Specifying the non-specific factors underlying opioid analgesia: expectancy, attention, and affect

Atlas, Lauren Y.; Wielgosz, Joseph; Whittington, Robert A.; Wager, Tor D.

doi:10.1007/s00213-013-3296-1

Cited by 42 publications

(39 citation statements)

References 48 publications

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“…The findings of this meta-analysis extend previous metaanalyses in which the pain-reducing effects of verbal suggestion and conditioning were studied in the context of placebo effects 80,81 and a meta-analysis and systematic reviews in which the pain-reducing effects of imagery were studied, 66,67,79 by directly comparing the effects of these expectation inductions, while focusing on brief interventions in clinical samples. The observed medium to large effects of verbal suggestion on experimentally evoked and acute procedural pain were generally in line with the findings of a previous meta-analysis 81 and more recent studies in healthy participants, 5,53,76 which supports the transferability of findings from healthy to clinical samples. In contrast, the effects of verbal suggestion on chronic pain were found to be small, possibly because of repeated negative treatment experiences in the past and consequently more negative expectations regarding pain treatment in general that cannot be easily molded by a brief verbal suggestion.…”

Section: Discussionsupporting

confidence: 88%

Relieving patients' pain with expectation interventions

Peerdeman

Laarhoven

Keij

et al. 2016

Pain

202

159

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Patients' expectations are important predictors of the outcome of analgesic treatments, as demonstrated predominantly in research on placebo effects. Three commonly investigated interventions that have been found to induce expectations (verbal suggestion, conditioning, and mental imagery) entail promising, brief, and easy-to-implement adjunctive procedures for optimizing the effectiveness of analgesic treatments. However, evidence for their efficacy stems mostly from research on experimentally evoked pain in healthy samples, and these findings might not be directly transferable to clinical populations. The current meta-analysis investigated the effects of these expectation inductions on patients' pain relief. Five bibliographic databases were systematically searched for studies that assessed the effects of brief verbal suggestion, conditioning, or imagery interventions on pain in clinical populations, with patients experiencing experimental, acute procedural, or chronic pain, compared with no treatment or control treatment. Of the 15,955 studies retrieved, 30 met the inclusion criteria, of which 27 provided sufficient data for quantitative analyses. Overall, a medium-sized effect of the interventions on patients' pain relief was observed (Hedges g = 0.61, I = 73%), with varying effects of verbal suggestion (k = 18, g = 0.75), conditioning (always paired with verbal suggestion, k = 3, g = 0.65), and imagery (k = 6, g = 0.27). Subset analyses indicated medium to large effects on experimental and acute procedural pain and small effects on chronic pain. In conclusion, patients' pain can be relieved with expectation interventions; particularly, verbal suggestion for acute procedural pain was found to be effective.

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Section: Discussionsupporting

confidence: 88%

Relieving patients' pain with expectation interventions

Peerdeman

Laarhoven

Keij

et al. 2016

Pain

202

159

View full text Add to dashboard Cite

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“…Additionally, six parameters generated during motion correction were entered as covariates. In the first GLM, market value r t was entered as parametric regressors at the fifth regressor (market price reveal of rounds [2][3][4][5][6][7][8][9][10][11][12][13][14][15][16][17][18][19]; in the second GLM, reward prediction error TD t was entered as parametric regressors at the fifth regressor (market price reveal of rounds 2-19). Regressors were orthogonalized in a standard SPM8 fashion.…”

Section: Behavioral Data Analysismentioning

confidence: 99%

“…These treatment effects are putatively accomplished by neurobiological processes usually associated with pharmacological actions of active drugs, even though active drugs are not administered (10)(11)(12)(13)(14). Interestingly, beliefs also directly impact behavioral (15)(16)(17)(18)(19)(20) and neurophysiological (21-26) responses when addictive drugs are administered. Drug dependence is a learned process in which cognitive factors are critical (2,5,(27)(28)(29)(30).…”

mentioning

confidence: 99%

Belief about nicotine selectively modulates value and reward prediction error signals in smokers

Lohrenz

Salas

et al. 2015

Proc. Natl. Acad. Sci. U.S.A.

