peugh
- Division of Behavioral Medicine and Clinical Psychology, Cincinnati Children's Hospital Medical Center, Cincinnati, OH, USA
- Department of Pediatrics, University of Cincinnati, College of Medicine, Cincinnati, OH, USA
| | - M Lopez-Sola
- Serra Hunter Programme, Department of Medicine, School of Medicine and Health Sciences, University of Barcelona, Barcelona, Spain
| | - C D King
- Pediatric Pain Research Center (PPRC), Cincinnati Children's Hospital Medical Center, Cincinnati, OH, USA
- Division of Behavioral Medicine and Clinical Psychology, Cincinnati Children's Hospital Medical Center, Cincinnati, OH, USA
- Department of Pediatrics, University of Cincinnati, College of Medicine, Cincinnati, OH, USA
| | - K R Goldschneider
- Pediatric Pain Research Center (PPRC), Cincinnati Children's Hospital Medical Center, Cincinnati, OH, USA
- Pain Management Center, Department of Anesthesiology, Cincinnati Children's Hospital Medical Center, Cincinnati, OH, USA
| | - R C Coghill
- Pediatric Pain Research Center (PPRC), Cincinnati Children's Hospital Medical Center, Cincinnati, OH, USA
- Division of Behavioral Medicine and Clinical Psychology, Cincinnati Children's Hospital Medical Center, Cincinnati, OH, USA
- Department of Pediatrics, University of Cincinnati, College of Medicine, Cincinnati, OH, USA
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25
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Xu J, Xie H, Liu L, Shen Z, Yang L, Wei W, Guo X, Liang F, Yu S, Yang J. Brain Mechanism of Acupuncture Treatment of Chronic Pain: An Individual-Level Positron Emission Tomography Study. Front Neurol 2022; 13:884770. [PMID: 35585847 PMCID: PMC9108276 DOI: 10.3389/fneur.2022.884770] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/27/2022] [Accepted: 03/22/2022] [Indexed: 11/13/2022] Open
Abstract
ObjectiveAcupuncture has been shown to be effective in the treatment of chronic pain. However, their neural mechanism underlying the effective acupuncture response to chronic pain is still unclear. We investigated whether metabolic patterns in the pain matrix network might predict acupuncture therapy responses in patients with primary dysmenorrhea (PDM) using a machine-learning-based multivariate pattern analysis (MVPA) on positron emission tomography data (PET).MethodsForty-two patients with PDM were selected and randomized into two groups: real acupuncture and sham acupuncture (three menstrual cycles). Brain metabolic data from the three special brain networks (the sensorimotor network (SMN), default mode network (DMN), and salience network (SN)) were extracted at the individual level by using PETSurfer in fluorine-18 fluorodeoxyglucose positron emission tomography (18F-FDG-PET) data. MVPA analysis based on metabolic network features was employed to predict the pain relief after treatment in the pooled group and real acupuncture treatment, separately.ResultsPaired t-tests revealed significant alterations in pain intensity after real but not sham acupuncture treatment. Traditional mass-univariate correlations between brain metabolic and alterations in pain intensity were not significant. The MVPA results showed that the brain metabolic pattern in the DMN and SMN did predict the pain relief in the pooled group of patients with PDM (R2 = 0.25, p = 0.005). In addition, the metabolic pattern in the DMN could predict the pain relief after treatment in the real acupuncture treatment group (R2 = 0.40, p = 0.01).ConclusionThis study indicates that the individual-level metabolic patterns in DMN is associated with real acupuncture treatment response in chronic pain. The present findings advanced the knowledge of the brain mechanism of the acupuncture treatment in chronic pain.
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Affiliation(s)
- Jin Xu
- Department of Acupuncture and Tuina, Chengdu University of Traditional Chinese Medicine, Chengdu, China
| | - Hongjun Xie
- Department of Nuclear Medicine, Sichuan Academy of Medical Sciences and Sichuan Provincial People's Hospital, Chengdu, China
| | - Liying Liu
- Department of Acupuncture and Tuina, Chengdu University of Traditional Chinese Medicine, Chengdu, China
| | - Zhifu Shen
- Department of Traditional Chinese and Western Medicine, North Sichuan Medical College, Nanchong, China
| | - Lu Yang
- Department of Acupuncture and Tuina, Chengdu University of Traditional Chinese Medicine, Chengdu, China
| | - Wei Wei
- Department of Acupuncture and Tuina, Chengdu University of Traditional Chinese Medicine, Chengdu, China
| | - Xiaoli Guo
- Department of Acupuncture and Tuina, Chengdu University of Traditional Chinese Medicine, Chengdu, China
| | - Fanrong Liang
- Department of Acupuncture and Tuina, Chengdu University of Traditional Chinese Medicine, Chengdu, China
| | - Siyi Yu
- Department of Acupuncture and Tuina, Chengdu University of Traditional Chinese Medicine, Chengdu, China
- Siyi Yu
| | - Jie Yang
- Department of Acupuncture and Tuina, Chengdu University of Traditional Chinese Medicine, Chengdu, China
- *Correspondence: Jie Yang
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26
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Vachon-Presseau E, Abdullah TB, Berger SE, Huang L, Griffith JW, Schnitzer TJ, Apkarian AV. Validating a biosignature-predicting placebo pill response in chronic pain in the settings of a randomized controlled trial. Pain 2022; 163:910-922. [PMID: 34433773 PMCID: PMC8863986 DOI: 10.1097/j.pain.0000000000002450] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/15/2021] [Accepted: 08/08/2021] [Indexed: 11/25/2022]
Abstract
ABSTRACT The objective of this study is to validate a placebo pill response predictive model-a biosignature-that classifies chronic pain patients into placebo responders (predicted-PTxResp) and nonresponders (predicted-PTxNonR) and test whether it can dissociate placebo and active treatment responses. The model, based on psychological and brain functional connectivity, was derived in our previous study and blindly applied to current trial participants. Ninety-four chronic low back pain (CLBP) patients were classified into predicted-PTxResp or predicted-PTxNonR and randomized into no treatment, placebo treatment, or naproxen treatment. To monitor analgesia, back pain intensity was collected twice a day: 3 weeks baseline, 6 weeks of treatment, and 3 weeks of washout. Eighty-nine CLBP patients were included in the intent-to-treat analyses and 77 CLBP patients in the per-protocol analyses. Both analyses showed similar results. At the group level, the predictive model performed remarkably well, dissociating the separate effect sizes of pure placebo response and pure active treatment response and demonstrating that these effects interacted additively. Pain relief was about 15% stronger in the predicted-PTxResp compared with the predicted-PTxNonR receiving either placebo or naproxen, and the predicted-PTxNonR successfully isolated the active drug effect. At a single subject level, the biosignature better predicted placebo nonresponders, with poor accuracy. One component of the biosignature (dorsolateral prefrontal cortex-precentral gyrus functional connectivity) could be generalized across 3 placebo studies and in 2 different cohorts-CLBP and osteoarthritis pain patients. This study shows that a biosignature can predict placebo response at a group level in the setting of a randomized controlled trial.
