Expectation requires treatment to boost pain relief: An fMRI study
Expectation requires treatment to boost pain relief: An fMRI study
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DOI：
10.1016/j.pain.2013.09.024
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发表时间：
2014-01-01
期刊：
影响因子：
7.4
通讯作者：
Buechel, Christian
中科院分区：
文献类型：
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作者：
Schenk, Lieven A.;Sprenger, Christian;Buechel, Christian
我们在2×2的受试者内设计(开放治疗、隐藏治疗、安慰剂、对照)中，通过结合局部利多卡因/普利洛卡因治疗和预期操作，在行为和神经元水平上调查了局部止痛治疗和治疗期望之间可能相互作用的影响。32名健康受试者接受了辣椒素处理的皮肤上的热痛刺激，并在功能磁共振成像中对他们经历的疼痛进行了评级。这使我们能够在行为和神经元水平上分离药物和预期相关的影响，并测试它们在处理痛苦刺激的过程中是否相互作用。在积极治疗期间，疼痛等级降低，并与前岛叶皮质活动减少有关。开放治疗的疼痛评分低于隐藏治疗，与前岛叶皮质、前扣带回皮质、次级躯体感觉皮质和丘脑的活动减少有关。交互作用测试显示，与非治疗条件相比，积极治疗条件下的期望效应明显更大，并与前岛叶皮质、前扣带回皮质和腹侧纹状体的信号变化有关。总而言之，这项研究表明，即使在局部止痛剂的情况下，期望与治疗在与安慰剂相关的大脑区域的疼痛评级和神经元反应水平上也是相互作用的。我们的结果与临床高度相关，因为它们表明(I)期望可以促进治疗，(Ii)期望和治疗并不一定像安慰剂对照临床试验中假设的那样是相加的。(C)2013年国际疼痛研究协会。爱思唯尔出版，版权所有。
We investigated the effect of a possible interaction between topical analgesic treatment and treatment expectation on pain at the behavioral and neuronal level by combining topical lidocaine/prilocaine treatment with an expectancy manipulation in a 2 by 2 within-subject design (open treatment, hidden treatment, placebo, control). Thirty-two healthy subjects received heat pain stimuli on capsaicin-pretreated skin and rated their experienced pain during functional magnetic resonance imaging. This allowed us to separate drug-and expectancy-related effects at the behavioral and neuronal levels and to test whether they interact during the processing of painful stimuli. Pain ratings were reduced during active treatment and were associated with reduced activity in the anterior insular cortex. Pain ratings were lower in open treatment compared with hidden treatment and were related to reduced activity in the anterior insular cortex, the anterior cingulate cortex, the secondary somatosensory cortex, and the thalamus. Testing for an interaction revealed that the expectation effect was significantly larger in the active treatment conditions compared with the no-treatment conditions and was associated with signal changes in the anterior insular cortex, the anterior cingulate cortex, and the ventral striatum. In conclusion, this study shows that even in the case of a topical analgesic, expectation interacts with treatment at the level of pain ratings and neuronal responses in placebo-related brain regions. Our results are highly relevant in the clinical context as they show (i) that expectation can boost treatment and (ii) that expectation and treatment are not necessarily additive as assumed in placebo-controlled clinical trials. (C) 2013 International Association for the Study of Pain. Published by Elsevier B.V. All rights reserved.