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Getting the pain you expect: mechanisms of placebo, nocebo and reappraisal effects in humans

Abstract

The perception of pain is subject to powerful influences. Understanding how these are mediated at a neuroanatomical and neurobiological level provides us with valuable information that has a direct impact on our ability to harness positive and minimize negative effects therapeutically, as well as optimize clinical trial designs when developing new analgesics. This is particularly relevant for placebo and nocebo effects. New research findings have directly contributed to an increased understanding of how placebo and nocebo effects are produced and what biological and psychological factors influence variances in the magnitude of the effect. The findings have relevance for chronic pain states and other disorders, where abnormal functioning of crucial brain regions might affect analgesic outcome even in the normal therapeutic setting.

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Figure 1: Factors influencing pain perception and the neural basis for endogenous pain modulation, placebo and nocebo effects.
Figure 2: The patient environment.

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Tracey, I. Getting the pain you expect: mechanisms of placebo, nocebo and reappraisal effects in humans. Nat Med 16, 1277–1283 (2010). https://doi.org/10.1038/nm.2229

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