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Affiliation(s)
- Etienne Vachon-Presseau
- Faculty of Dentistry, McGill University, Montreal, QC, Canada
- Department of Anesthesia, Faculty of Medicine, McGill University, Montreal, QC, Canada
- Alan Edwards Centre for Research on Pain (AECRP), McGill University, Montreal, QC, Canada
| | - Taha B. Abdullah
- Department of Physiology, Northwestern University Feinberg School of Medicine, 710 N Lake Shore Drive, Room 1020, Chicago, IL 60611, USA
| | - Sara E. Berger
- Healthcare and Life Sciences Department, IBM Watson Research Center, 1101 Kitchawan Rd, Yorktown Heights, NY 10598, USA
| | - Lejian Huang
- Department of Physiology, Northwestern University Feinberg School of Medicine, 710 N Lake Shore Drive, Room 1020, Chicago, IL 60611, USA
| | - James W. Griffith
- Department of Medical Social Sciences, Northwestern University Feinberg School of Medicine, 710 N Lake Shore Drive, Room 1020, Chicago, IL 60611, USA
| | - Thomas J. Schnitzer
- Departments of Internal Medicine and Rheumatology, Northwestern University Feinberg School of Medicine, 710 N Lake Shore Drive, Room 1020, Chicago, IL 60611, USA
- Department of Physical Medicine and Rehabilitation, Northwestern University Feinberg School of Medicine, 710 N Lake Shore Drive, Room 1020, Chicago, IL 60611, USA
| | - A. Vania Apkarian
- Department of Physiology, Northwestern University Feinberg School of Medicine, 710 N Lake Shore Drive, Room 1020, Chicago, IL 60611, USA
- Department of Physical Medicine and Rehabilitation, Northwestern University Feinberg School of Medicine, 710 N Lake Shore Drive, Room 1020, Chicago, IL 60611, USA
- Department of Anesthesia, Northwestern University Feinberg School of Medicine, 710 N Lake Shore Drive, Room 1020, Chicago, IL 60611, USA
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27
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Psycho-Neuro-Endocrine-Immunological Basis of the Placebo Effect: Potential Applications beyond Pain Therapy. Int J Mol Sci 2022; 23:ijms23084196. [PMID: 35457014 PMCID: PMC9028312 DOI: 10.3390/ijms23084196] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/16/2022] [Revised: 04/03/2022] [Accepted: 04/04/2022] [Indexed: 12/12/2022] Open
Abstract
The placebo effect can be defined as the improvement of symptoms in a patient after the administration of an innocuous substance in a context that induces expectations regarding its effects. During recent years, it has been discovered that the placebo response not only has neurobiological functions on analgesia, but that it is also capable of generating effects on the immune and endocrine systems. The possible integration of changes in different systems of the organism could favor the well-being of the individuals and go hand in hand with conventional treatment for multiple diseases. In this sense, classic conditioning and setting expectations stand out as psychological mechanisms implicated in the placebo effect. Recent advances in neuroimaging studies suggest a relationship between the placebo response and the opioid, cannabinoid, and monoaminergic systems. Likewise, a possible immune response conditioned by the placebo effect has been reported. There is evidence of immune suppression conditioned through the insular cortex and the amygdala, with noradrenalin as the responsible neurotransmitter. Finally, a conditioned response in the secretion of different hormones has been determined in different studies; however, the molecular mechanisms involved are not entirely known. Beyond studies about its mechanism of action, the placebo effect has proved to be useful in the clinical setting with promising results in the management of neurological, psychiatric, and immunologic disorders. However, more research is needed to better characterize its potential use. This review integrates current knowledge about the psycho-neuro-endocrine-immune basis of the placebo effect and its possible clinical applications.
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28
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Jabakhanji R, Vigotsky AD, Bielefeld J, Huang L, Baliki MN, Iannetti G, Apkarian AV. Limits of decoding mental states with fMRI. Cortex 2022; 149:101-122. [PMID: 35219121 PMCID: PMC9238276 DOI: 10.1016/j.cortex.2021.12.015] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/23/2021] [Revised: 11/22/2021] [Accepted: 12/13/2021] [Indexed: 12/15/2022]
Abstract
A growing number of studies claim to decode mental states using multi-voxel decoders of brain activity. It has been proposed that the fixed, fine-grained, multi-voxel patterns in these decoders are necessary for discriminating between and identifying mental states. Here, we present evidence that the efficacy of these decoders might be overstated. Across various tasks, decoder patterns were spatially imprecise, as decoder performance was unaffected by spatial smoothing; 90% redundant, as selecting a random 10% of a decoder's constituent voxels recovered full decoder performance; and performed similarly to brain activity maps used as decoders. We distinguish decoder performance in discriminating between mental states from performance in identifying a given mental state, and show that even when discrimination performance is adequate, identification can be poor. Finally, we demonstrate that simple and intuitive similarity metrics explain 91% and 62% of discrimination performance within- and across-subjects, respectively. These findings indicate that currently used across-subject decoders of mental states are superfluous and inappropriate for decision-making.
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Affiliation(s)
- Rami Jabakhanji
- Department of Neuroscience, Feinberg School of Medicine, Northwestern University, Chicago, USA; Center for Translational Pain Research, Feinberg School of Medicine, Northwestern University, Chicago, USA
| | - Andrew D Vigotsky
- Departments of Biomedical Engineering and Statistics, Northwestern University, Evanston, USA; Center for Translational Pain Research, Feinberg School of Medicine, Northwestern University, Chicago, USA
| | - Jannis Bielefeld
- Department of Neuroscience, Feinberg School of Medicine, Northwestern University, Chicago, USA; Center for Translational Pain Research, Feinberg School of Medicine, Northwestern University, Chicago, USA
| | - Lejian Huang
- Department of Neuroscience, Feinberg School of Medicine, Northwestern University, Chicago, USA; Center for Translational Pain Research, Feinberg School of Medicine, Northwestern University, Chicago, USA
| | - Marwan N Baliki
- Department of Physical Medicine and Rehabilitation, Feinberg School of Medicine, Northwestern University, Chicago, USA; Shirley Ryan AbilityLab, Chicago, USA; Center for Translational Pain Research, Feinberg School of Medicine, Northwestern University, Chicago, USA
| | - Giandomenico Iannetti
- Division of Biosciences, University College London, London, UK; Neuroscience and Behaviour Laboratory, Italian Institute of Technology, Rome, Italy
| | - A Vania Apkarian
- Department of Neuroscience, Feinberg School of Medicine, Northwestern University, Chicago, USA; Department of Physical Medicine and Rehabilitation, Feinberg School of Medicine, Northwestern University, Chicago, USA; Department of Anesthesiology, Feinberg School of Medicine, Northwestern University, Chicago, USA; Center for Translational Pain Research, Feinberg School of Medicine, Northwestern University, Chicago, USA.
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29
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van 't Hof SR, Van Oudenhove L, Janssen E, Klein S, Reddan MC, Kragel PA, Stark R, Wager TD. The Brain Activation-Based Sexual Image Classifier (BASIC): A Sensitive and Specific fMRI Activity Pattern for Sexual Image Processing. Cereb Cortex 2021; 32:3014-3030. [PMID: 34905775 PMCID: PMC9290618 DOI: 10.1093/cercor/bhab397] [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: 12/07/2020] [Revised: 09/27/2021] [Accepted: 09/28/2021] [Indexed: 11/19/2022] Open
Abstract
Previous studies suggest there is a complex relationship between sexual and general affective stimulus processing, which varies across individuals and situations. We examined whether sexual and general affective processing can be distinguished at the brain level. In addition, we explored to what degree possible distinctions are generalizable across individuals and different types of sexual stimuli, and whether they are limited to the engagement of lower-level processes, such as the detection of visual features. Data on sexual images, nonsexual positive and negative images, and neutral images from Wehrum et al. (2013) (N = 100) were reanalyzed using multivariate support vector machine models to create the brain activation-based sexual image classifier (BASIC) model. This model was tested for sensitivity, specificity, and generalizability in cross-validation (N = 100) and an independent test cohort (N = 18; Kragel et al. 2019). The BASIC model showed highly accurate performance (94–100%) in classifying sexual versus neutral or nonsexual affective images in both datasets with forced choice tests. Virtual lesions and tests of individual large-scale networks (e.g., visual or attention networks) show that individual networks are neither necessary nor sufficient to classify sexual versus nonsexual stimulus processing. Thus, responses to sexual images are distributed across brain systems.