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Little is known about how prior beliefs impact biophysically described processes in the presence of neuroactive drugs, which presents a profound challenge to the understanding of the mechanisms and treatments of addiction. We engineered smokers' prior beliefs about the presence of nicotine in a cigarette smoked before a functional magnetic resonance imaging session where subjects carried out a sequential choice task. Using a model-based approach, we show that smokers' beliefs about nicotine specifically modulated learning signals (value and reward prediction error) defined by a computational model of mesolimbic dopamine systems. Belief of "no nicotine in cigarette" (compared with "nicotine in cigarette") strongly diminished neural responses in the striatum to value and reward prediction errors and reduced the impact of both on smokers' choices. These effects of belief could not be explained by global changes in visual attention and were specific to value and reward prediction errors. Thus, by modulating the expression of computationally explicit signals important for valuation and choice, beliefs can override the physical presence of a potent neuroactive compound like nicotine. These selective effects of belief demonstrate that belief can modulate modelbased parameters important for learning. The implications of these findings may be far ranging because belief-dependent effects on learning signals could impact a host of other behaviors in addiction as well as in other mental health problems.O ne materialist view of mental function suggests that even the most abstract beliefs can be represented in terms of physiological states available to the brain (1). These mappings are critical in conditions like drug addiction, where our ignorance of how prior beliefs about drugs influence physiological processes related to drugs of abuse presents a profound challenge to the understanding of the mechanism and treatment of addiction (2, 3). Although extensive work has shown that addictive drugs act on the mesolimbic dopaminergic (DA) pathway (2, 4), it has become clear that these purely biochemical explanations are not sufficient to account for the huge heterogeneity among drug-dependent individuals and the low success rate of quitting and remaining drug-free (2, 5) and that cognitive factors such as beliefs and expectations have a profound impact on drug-related neurobiological effects (6, 7).Beliefs are known to contribute to the placebo effect. The placebo effect is a treatment effect not caused by the physical presence of an active drug, but rather by the meaning ascribed to it and the subjective expectation of receiving a treatment (8, 9). A subject's belief that he or she is receiving a treatment could lead to observable improvement even in the absence of active drugs. These treatment effects are putatively accomplished by neurobiological processes usually associated with pharmacological actions of active drugs, even though active drugs are not administered (10-14). Interestingly, beliefs also directly impact behavioral...

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“…While individual fluctuations in the moment-to-moment experience can shape pain [47], we also learn to continuously anticipate impending noxious sensory events through associative learning processes [4; 5; 45; 46; 54]. Repeated pairings between contextual cues and subsequent sensory events shape our perceptual framework [4].…”

Section: Introductionmentioning

confidence: 99%

Brain mechanisms supporting violated expectations of pain

Zeidan¹,

Lobanov²,

Kraft

et al. 2015

Pain

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The subjective experience of pain is influenced by interactions between prior experiences, future predictions and incoming afferent information. Expectations of high pain can exacerbate pain while expectations of low pain during a consistently noxious stimulus can produce significant reductions in pain. However, the brain mechanisms associated with processing mismatches between expected and experienced pain are poorly understood, but are important for imparting salience to a sensory event in order to override erroneous top-down expectancy-mediated information. The present investigation examined pain-related brain activation when expectations of pain were abruptly violated. After conditioning participants to cues predicting low or high pain, ten incorrectly cued stimuli were administered across 56 stimulus trials to determine if expectations would be less influential on pain when there is a high discordance between pre-stimulus cues and corresponding thermal stimulation. Incorrectly cued stimuli produced pain ratings and pain-related brain activation consistent with placebo analgesia, nocebo hyperalgesia, and violated expectations. Violated expectations of pain were associated with activation in distinct regions of the inferior parietal lobe, including the supramarginal and angular gyrus, and intraparietal sulcus, the superior parietal lobe, cerebellum and occipital lobe. Thus, violated expectations of pain engage mechanisms supporting salience-driven sensory discrimination, working memory, and associative learning processes. By overriding the influence of expectations on pain, these brain mechanisms are likely engaged in clinical situations where patients’ unrealistic expectations for pain relief diminish the efficacy of pain treatments. Accordingly, these findings underscore the importance of maintaining realistic expectations to augment the effectiveness of pain management.

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Specifying the non-specific factors underlying opioid analgesia: expectancy, attention, and affect

Cited by 42 publications

References 48 publications

Relieving patients' pain with expectation interventions

Relieving patients' pain with expectation interventions

Belief about nicotine selectively modulates value and reward prediction error signals in smokers

Brain mechanisms supporting violated expectations of pain

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