Placebo conditioning and placebo analgesia modulate a common brain network during pain anticipation and perception.
Placebo conditioning and placebo analgesia modulate a common brain network during pain anticipation and perception.
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DOI：
10.1016/j.pain.2009.04.003
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发表时间：
2009-09
期刊：
影响因子：
7.4
通讯作者：
Jones AK
中科院分区：
文献类型：
--
作者：
Watson A;El-Deredy W;Iannetti GD;Lloyd D;Tracey I;Vogt BA;Nadeau V;Jones AK
安慰剂条件反射导致安慰剂镇痛的神经机制尚不清楚。在这项研究中，我们的目的是确定在安慰剂条件反射和随后的安慰剂镇痛过程中激活的大脑结构。我们通过将假治疗与疼痛减轻相关联来诱导安慰剂镇痛，并使用fMRI测量与安慰剂反应的三个阶段相关的大脑活动：假治疗之前，期间和之后，而参与者预期并经历了短暂的激光疼痛。在控制阶段，参与者被明确告知治疗无效。假手术治疗组报告疼痛评分显著降低（p = 0.012）。在安慰剂调节期间，在涉及左背外侧前额叶皮层（DLPFC）、内侧额叶皮层和前中扣带皮层（aMCC）的额-扣带网络中，预期脑活动被调制。在安慰剂镇痛阶段，在预期过程中，通过添加眶额皮质（OFC）来调制相同的区域。然而，在改变疼痛的经验，只有aMCC，中央后回和后扣带回表现出改变活动。在安慰剂调节和安慰剂镇痛阶段的预期过程中调制的共同额叶皮层区域先前已被牵连在安慰剂镇痛。我们的研究结果表明，安慰剂的主要影响来自减少预期的疼痛在安慰剂条件反射，随后维持在安慰剂镇痛。
The neural mechanisms whereby placebo conditioning leads to placebo analgesia remain unclear. In this study we aimed to identify the brain structures activated during placebo conditioning and subsequent placebo analgesia. We induced placebo analgesia by associating a sham treatment with pain reduction and used fMRI to measure brain activity associated with three stages of the placebo response: before, during and after the sham treatment, while participants anticipated and experienced brief laser pain. In the control session participants were explicitly told that the treatment was inactive. The sham treatment group reported a significant reduction in pain rating (p = 0.012). Anticipatory brain activity was modulated during placebo conditioning in a fronto-cingulate network involving the left dorsolateral prefrontal cortex (DLPFC), medial frontal cortex and the anterior mid-cingulate cortex (aMCC). Identical areas were modulated during anticipation in the placebo analgesia phase with the addition of the orbitofrontal cortex (OFC). However, during altered pain experience only aMCC, post-central gyrus and posterior cingulate demonstrated altered activity. The common frontal cortical areas modulated during anticipation in both the placebo conditioning and placebo analgesia phases have previously been implicated in placebo analgesia. Our results suggest that the main effect of placebo arises from the reduction of anticipation of pain during placebo conditioning that is subsequently maintained during placebo analgesia.
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