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Affiliation(s)
- Sophie R van 't Hof
- Department of Psychological and Brain Sciences, Dartmouth College, Hanover, NH 03755, USA.,Department of Psychiatry, Amsterdam Medical Centre, 1105 AZ, The Netherlands
| | - Lukas Van Oudenhove
- Department of Psychological and Brain Sciences, Dartmouth College, Hanover, NH 03755, USA.,Laboratory for Brain-Gut Axis Studies, Translational Research Center for Gastrointestinal Disorders, Department of Chronic Diseases and Metabolism, KU Leuven, Leuven 3000, Belgium
| | - Erick Janssen
- Institute for Family and Sexuality Studies, KU Leuven, Leuven 3000, Belgium
| | - Sanja Klein
- Bender Institute of Neuroimaging (BION), Justus Liebig University Giessen, Giessen 35390, Germany.,Department of Psychotherapy and Systems Neuroscience, Justus Liebig University Giessen, Giessen 35390, Germany
| | - Marianne C Reddan
- Institute of Cognitive Science, Department of Psychology and Neuroscience, University of Colorado Boulder, Boulder, CO 80309, USA.,Stanford University, Palo Alto, CA, USA
| | - Philip A Kragel
- Institute of Cognitive Science, Department of Psychology and Neuroscience, University of Colorado Boulder, Boulder, CO 80309, USA.,Emory University, Atlanta, GA, USA
| | - Rudolf Stark
- Bender Institute of Neuroimaging (BION), Justus Liebig University Giessen, Giessen 35390, Germany.,Department of Psychotherapy and Systems Neuroscience, Justus Liebig University Giessen, Giessen 35390, Germany
| | - Tor D Wager
- Department of Psychological and Brain Sciences, Dartmouth College, Hanover, NH 03755, USA.,Institute of Cognitive Science, Department of Psychology and Neuroscience, University of Colorado Boulder, Boulder, CO 80309, USA
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30
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Atlas LY. A social affective neuroscience lens on placebo analgesia. Trends Cogn Sci 2021; 25:992-1005. [PMID: 34538720 PMCID: PMC8516707 DOI: 10.1016/j.tics.2021.07.016] [Citation(s) in RCA: 19] [Impact Index Per Article: 6.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/01/2020] [Revised: 07/28/2021] [Accepted: 07/29/2021] [Indexed: 12/26/2022]
Abstract
Pain is a fundamental experience that promotes survival. In humans, pain stands at the intersection of multiple health crises: chronic pain, the opioid epidemic, and health disparities. The study of placebo analgesia highlights how social, cognitive, and affective processes can directly shape pain, and identifies potential paths for mitigating these crises. This review examines recent progress in the study of placebo analgesia through affective science. It focuses on how placebo effects are shaped by expectations, affect, and the social context surrounding treatment, and discusses neurobiological mechanisms of placebo, highlighting unanswered questions and implications for health. Collaborations between clinicians and social and affective scientists can address outstanding questions and leverage placebo to reduce pain and improve human health.
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Affiliation(s)
- Lauren Y Atlas
- National Center for Complementary and Integrative Health, National Institutes of Health, Bethesda, MD, USA; National Institute of Mental Health, National Institutes of Health, Bethesda, MD, USA; National Institute on Drug Abuse, National Institutes of Health, Baltimore, MD, USA.
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31
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Parelman JM, Doré BP, Cooper N, O'Donnell MB, Chan HY, Falk EB. Overlapping Functional Representations of Self- and Other-Related Thought are Separable Through Multivoxel Pattern Classification. Cereb Cortex 2021; 32:1131-1141. [PMID: 34398230 DOI: 10.1093/cercor/bhab272] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/17/2021] [Revised: 07/14/2021] [Accepted: 07/15/2021] [Indexed: 12/13/2022] Open
Abstract
Self-reflection and thinking about the thoughts and behaviors of others are important skills for humans to function in the social world. These two processes overlap in terms of the component processes involved, and share overlapping functional organizations within the human brain, in particular within the medial prefrontal cortex (MPFC). Several functional models have been proposed to explain these two processes, but none has directly explored the extent to which they are distinctly represented within different parts of the brain. This study used multivoxel pattern classification to quantify the separability of self- and other-related thought in the MPFC and expanded this question to the entire brain. Using a large-scale mega-analytic dataset, spanning three separate studies (n = 142), we find that self- and other-related thought can be reliably distinguished above chance within the MPFC, posterior cingulate cortex and temporal lobes. We highlight subcomponents of the ventral MPFC that are particularly important in representing self-related thought, and subcomponents of the orbitofrontal cortex robustly involved in representing other-related thought. Our findings indicate that representations of self- and other-related thought in the human brain are described best by a distributed pattern rather than stark localization or a purely ventral to dorsal linear gradient in the MPFC.
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Affiliation(s)
- Jacob M Parelman
- Annenberg School for Communication, University of Pennsylvania, Philadelphia, PA 19104, USA
| | - Bruce P Doré
- Desautels Faculty of Management, McGill University, H3A 1G5, Montreal, Canada
| | - Nicole Cooper
- Annenberg School for Communication, University of Pennsylvania, Philadelphia, PA 19104, USA
| | | | - Hang-Yee Chan
- Amsterdam School of Communication Research, University of Amsterdam, Nieuwe Achtergracht 166, 1018 WV Amsterdam, The Netherlands
| | - Emily B Falk
- Annenberg School for Communication, University of Pennsylvania, Philadelphia, PA 19104, USA
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32
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Gianaros PJ, Kraynak TE, Kuan DCH, Gross JJ, McRae K, Hariri AR, Manuck SB, Rasero J, Verstynen TD. Affective brain patterns as multivariate neural correlates of cardiovascular disease risk. Soc Cogn Affect Neurosci 2021; 15:1034-1045. [PMID: 32301993 PMCID: PMC7657455 DOI: 10.1093/scan/nsaa050] [Citation(s) in RCA: 15] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/28/2019] [Revised: 03/18/2020] [Accepted: 04/06/2020] [Indexed: 01/27/2023] Open
Abstract
This study tested whether brain activity patterns evoked by affective stimuli relate to individual differences in an indicator of pre-clinical atherosclerosis: carotid artery intima-media thickness (CA-IMT). Adults (aged 30-54 years) completed functional magnetic resonance imaging (fMRI) tasks that involved viewing three sets of affective stimuli. Two sets included facial expressions of emotion, and one set included neutral and unpleasant images from the International Affective Picture System (IAPS). Cross-validated, multivariate and machine learning models showed that individual differences in CA-IMT were partially predicted by brain activity patterns evoked by unpleasant IAPS images, even after accounting for age, sex and known cardiovascular disease risk factors. CA-IMT was also predicted by brain activity patterns evoked by angry and fearful faces from one of the two stimulus sets of facial expressions, but this predictive association did not persist after accounting for known cardiovascular risk factors. The reliability (internal consistency) of brain activity patterns evoked by affective stimuli may have constrained their prediction of CA-IMT. Distributed brain activity patterns could comprise affective neural correlates of pre-clinical atherosclerosis; however, the interpretation of such correlates may depend on their psychometric properties, as well as the influence of other cardiovascular risk factors and specific affective cues.
