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Placebo analgesia

Placebo analgesia. Predrag Petrovic, MD, PhD Karolinska Institute, Stockholm, Sweden Wellcome Institute of congnitive Neuroscience, London, UK. Cognition and pain. vlPFC. lObfc. mObfc. vmPfc. Basal ganglia. Basal ganglia. rACC. cACC. Ant Ins. Amy. S1. Post Ins. Hyp . S2 / iPC.

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Placebo analgesia

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  1. Placebo analgesia Predrag Petrovic, MD, PhD Karolinska Institute, Stockholm, Sweden Wellcome Institute of congnitive Neuroscience, London, UK

  2. Cognition and pain

  3. vlPFC lObfc mObfc vmPfc Basal ganglia Basal ganglia rACC cACC Ant Ins Amy S1 Post Ins Hyp S2 / iPC PAG PBn Ret dlPT / LC VMP VPL VPI VMp/b IL MDvc RVM aSTT lSTT SB

  4. Main effect of pain Petrovic et al Science 295 (1737-1740) 2003

  5. Can we feel pain wihout noxious input Jackson et al Neuroimage 771-779 2005

  6. Can we feel pain wihout noxious input Jackson et al Neuroimage 771-779 2005

  7. Anticipation of pain Jensen et al Neuron 40 1251-1257 2003

  8. Empathy for pain Singer et al Science 1157-1152 2004

  9. Empathy for pain vs. Saarelet al Cerebral Cortex 2006

  10. Distraction and pain Petrovic et al Pain 85 (1-2) 2000

  11. ?

  12. Cognitive modulation of pain

  13. Placebo analgesia

  14. Bottlenecks in Placebo analgesia Expectation Opioid system

  15. Treatment expectation and Placebo analgesia Pain presentation Expectation manipulation and learning Placebo manipulation Placebo cream Placebo cream Rating: 75 Rating: 25 Rating: 50 Voundouris et al J Per Soc Psychol 48 (47-53) 1985 Voundouris et al pain 38 (109-116) 1989 Voundouris et al pain 43 (121-128) 1990 Montgomery and Kirsch Pain 72 (107-113) 1997

  16. The Opioid system and Placebo analgesia Opioid analgesia Placebo analgesia - - Naloxone

  17. Placebo and opioid analgesia Non-painful Warrm stim Heat Pain Opioids(remifentanil) wop pop Placebo (saline) ppl wpl No treatment p w Petrovic et al Science 295 (1737-1740) 2003

  18. Pain network Petrovic et al Science 295 (1737-1740) 2003

  19. Opioid effects and Placebo analgesia (POP+WOP)-(P+W) (PPL – P) Petrovic et al Science 295 (1737-1740) 2003

  20. Orbitofrontal cortex (PPL – P) Petrovic et al Science 295 (1737-1740) 2003

  21. Placebo and expectation modulation Kong et al. J Neurosci. 2006 Jan 11;26(2):381-8.

  22. Placebo and expectation modulation Bingel et al. Pain. 2006 Jan;120(1-2):8-15

  23. Placebo and expectation modulation Wager et al. Science. 2004 Feb 20;303(5661):1162-7.

  24. Placebo and expectation modulation Wager et al. Science. 2004 Feb 20;303(5661):1162-7.

  25. Placebo in chronic pain patients Lieberman et al. Neuroimage. 2004 May;22(1):447-55.

  26. Placebo analgesia effect - activation of cognitive modulatory network

  27. ACC and Placebo

  28. Opioid effects and Placebo analgesia Petrovic et al Science 295 (1737-1740) 2003

  29. The Cortical Opioid System Rostral ACC Willoch et al 1999

  30. Opioid analgesia High Placebo responders Low Placebo responders (POP-P) (POP-P) Petrovic et al Science 295 (1737-1740) 2003

  31. Opioid receptor imaging Zubieta et al 2005

  32. Filelds et al Nature NeuroscienceReviews 2004

  33. POP PPL P Regression analysis Petrovic et al Science 295 (1737-1740) 2003

  34. ACC and Cognition - Conflict monitoring or conflict resolution ? Emotional Counting Stroop Counting Stroop Murder Murder Murder Murder Three Three Three Three Bush et a. Trends in Cognitive Sciences 4 (6) 2000

  35. Anterior Cingulate Cortex: • Interaction with cognitive attentional systems that regulate conflicting processes. • Modulation of pain processing through opioid system.

  36. Obfc / vlPFC and Placebo

  37. Placebo. Petrovic et al 2002 Petrovic et al Science 295 (1737-1740) 2003

  38. Opioid effects: Placebo effects:

  39. Opioid effects: Placebo effects:

  40. Relation between rACC and vlPFC in Placebo 1

  41. Orbitofrontal cortex - goals and expectations

  42. Orbitofrontal cortex - goals and expectations

  43. Orbitofrontal cortex - goals and expectations

  44. Aversive temporal difference prediction error Seymour et al Nature Neuroscience 8 (1234-1240) 2005

  45. Anterior Cingulate Cortex: • Interaction with cognitive attentional systems that regulate conflicting processes. • Modulation of pain processing through opioid system. • Orbitofrontal Cortex: • Emotional and motivational goals and expectations. • Computing errors between expected and real outcome.

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