On April 26, Luana Colloca gave a talk on placebo and nocebo effects in pain research. After her talk, there was a panel discussion featuring:
- Javeria Ali Hashmi, Dalhousie University, Halifax, Nova Scotia, Canada
- Marta Pecina, University of Pittsburgh, US
- Tor Wager, University of Colorado Boulder, US (moderator)
Watch the webinar recording below (and access a written summary of the event here).
Colloca’s talk covered the following:
Expectancies produce positive outcomes and placebo effects in individuals by virtue of anticipations of a benefit and activation of specific endogenous modulatory systems. Based on a well-established proposed conceptual framework, placebo effects will be presented as the product of expectancy mechanisms in which conditioned, verbal, and observational cues are centrally integrated to change behaviors and outcomes. Neuroimaging studies that have capitalized on well-established behavioral paradigms within this framework implicate the dorsolateral prefrontal cortex as a key region in producing these effects. However, expectancies of improvements in real-world settings are often violated. The effects of expectancy violation will be presented along with the brain mechanism implicated in mismatch processing and abolishment of placebo effects. Strategies to harness placebo effects will also be discussed, including the use of dose-extending placebos as well as vasopressin as potential promising adjuvants contributing to the enhancement of placebo effects.
Moreover, providers’ behaviors, environmental cues, and the appearance of medical devices can induce nocebo effects that dramatically influence clinical outcomes in pain patients. The anticipation of negative outcomes engages a complex set of neural circuits along with biochemical changes both in peripheral tissues and in the central nervous system, resulting in the occurrence and/or worsening of clinical pain outcomes.Nocebo effects are formed through anticipation of adverse events, prior unsuccessful therapeutic experiences, and observation of adverse events in others. Knowledge of the mechanisms of nocebo effects can definitely be valuable for daily clinical practice.
Learning objectives:
- To present how placebo and nocebo effects are formed in the context of pain research
- To identify the mechanisms underlying learning and violation of reinforced expectations, with the scope for exploiting knowledge of placebo effects and endogenous pain modulatory systems and minimizing nocebo effects
Want some background reading? See the recent papers under Related Content in the right column of this page. And join the conversation about the webinar on Twitter @PainResForum #PRFWebinar.
See previous PRF webinars here.