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Affiliation(s)
- Peter J Gianaros
- Department of Psychology, University of Pittsburgh, Pittsburgh, PA 15260, USA.,Center for the Neural Basis of Cognition, University of Pittsburgh and Carnegie Mellon University, Pittsburgh, PA 15213, USA
| | - Thomas E Kraynak
- Department of Psychology, University of Pittsburgh, Pittsburgh, PA 15260, USA.,Center for the Neural Basis of Cognition, University of Pittsburgh and Carnegie Mellon University, Pittsburgh, PA 15213, USA
| | - Dora C-H Kuan
- Department of Psychology, University of Pittsburgh, Pittsburgh, PA 15260, USA
| | - James J Gross
- Department of Psychology, Stanford University, Stanford, CA, 94305, USA
| | - Kateri McRae
- Department of Psychology, University of Denver, Denver, CO, 80208, USA
| | - Ahmad R Hariri
- Department of Psychology and Neuroscience, Duke University, Durham, NC, 27708, USA
| | - Stephen B Manuck
- Center for the Neural Basis of Cognition, University of Pittsburgh and Carnegie Mellon University, Pittsburgh, PA 15213, USA
| | - Javier Rasero
- Department of Psychology, Carnegie Mellon University, Pittsburgh, PA 15213, USA
| | - Timothy D Verstynen
- Center for the Neural Basis of Cognition, University of Pittsburgh and Carnegie Mellon University, Pittsburgh, PA 15213, USA.,Department of Psychology, Carnegie Mellon University, Pittsburgh, PA 15213, USA
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33
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Case L, Adler-Neal AL, Wells RE, Zeidan F. The Role of Expectations and Endogenous Opioids in Mindfulness-Based Relief of Experimentally Induced Acute Pain. Psychosom Med 2021; 83:549-556. [PMID: 33480666 PMCID: PMC8415135 DOI: 10.1097/psy.0000000000000908] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/25/2022]
Abstract
OBJECTIVE Expectations contribute to cognitive pain modulation through opioidergically mediated descending inhibition. Mindfulness meditation reduces pain independent of endogenous opioids, engaging unique corticothalamocortical mechanisms. However, it remains unknown whether expectations for pain relief predict mindfulness-induced analgesia and if these expectations are modified by endogenous opioids. METHODS In this secondary analysis of previously published work, 78 pain-free participants (mean age, 27 ± 7 years; 50% women) were randomized to a four-session mindfulness meditation or book listening regimen. Expectations for intervention-induced pain relief were assessed before and after each intervention. Pain ratings were examined after meditation or rest (control group) during noxious heat (49°C) and intravenous administration of saline placebo or the opioid antagonist naloxone (0.15 mg/kg bolus + 0.1 mg kg-1 h-1 infusion. RESULTS Mindfulness significantly lowered pain during saline and naloxone infusion. Higher expected pain relief from mindfulness predicted lower pain intensity (r(40) = -0.41, p = .009). The relationship between meditation-related expectations and pain intensity reductions was exhibited during naloxone (r(20) = -0.76, p < .001) but not saline (r(20) = -0.22, p = .36). Expectations for book listening-based analgesia did not significantly predict pain changes during saline (r(20) = -0.37, p = .11) or naloxone (r(18) = 0.26, p = .30) in the control group. CONCLUSIONS These novel findings demonstrate a significant role for expectations in mindfulness-based pain relief. However, this role was minimal during saline and stronger during opioid blockade, despite similar pain reductions. This supports growing evidence that mindfulness engages multiple mechanisms to reduce pain, suggesting that mindfulness might be an effective pain-reducing technique even for individuals with low expectations for pain relief.
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Affiliation(s)
- Laura Case
- Department of Anesthesiology, University of California at San Diego
| | | | | | - Fadel Zeidan
- Department of Anesthesiology, University of California at San Diego
- Department of Neurobiology and Anatomy, Wake Forest School of Medicine
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34
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Yang H, Yang X, Liu H, Long H, Hu H, Wang Q, Huang R, Shan D, Li K, Lai W. Placebo modulation in orthodontic pain: a single-blind functional magnetic resonance study. LA RADIOLOGIA MEDICA 2021; 126:1356-1365. [PMID: 34160776 DOI: 10.1007/s11547-021-01374-4] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 12/02/2019] [Accepted: 05/12/2021] [Indexed: 02/08/2023]
Abstract
OBJECTIVES The mechanism of orthodontic pain modulation with a placebo remains largely unknown. This study aimed to investigate the placebo modulation of brain activity associated with orthodontic pain using functional magnetic resonance imaging (fMRI). METHODS This longitudinal fMRI experiment recruited 23 volunteers and a self-contrast method was used. At first time, the participants were scanned without placebo (first period), followed by a 30-day washout, the participants were scanned again with placebo administration (second period). Orthodontic pain was caused by orthodontic separators placement between the lower right molars for both two periods. 24 h after placement, the MRI scans were taken, including a bite/non-bite task fMRI and a resting-state fMRI. A generalized linear model was used to identify pain-regulating network from task fMRI. Functional connectivity analysis of pain-related brain regions was performed to study the placebo effect on connectivity of pain-regulating networks using resting-state fMRI. RESULTS The results of brain activation patterns were largely similar under placebo and non-placebo conditions. Under the non-placebo condition, the activities in multiple brain regions, including the pre-central gyrus, superior frontal gyrus, superior parietal lobule, and supramarginal gyrus, were significantly higher than that of the placebo condition. However, the anterior cingulate cortex (ACC) was activated under the non-placebo condition but not in the placebo one. The functional connectivities between ACC and orbitofrontal cortex, and the dorsolateral prefrontal cortex and orbitofrontal cortex were reduced under placebo condition. CONCLUSION Participants demonstrated similar brain activation patterns for orthodontic pain with or without placebos. With placebo, reduced activation in primary sensory cortex and decreased activation in ACC indicated that ACC could be fundamental in analgesia.
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Affiliation(s)
- Hong Yang
- State Key Laboratory of Oral Diseases and National Clinical Research Center for Oral Diseases and Department of Orthodontics, West China Hospital of Stomatology, Sichuan University, No. 14, 3Rd Section of Ren Min Nan Rd., ChengduSichuan, 610041, China.,School of Stomatology, Southern Medical University, Guangzhou, 510515, China
| | - Xin Yang
- Department of Stomatology, Shanghai Jiaotong University School of Medicine Xinhua Hospital, Shanghai, China
| | - He Liu
- China-Japan Friendship Hospital, BeiJing, China
| | - Hu Long
- State Key Laboratory of Oral Diseases and National Clinical Research Center for Oral Diseases and Department of Orthodontics, West China Hospital of Stomatology, Sichuan University, No. 14, 3Rd Section of Ren Min Nan Rd., ChengduSichuan, 610041, China
| | - Huimin Hu
- State Key Laboratory of Oral Diseases and National Clinical Research Center for Oral Diseases and Department of Orthodontics, West China Hospital of Stomatology, Sichuan University, No. 14, 3Rd Section of Ren Min Nan Rd., ChengduSichuan, 610041, China
| | - Qingxuan Wang
- State Key Laboratory of Oral Diseases and National Clinical Research Center for Oral Diseases and Department of Orthodontics, West China Hospital of Stomatology, Sichuan University, No. 14, 3Rd Section of Ren Min Nan Rd., ChengduSichuan, 610041, China
| | - Renhuan Huang
- Shanghai Tenth People's Hospital, Tongji University School of Medicine, ShangHai, China
| | - Di Shan
- State Key Laboratory of Oral Diseases and National Clinical Research Center for Oral Diseases and Department of Orthodontics, West China Hospital of Stomatology, Sichuan University, No. 14, 3Rd Section of Ren Min Nan Rd., ChengduSichuan, 610041, China
| | - Kaiming Li
- Department of Bioengineering, University of California, 900 University Ave., Riverside, CA, 92507, USA.
| | - Wenli Lai
- State Key Laboratory of Oral Diseases and National Clinical Research Center for Oral Diseases and Department of Orthodontics, West China Hospital of Stomatology, Sichuan University, No. 14, 3Rd Section of Ren Min Nan Rd., ChengduSichuan, 610041, China.
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35
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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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36
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Flowers KM, Patton ME, Hruschak VJ, Fields KG, Schwartz E, Zeballos J, Kang JD, Edwards RR, Kaptchuk TJ, Schreiber KL. Conditioned open-label placebo for opioid reduction after spine surgery: a randomized controlled trial. Pain 2021; 162:1828-1839. [PMID: 33449503 PMCID: PMC8378225 DOI: 10.1097/j.pain.0000000000002185] [Citation(s) in RCA: 12] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/05/2020] [Accepted: 12/31/2020] [Indexed: 12/19/2022]
Abstract
ABSTRACT Placebo effects have traditionally involved concealment or deception. However, recent evidence suggests that placebo effects can also be elicited when prescribed transparently as "open-label placebos" (OLPs), and that the pairing of an unconditioned stimulus (eg, opioid analgesic) with a conditioned stimulus (eg, placebo pill) can lead to the conditioned stimulus alone reducing pain. In this randomized control trial, we investigated whether combining conditioning with an OLP (COLP) in the immediate postoperative period could reduce daily opioid use and postsurgical pain among patients recovering from spine surgery. Patients were randomized to COLP or treatment as usual, with both groups receiving unrestricted access to a typical opioid-based postoperative analgesic regimen. The generalized estimating equations method was used to assess the treatment effect of COLP on daily opioid consumption and pain during postoperative period from postoperative day (POD) 1 to POD 17. Patients in the COLP group consumed approximately 30% less daily morphine milligram equivalents compared with patients in the treatment as usual group during POD 1 to 17 (-14.5 daily morphine milligram equivalents; 95% CI: [-26.8, -2.2]). Daily worst pain scores were also lower in the COLP group (-1.0 point on the 10-point scale; 95% CI: [-2.0, -0.1]), although a significant difference was not detected in average daily pain between the groups (-0.8 point; 95% CI: [-1.7, 0.2]). These findings suggest that COLP may serve as a potential adjuvant analgesic therapy to decrease opioid consumption in the early postoperative period, without increasing pain.
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Affiliation(s)
- Kelsey M. Flowers
- Departments of Anesthesiology, Perioperative, and Pain Medicine Orthopedic Surgery, Brigham and Women’s Hospital, Harvard Medical School, Boston, MA, United States
| | - Megan E. Patton
- Departments of Anesthesiology, Perioperative, and Pain Medicine Orthopedic Surgery, Brigham and Women’s Hospital, Harvard Medical School, Boston, MA, United States
| | - Valerie J. Hruschak
- Departments of Anesthesiology, Perioperative, and Pain Medicine Orthopedic Surgery, Brigham and Women’s Hospital, Harvard Medical School, Boston, MA, United States
| | - Kara G. Fields
- Departments of Anesthesiology, Perioperative, and Pain Medicine Orthopedic Surgery, Brigham and Women’s Hospital, Harvard Medical School, Boston, MA, United States
| | - Emily Schwartz
- Departments of Anesthesiology, Perioperative, and Pain Medicine Orthopedic Surgery, Brigham and Women’s Hospital, Harvard Medical School, Boston, MA, United States
| | - Jose Zeballos
- Departments of Anesthesiology, Perioperative, and Pain Medicine Orthopedic Surgery, Brigham and Women’s Hospital, Harvard Medical School, Boston, MA, United States
| | - James D. Kang
- Departments of Orthopedic Surgery, Brigham and Women’s Hospital, Harvard Medical School, Boston, MA, United States
| | - Rob R. Edwards
- Departments of Anesthesiology, Perioperative, and Pain Medicine Orthopedic Surgery, Brigham and Women’s Hospital, Harvard Medical School, Boston, MA, United States
| | - Ted J. Kaptchuk
- Program in Placebo Studies and Therapeutic Encounter, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, MA, United States
| | - Kristin L. Schreiber
- Departments of Anesthesiology, Perioperative, and Pain Medicine Orthopedic Surgery, Brigham and Women’s Hospital, Harvard Medical School, Boston, MA, United States
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Elliott BL, D'Ardenne K, Mukherjee P, Schweitzer JB, McClure SM. Limbic and Executive Meso- and Nigrostriatal Tracts Predict Impulsivity Differences in Attention-Deficit/Hyperactivity Disorder. BIOLOGICAL PSYCHIATRY: COGNITIVE NEUROSCIENCE AND NEUROIMAGING 2021; 7:415-423. [PMID: 34051394 DOI: 10.1016/j.bpsc.2021.05.002] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 01/18/2021] [Revised: 04/22/2021] [Accepted: 05/17/2021] [Indexed: 11/27/2022]
Abstract
BACKGROUND Impulsivity is a defining characteristic of attention-deficit/hyperactivity disorder (ADHD), which has been associated with substance use disorders, higher accident rates, and lower educational and occupational outcomes. The meso- and nigrostriatal pathways of the dopamine system are hypothesized to be functionally heterogeneous, supporting diverse cognitive functions and impairments, including those associated with ADHD. We tested whether human midbrain pathways (where dopaminergic cell bodies originate) between the substantia nigra (SN) and ventral tegmental area (VTA) and the striatum differed between participants with ADHD and typically developing adolescent and young adult participants. We also assessed whether pathway connectivity predicted impulsivity regardless of diagnosis. METHODS Diffusion tensor imaging data were used to predict impulsivity (parent and self-report ratings, task-based behavioral measures) from participants with ADHD and typically developing adolescent and young adult participants (n = 155; 86 male, 69 female). Using probabilistic tractography, we mapped these pathways and divided the tracts into limbic, executive, and sensorimotor based on frontostriatal connectivity. ADHD and typically developing participants differed on all behavioral measures of impulsivity. We used correlation and machine learning analyses to test for a relationship between tract probabilities and impulsivity regardless of diagnosis. RESULTS Participants with ADHD had stronger structural connectivity between SN/VTA regions and the limbic striatum, weaker connectivity with the executive striatum, and no significant differences in sensorimotor tracts. Increased tract integrity between the limbic striatal and SN/VTA regions predicted greater impulsivity, while increased integrity between executive striatal and SN/VTA regions predicted reduced impulsivity. CONCLUSIONS These findings support the theory that functional diversity in the dopamine system is an important consideration for understanding dysfunction in ADHD.
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Affiliation(s)
- Blake L Elliott
- Department of Psychology, Arizona State University, Tempe, Arizona.
| | | | - Prerona Mukherjee
- Department of Psychiatry and Behavioral Sciences, University of California, Davis, Sacramento, California; MIND Institute, University of California, Davis, Sacramento, California
| | - Julie B Schweitzer
- Department of Psychiatry and Behavioral Sciences, University of California, Davis, Sacramento, California; MIND Institute, University of California, Davis, Sacramento, California
| | - Samuel M McClure
- Department of Psychology, Arizona State University, Tempe, Arizona
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38
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Sevel L, Boissoneault J, Alappattu M, Bishop M, Robinson M. Training endogenous pain modulation: a preliminary investigation of neural adaptation following repeated exposure to clinically-relevant pain. Brain Imaging Behav 2021; 14:881-896. [PMID: 30617786 DOI: 10.1007/s11682-018-0033-8] [Citation(s) in RCA: 13] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/11/2022]
Abstract
Analgesic treatments that aim to eliminate pain display marginal success in relieving chronic pain and may increase pain vulnerability. Repeated exposure to pain may result in increased pain modulation via engagement of anti-nociceptive brain regions. It was hypothesized that repeated exposure to delayed onset muscle soreness (DOMS) would result in increased pain modulatory capacity (PMC) via functional neural adaptation. 23 healthy participants completed Baseline and Follow Up resting-state fMRI and quantitative sensory testing (QST) visits 40 days apart. Participants were randomized to two groups: A Repeated DOMS Group (RD Group) that received four, weekly DOMS inductions and a Control Group that received one baseline induction. Daily pain ratings were collected for seven days post-induction, as were quantitative sensory testing (QST) metrics at baseline and Follow Up. Regional functional connectivity (FC) was estimated among areas involved in pain modulation. Seed and network FC was estimated among areas involved in pain modulation and sensory processing. Changes in FC were compared between groups. The RD Group displayed significant reductions in post-DOMS pain ratings and significant changes in thermal QST measures. RD Group participants displayed greater adaptation in nucleus accumbens-medial prefrontal cortex (NAc-mPFC) FC and in sensorimotor network (SMN) connectivity with the dorsomedial, ventromedial, and rostromedial prefrontal cortices. Changes in SMN-PFC connectivity correlated with reductions in post-DOMS affective distress. Results suggest that repeated exposure to clinically-relevant pain results in adaptations among brain regions involved in pain modulation. Repeated exposure to clinically-relevant pain may serve as a mechanism to increase PMC via inhibition of emotional valuation of painful stimuli.
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Affiliation(s)
- Landrew Sevel
- Osher Center for Integrative Medicine at Vanderbilt, Department of Physical Medicine & Rehabilitation, Vanderbilt University Medical Center, Suite 380, 3401 West End Avenue, Nashville, TN, 37203, USA.
| | - Jeff Boissoneault
- Department of Clinical and Health Psychology, University of Florida, Gainesville, FL, USA
| | - Meryl Alappattu
- Department of Physical Therapy, University of Florida, Gainesville, FL, USA
| | - Mark Bishop
- Department of Physical Therapy, University of Florida, Gainesville, FL, USA
| | - Michael Robinson
- Department of Clinical and Health Psychology, University of Florida, Gainesville, FL, USA
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39
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Expressive suppression to pain in others reduces negative emotion but not vicarious pain in the observer. COGNITIVE AFFECTIVE & BEHAVIORAL NEUROSCIENCE 2021; 21:292-310. [PMID: 33759062 DOI: 10.3758/s13415-021-00873-1] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Accepted: 01/31/2021] [Indexed: 01/01/2023]
Abstract
Although there are situations where it may be appropriate to reduce one's emotional response to the pain of others, the impact of an observer's emotional expressivity on their response to pain in others is still not well understood. In the present study, we examined how the emotion regulation strategy expressive suppression influences responses to pain in others. Based on prior research findings on expressive suppression and pain empathy, we hypothesized that expressive suppression to pain expression faces would reduce neural representations of negative emotion, vicarious pain, or both. To test this, we applied two multivariate pattern analysis (MVPA)-derived neural signatures to our data, the Picture Induced Negative Emotion Signature (PINES; Chang, Gianaros, Manuck, Krishnan, and Wager (2015)) and a neural signature of facial expression induced vicarious pain (Zhou et al., 2020). In a sample of 60 healthy individuals, we found that viewing pain expression faces increased neural representations of negative emotion and vicarious pain. However, expressive suppression to pain faces reduced neural representations of negative emotion only. Providing support for a connection between neural representations of negative emotion and pain empathy, PINES responses to pain faces were associated with participants' trait-level empathy and the perceived unpleasantness of pain faces. Findings suggest that a consequence of suppressing one's facial expressions in response to the pain of others may be a reduction in the affective aspect of empathy but not the experience of vicarious pain itself.
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40
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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] [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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41
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Jolly E, Chang LJ. Multivariate spatial feature selection in fMRI. Soc Cogn Affect Neurosci 2021; 16:795-806. [PMID: 33501987 PMCID: PMC8343556 DOI: 10.1093/scan/nsab010] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/22/2020] [Revised: 09/16/2020] [Accepted: 01/25/2021] [Indexed: 01/20/2023] Open
Abstract
Multivariate neuroimaging analyses constitute a powerful class of techniques to identify psychological representations. However, not all psychological processes are represented at the same spatial scale throughout the brain. This heterogeneity is apparent when comparing hierarchically organized local representations of perceptual processes to flexible transmodal representations of more abstract cognitive processes such as social and affective operations. An open question is how the spatial scale of analytic approaches interacts with the spatial scale of the representations under investigation. In this article, we describe how multivariate analyses can be viewed as existing on a spatial spectrum, anchored by searchlights used to identify locally distributed patterns of information on one end, whole brain approach used to identify diffuse neural representations at the other and region-based approaches in between. We describe how these distinctions are an important and often overlooked analytic consideration and provide heuristics to compare these different techniques to choose based on the analyst’s inferential goals.
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Affiliation(s)
- E Jolly
- Computational Social Affective Neuroscience Laboratory, Department of Psychological and Brain Science, Dartmouth College, Hanover, NH 03755, USA
| | - L J Chang
- Computational Social Affective Neuroscience Laboratory, Department of Psychological and Brain Science, Dartmouth College, Hanover, NH 03755, USA
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42
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Lee JJ, Kim HJ, Čeko M, Park BY, Lee SA, Park H, Roy M, Kim SG, Wager TD, Woo CW. A neuroimaging biomarker for sustained experimental and clinical pain. Nat Med 2021; 27:174-182. [PMID: 33398159 DOI: 10.1038/s41591-020-1142-7] [Citation(s) in RCA: 85] [Impact Index Per Article: 28.3] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/12/2020] [Accepted: 10/19/2020] [Indexed: 12/22/2022]
Abstract
Sustained pain is a major characteristic of clinical pain disorders, but it is difficult to assess in isolation from co-occurring cognitive and emotional features in patients. In this study, we developed a functional magnetic resonance imaging signature based on whole-brain functional connectivity that tracks experimentally induced tonic pain intensity and tested its sensitivity, specificity and generalizability to clinical pain across six studies (total n = 334). The signature displayed high sensitivity and specificity to tonic pain across three independent studies of orofacial tonic pain and aversive taste. It also predicted clinical pain severity and classified patients versus controls in two independent studies of clinical low back pain. Tonic and clinical pain showed similar network-level representations, particularly in somatomotor, frontoparietal and dorsal attention networks. These patterns were distinct from representations of experimental phasic pain. This study identified a brain biomarker for sustained pain with high potential for clinical translation.
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Affiliation(s)
- Jae-Joong Lee
- Center for Neuroscience Imaging Research, Institute for Basic Science, Suwon, South Korea.,Department of Biomedical Engineering, Sungkyunkwan University, Suwon, South Korea
| | - Hong Ji Kim
- Center for Neuroscience Imaging Research, Institute for Basic Science, Suwon, South Korea.,Department of Biomedical Engineering, Sungkyunkwan University, Suwon, South Korea
| | - Marta Čeko
- Institute of Cognitive Science, University of Colorado, Boulder CO, USA.,Department of Psychology and Neuroscience, University of Colorado, Boulder CO, USA
| | - Bo-Yong Park
- Center for Neuroscience Imaging Research, Institute for Basic Science, Suwon, South Korea.,McConnell Brain Imaging Centre, Montreal Neurological institute and Hospital, McGill University, Montreal, QC, Canada
| | - Soo Ahn Lee
- Center for Neuroscience Imaging Research, Institute for Basic Science, Suwon, South Korea.,Department of Biomedical Engineering, Sungkyunkwan University, Suwon, South Korea
| | - Hyunjin Park
- Center for Neuroscience Imaging Research, Institute for Basic Science, Suwon, South Korea.,School of Electronic and Electrical Engineering, Sungkyunkwan University, Suwon, South Korea
| | - Mathieu Roy
- Department of Psychology, McGill University, Montreal, QC, Canada.,Alan Edwards Centre for Research on Pain, McGill University, Montreal, QC, Canada
| | - Seong-Gi Kim
- Center for Neuroscience Imaging Research, Institute for Basic Science, Suwon, South Korea.,Department of Biomedical Engineering, Sungkyunkwan University, Suwon, South Korea
| | - Tor D Wager
- Department of Psychological and Brain Sciences, Dartmouth College, Hanover NH, USA.
| | - Choong-Wan Woo
- Center for Neuroscience Imaging Research, Institute for Basic Science, Suwon, South Korea. .,Department of Biomedical Engineering, Sungkyunkwan University, Suwon, South Korea. .,Biomedical Institute for Convergence at SKKU, Sungkyunkwan University, Suwon, South Korea. .,Department of Intelligent Precision Healthcare Convergence, Sungkyunkwan University, Suwon, Korea.
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43
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Duan L, Van Dam NT, Ai H, Xu P. Intrinsic organization of cortical networks predicts state anxiety: an functional near-infrared spectroscopy (fNIRS) study. Transl Psychiatry 2020; 10:402. [PMID: 33219215 PMCID: PMC7679458 DOI: 10.1038/s41398-020-01088-7] [Citation(s) in RCA: 12] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/08/2020] [Revised: 10/04/2020] [Accepted: 10/29/2020] [Indexed: 12/22/2022] Open
Abstract
Although state anxiety has been characterized by hyper-responsive subcortical activity and its bottom-up connectivity with cortical regions, the role of cortical networks in state anxiety is not yet well understood. To this end, we decoded individual state anxiety by using a machine-learning approach based on resting-state functional connectivity (RSFC) with functional near-infrared spectroscopy (fNIRS). Our results showed that the RSFC among a set of cortical networks were highly predictive of state anxiety, rather than trait anxiety. Specifically, these networks included connectivity between cortical areas in the default mode network (DMN) and dorsal attention network (DAN), and connectivity within the DMN, which were negatively correlated with state anxiety; connectivity between cortical areas in the DMN and frontoparietal network (FPN), FPN and salience network (SN), FPN and DAN, DMN and SN, which were positively correlated with state anxiety. These findings suggest a predictive role of intrinsic cortical organization in the assessment of state anxiety. The work provides new insights into potential neural mechanisms of emotion states and implications for prognosis, diagnosis, and treatment of affective disorders.
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Affiliation(s)
- Lian Duan
- Shenzhen Key Laboratory of Affective and Social Neuroscience, Magnetic Resonance Imaging Center, Center for Brain Disorders and Cognitive Sciences, Shenzhen University, Shenzhen, China
| | - Nicholas T Van Dam
- School of Psychological Sciences, University of Melbourne, Melbourne, Australia
- Department of Psychiatry, Icahn School of Medicine at Mount Sinai, New York, New York, USA
| | - Hui Ai
- Shenzhen Key Laboratory of Affective and Social Neuroscience, Magnetic Resonance Imaging Center, Center for Brain Disorders and Cognitive Sciences, Shenzhen University, Shenzhen, China.
| | - Pengfei Xu
- Beijing Key Laboratory of Applied Experimental Psychology, Faculty of Psychology, Beijing Normal University, Beijing, China.
- Center for Neuroimaging, Shenzhen Institute of Neuroscience, Shenzhen, China.
- Guangdong-Hong Kong-Macao Greater Bay Area Research Institute for Neuroscience and Neurotechnologies, Kwun Tong, Hong Kong, China.
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44
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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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45
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Maity S, Priyadharshini V, Basavaraju S. A comparative evaluation of propolis and light-cured ormocer-based desensitizer in reducing dentin hypersensitivity. J Indian Soc Periodontol 2020; 24:441-446. [PMID: 33144772 PMCID: PMC7592609 DOI: 10.4103/jisp.jisp_500_19] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/25/2019] [Revised: 01/30/2020] [Accepted: 02/06/2020] [Indexed: 11/04/2022] Open
Abstract
Objectives The purpose of the study was to evaluate and compare the clinical efficacy and the durability of propolis and Light-cured ormocer-based desensitizer (Admira Protect, Voco: Cuxhaven Germany) in the treatment of dentin hypersensitivity (DH). Materials and Methods The study was conducted over a period of 2 months on 13 patients with 72 hypersensitive teeth, randomly allocated into three treatment groups: Group A: Treated with Propolis, Group B: Admira protect (Voco: Cuxhaven Germany), and Group C: Sterile water (Placebo control). Baseline sensitivity was recorded by the operator using tactile and evaporative stimuli. Visual analog scale (VAS) was used to record the degree of sensitivity perceived by the patients. All the groups received applications of allotted materials on day 1, 7, 14, and 21. After each applications VAS scoring was recorded. On day 30 and 60, only pain evaluation was done to determine the durability of each test materials. Statistical Analysis One-way ANOVA, repeated measure ANOVA and post hoc test was done for multiple comparison. Results All the groups showed significant results in reducing DH. Among Groups A and B, Group B showed immediate postoperative result at the end of the 1st week. Conclusion Both the test materials were effective in reducing DH but Admira protect was found to be more efficient in reducing pain with longer duration of action (CTRI regd no: CTRI/2017/12/010755).
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Affiliation(s)
- Snigdha Maity
- Department of Periodontology, JSS Dental College and Hospital, Mysuru, Karnataka, India
| | - Vidya Priyadharshini
- Department of Periodontology, JSS Dental College and Hospital, Mysuru, Karnataka, India
| | - Suman Basavaraju
- Department of Periodontology, JSS Dental College and Hospital, Mysuru, Karnataka, India
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Yu S, Xie M, Liu S, Guo X, Tian J, Wei W, Zhang Q, Zeng F, Liang F, Yang J. Resting-State Functional Connectivity Patterns Predict Acupuncture Treatment Response in Primary Dysmenorrhea. Front Neurosci 2020; 14:559191. [PMID: 33013312 PMCID: PMC7506136 DOI: 10.3389/fnins.2020.559191] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/29/2020] [Accepted: 08/14/2020] [Indexed: 12/13/2022] Open
Abstract
Primary dysmenorrhea (PDM) is a common complaint in women throughout the menstrual years. Acupuncture has been shown to be effective in dysmenorrhea; however, there are large interindividual differences in patients’ responses to acupuncture treatment. Fifty-four patients with PDM were recruited and randomized into real or sham acupuncture treatment groups (over the course of three menstrual cycles). Pain-related functional connectivity (FC) matrices were constructed at baseline and post-treatment period. The different neural mechanisms altered by real and sham acupuncture were detected with multivariate analysis of variance. Multivariate pattern analysis (MVPA) based on a machine learning approach was used to explore whether the different FC patterns predicted the acupuncture treatment response in the PDM patients. The results showed that real but not sham acupuncture significantly relieved pain severity in PDM patients. Real and sham acupuncture displayed differences in FC alterations between the descending pain modulatory system (DPMS) and sensorimotor network (SMN), the salience network (SN) and SMN, and the SN and default mode network (DMN). Furthermore, MVPA found that these FC patterns at baseline could predict the acupuncture treatment response in PDM patients. The present study verified differentially altered brain mechanisms underlying real and sham acupuncture in PDM patients and supported the use of neuroimaging biomarkers for individual-based precise acupuncture treatment in patients with PDM.
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Affiliation(s)
- Siyi Yu
- Brain Research Center, Department of Acupuncture & Tuina, Chengdu University of Traditional Chinese Medicine, Chengdu, China
| | - Mingguo Xie
- Department of Radiology, Hospital of Chengdu University of Traditional Chinese Medicine, Chengdu, China
| | - Shuqin Liu
- Department of Radiology, Hospital of Chengdu University of Traditional Chinese Medicine, Chengdu, China
| | - Xiaoli Guo
- Brain Research Center, Department of Acupuncture & Tuina, Chengdu University of Traditional Chinese Medicine, Chengdu, China
| | - Jin Tian
- Brain Research Center, Department of Acupuncture & Tuina, Chengdu University of Traditional Chinese Medicine, Chengdu, China
| | - Wei Wei
- Brain Research Center, Department of Acupuncture & Tuina, Chengdu University of Traditional Chinese Medicine, Chengdu, China
| | - Qi Zhang
- Brain Research Center, Department of Acupuncture & Tuina, Chengdu University of Traditional Chinese Medicine, Chengdu, China
| | - Fang Zeng
- Brain Research Center, Department of Acupuncture & Tuina, Chengdu University of Traditional Chinese Medicine, Chengdu, China
| | - Fanrong Liang
- Brain Research Center, Department of Acupuncture & Tuina, Chengdu University of Traditional Chinese Medicine, Chengdu, China
| | - Jie Yang
- Brain Research Center, Department of Acupuncture & Tuina, Chengdu University of Traditional Chinese Medicine, Chengdu, China
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Hartmann H, Rütgen M, Riva F, Lamm C. Another's pain in my brain: No evidence that placebo analgesia affects the sensory-discriminative component in empathy for pain. Neuroimage 2020; 224:117397. [PMID: 32971262 DOI: 10.1016/j.neuroimage.2020.117397] [Citation(s) in RCA: 12] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/18/2020] [Revised: 08/04/2020] [Accepted: 09/15/2020] [Indexed: 02/06/2023] Open
Abstract
The shared representations account of empathy suggests that sharing other people's emotions relies on neural processes similar to those engaged when directly experiencing such emotions. Recent research corroborated this by showing that placebo analgesia induced for first-hand pain resulted in reduced pain empathy and decreased activation in shared neural networks. However, those studies did not report any placebo-related variation of somatosensory engagement during pain empathy. The experimental paradigms used in these studies did not direct attention towards a specific body part in pain, which may explain the absence of effects for somatosensation. The main objective of this preregistered study was to implement a paradigm overcoming this limitation, and to investigate whether placebo analgesia may also modulate the sensory-discriminative component of empathy for pain. We induced a localized, first-hand placebo analgesia effect in the right hand of 45 participants by means of a placebo gel and conditioning techniques, and compared this to the left hand as a control condition. Participants underwent a pain task in the MRI scanner, receiving painful or non-painful electrical stimulation on their left or right hand, or witnessing another person receiving such stimulation. In contrast to a robust localized placebo analgesia effect for self-experienced pain, the empathy condition showed no differences between the two hands, neither for behavioral nor neural responses. We thus report no evidence for somatosensory sharing in empathy, while replicating previous studies showing overlapping brain activity in the affective-motivational component for first-hand and empathy for pain. Hence, in a more rigorous test aiming to overcome limitations of previous work, we again find no causal evidence for the engagement of somatosensory sharing in empathy. Our study refines the understanding of the neural underpinnings of empathy for pain, and the use of placebo analgesia in investigating such models.
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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, Liebiggasse 5, 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, Liebiggasse 5, 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, Liebiggasse 5, 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, Liebiggasse 5, 1010 Vienna, Austria.
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Kleine-Borgmann J, Bingel U. Der Placeboeffekt in der Schmerztherapie – für den
klinischen Alltag nutzbar? Ja, unbedingt! AKTUEL RHEUMATOL 2020. [DOI: 10.1055/a-1165-6689] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/23/2022]
Abstract
ZusammenfassungAls Placeboeffekte bezeichnet man positive physiologische oder psychologische
Veränderungen, die nach einer Einnahme von Medikamenten ohne
spezifischen Wirkstoff oder Scheineingriffen auftreten und durch Erwartungs- und
Konditionierungsprozesse induziert werden. Die mit Placeboeffekten
einhergehenden neurobiologischen und peripher-physiologischen Vorgänge
können auch bei der Vergabe von wirkstoffhaltigen Medikamenten eine
wichtige Rolle spielen und sind somit nicht zwingend an die Gabe eines
Scheinmedikamentes gebunden. Die Darreichung von
„traditionellen“ Placebos ist im klinischen Alltag aus
juristischen und ethischen Gründen höchst problematisch. Dieser
Beitrag zeigt neben neuen Erkenntnissen zu offenen Placebo-Anwendungen
(Open-Label Placebos) Wege auf, wie die zugrundeliegenden Mechanismen von
Placeboantworten dennoch gezielt im schmerztherapeutischen Alltag genutzt werden
können, um die Wirksamkeit, Verträglichkeit und Compliance
bestehender pharmakologischer und anderer Therapien zum Wohle des Patienten zu
optimieren.
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Affiliation(s)
| | - Ulrike Bingel
- Klinik für Neurologie, Universitätsmedizin Essen,
Essen
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Rossettini G, Camerone EM, Carlino E, Benedetti F, Testa M. Context matters: the psychoneurobiological determinants of placebo, nocebo and context-related effects in physiotherapy. Arch Physiother 2020; 10:11. [PMID: 32537245 PMCID: PMC7288522 DOI: 10.1186/s40945-020-00082-y] [Citation(s) in RCA: 49] [Impact Index Per Article: 12.3] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/12/2020] [Accepted: 05/25/2020] [Indexed: 12/22/2022] Open
Abstract
Background Placebo and nocebo effects embody psychoneurobiological phenomena where behavioural, neurophysiological, perceptive and cognitive changes occur during the therapeutic encounter in the healthcare context. Placebo effects are produced by a positive healthcare context; while nocebo effects are consequences of negative healthcare context. Historically, placebo, nocebo and context-related effects were considered as confounding elements for clinicians and researchers. In the last two decades this attitude started to change, and the understanding of the value of these effects has increased. Despite the growing interest, the knowledge and the awareness of using the healthcare context to trigger placebo and nocebo effects is currently limited and heterogeneous among physiotherapists, reducing their translational value in the physiotherapy field. Objectives To introduce the placebo, nocebo and context-related effects by: (1) presenting their psychological models; (2) describing their neurophysiological mechanisms; (3) underlining their impact for the physiotherapy profession; and (4) tracing lines for future researches. Conclusion Several psychological mechanisms are involved in placebo, nocebo and context-related effects; including expectation, learning processes (classical conditioning and observational learning), reinforced expectations, mindset and personality traits. The neurophysiological mechanisms mainly include the endogenous opioid, the endocannabinoid and the dopaminergic systems. Neuroimaging studies have identified different brain regions involved such as the dorsolateral prefrontal cortex, the rostral anterior cingulate cortex, the periaqueductal gray and the dorsal horn of spine. From a clinical perspective, the manipulation of the healthcare context with the best evidence-based therapy represents an opportunity to trigger placebo effects and to avoid nocebo effects respecting the ethical code of conduct. From a managerial perspective, stakeholders, organizations and governments should encourage the assessment of the healthcare context aimed to improve the quality of physiotherapy services. From an educational perspective, placebo and nocebo effects are professional topics that should be integrated in the university program of health and medical professions. From a research perspective, the control of placebo, nocebo and context-related effects offers to the scientific community the chance to better measure the impact of physiotherapy on different outcomes and in different conditions through primary studies.
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Affiliation(s)
- Giacomo Rossettini
- Department of Neuroscience, Rehabilitation, Ophtalmology, Genetics, Maternal and Child Health, University of Genova, Campus Universitario di Savona, via Magliotto 2, 17100 Savona, Italy
| | - Eleonora Maria Camerone
- Department of Neuroscience, Rehabilitation, Ophtalmology, Genetics, Maternal and Child Health, University of Genova, Campus Universitario di Savona, via Magliotto 2, 17100 Savona, Italy.,Department of Neuroscience, University of Turin Medical School, Turin, Italy
| | - Elisa Carlino
- Department of Neuroscience, University of Turin Medical School, Turin, Italy
| | - Fabrizio Benedetti
- Department of Neuroscience, University of Turin Medical School, Turin, Italy.,Plateau Rosà Laboratories, Plateau Rosà Laboratories, Zermatt, Switzerland
| | - Marco Testa
- Department of Neuroscience, Rehabilitation, Ophtalmology, Genetics, Maternal and Child Health, University of Genova, Campus Universitario di Savona, via Magliotto 2, 17100 Savona, Italy
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Maximizing placebo response in neurological clinical practice. INTERNATIONAL REVIEW OF NEUROBIOLOGY 2020; 153:71-101. [PMID: 32563294 DOI: 10.1016/bs.irn.2020.04.003] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/16/2022]
Abstract
The placebo effect is a widely recognized phenomenon in clinical research, with a negative perception that it could hide the "true" drug effect. In clinical care its positive potential to increase known drug effects has been neglected for too long. The placebo and nocebo responses have been described in many neurologic disorders such as Parkinson's, Huntington's and Alzheimer's diseases, restless leg syndrome, tics, essential tremor, dystonia, functional movement disorders, neuropathic pain, headaches, migraine, amyotrophic lateral sclerosis, myasthenia gravis, chronic inflammatory demyelinating polyneuropathy, multiple sclerosis and epilepsy. Knowledge regarding placebo mechanisms and their consequences on clinical outcome have greatly improved over the last two decades. This evolution has led to reconsiderations of the importance of placebo response in the clinic and has given several clues on how to improve it in daily practice. In this chapter, we first illustrate "why," e.g. the reasons (relevance to clinical practice, help in differential diagnosis/treatment of psychogenic movements, clinical impact, proven neurobiological grounds, health economic potential), and "how," e.g. the means (increase patients' knowledge, increase learning, improve patient-doctor relationship, increase Hawthorne effect, increase positive/decrease negative expectations (the Rosenthal effect), personalize placebo response), the placebo should be maximized (and nocebo avoided) in neurological clinical practice. Future studies regarding more specific neurobiological mechanisms will allow a finer tuning of placebo response in clinical practice. The use of placebo in clinical practice raises ethical issues, and a recent expert consensus regarding placebo use in the clinic is a first step to future guidelines necessary to this field.
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