The importance of context: When relative relief renders pain pleasant

Leknes, Siri; Berna, Chantal; Lee, Michael C.; Snyder, Gregory D.; Biele, Guido; Tracey, Irene

doi:10.1016/j.pain.2012.11.018

Cited by 151 publications

(149 citation statements)

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“…Relief from pain can induce a pleasant experience underpinned by activation of reward neurocircuitry (2)(3)(4). Moreover, a painful stimulus can even be perceived as pleasant when it represents relief from a more severe outcome (5). In line with this pain-pleasure link, placebo analgesia can be conceptualized as a type of reward mechanism; pain relief is a better outcome than the alternative (6)(7)(8) and is typically framed as a gain (improvement of pain) (9).…”

mentioning

confidence: 99%

Placebo improves pleasure and pain through opposite modulation of sensory processing

Ellingsen

Wessberg

Eikemo

et al. 2013

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

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Placebo analgesia is often conceptualized as a reward mechanism. However, by targeting only negative experiences, such as pain, placebo research may tell only half the story. We compared placebo improvement of painful touch (analgesia) with placebo improvement of pleasant touch (hyperhedonia) using functional MRI and a crossover design. Somatosensory processing was decreased during placebo analgesia and increased during placebo hyperhedonia. Both placebo responses were associated with similar patterns of activation increase in circuitry involved in emotion appraisal, including the pregenual anterior cingulate, medial orbitofrontal cortex, amygdala, accumbens, and midbrain structures. Importantly, placebo-induced coupling between the ventromedial prefrontal cortex and periaqueductal gray correlated with somatosensory decreases to painful touch and somatosensory increases to pleasant touch. These findings suggest that placebo analgesia and hyperhedonia are mediated by activation of shared emotion appraisal neurocircuitry, which down-or upregulates early sensory processing, depending on whether the expectation is reduced pain or increased pleasure.expectancy | neuroimaging | hedonic feelings M edical treatments aim to provide relief from pain and aversive states. Consequently, research on placebo effects has focused on relief of negative hedonic feelings, like pain and displeasure (1). In contrast, placebo improvement of positive hedonics has received little attention. However, pain and pleasure processes are tightly linked. Relief from pain can induce a pleasant experience underpinned by activation of reward neurocircuitry (2-4). Moreover, a painful stimulus can even be perceived as pleasant when it represents relief from a more severe outcome (5). In line with this pain-pleasure link, placebo analgesia can be conceptualized as a type of reward mechanism; pain relief is a better outcome than the alternative (6-8) and is typically framed as a gain (improvement of pain) (9).Like pain, pleasure is greatly affected by context and expectation (10). Manipulation of people's beliefs about the price of a wine (11), the amount of fruit in a sweet drink (12), the richness of a skin cream (13), and who is caressing them (14) alters the experienced pleasantness of these stimuli.Placebo-induced improvement of aversive experiences (e.g., pain, anxiety, unpleasant taste) is often underpinned by a decrease in central sensory processing. Placebo analgesia is characterized by decreases in the thalamus, posterior insula (pINS), and primary and secondary somatosensory areas (SI and SII) (15)(16)(17). Placebo reduction of affective responses to unpleasant visual stimuli is similarly underpinned by suppression of visual processing (8). It is not, however, known whether placeboenhanced pleasantness (i.e., hyperhedonia) also alters early stages of sensory processing, or if this change is encoded in higher-level valuation areas.Functional neuroimaging studies have revealed that the ventromedial prefrontal cortex (vmPFC), amygdala, ventral...

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Placebo improves pleasure and pain through opposite modulation of sensory processing

Ellingsen

Wessberg

Eikemo

et al. 2013

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

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“…Pain relief is a reward, but even the experience of moderate pain can be relatively rewarding when the alternative is intense pain. 5 The stimulation delivered to the skin in the absence of penetration by placebo needles (ie, poking) would be a pain or nuisance in a non-medical context; however, such stimulation can be rewarding when the patient is in pain and the action leads to pain relief.…”

Section: Powerful Effects Of Placebo Needlesmentioning

confidence: 99%

Powerful Effects of Placebo Needles

Lee

Chae

2018

Acupunct Med

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Figure 1 Powerful effects of placebo needles. Acupuncture treatment, whether real or placebo, encompasses two modalities that are recognised by the patient during treatment: the visual and verbal context, including the clinical setting surrounded by place cues, social cues and treatment cues, together with verbal suggestions; and the tactile context, consisting of tactile stimulation delivered by the doctor, including gentle touch and (in the case of placebo needles) poking without penetration; and the consequential bodily sensation by the patient, including the de qi sensation. These contexts combine to form a patient's prior experience of acupuncture and their expectations and can enhance the doctor-patient relationship.

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“…Le développement des neurosciences montre de plus en plus la complexité des relations et des capacités de modulation de la douleur, des facteurs psychosociaux et contextuels. L'importance du cadre contextuel, des rituels, est fondamentale pour modifier de façon positive ou négative le ressenti douloureux [31][32][33][34].…”

Section: Quelles Sont Ces Médecines Complémentaires ?unclassified

Complementary medicine and chronic pain management

Collin

2015

Douleur analg

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Reçu le 27 mai 2015 ; accepté le 28 mai 2015 © Lavoisier SAS 2015Résumé Le recours aux médecines complémentaires par les patients douloureux chroniques est fréquent, ainsi que leur utilisation par les structures de prise en charge de la douleur. L'utilisation de ces pratiques a un effet important sur la modulation cognitive de la douleur et la mise en place de stratégies d'adaptation par les patients. La médecine de la douleur pourrait devenir un modèle d'intégration de ces thé-rapies à notre médecine conventionnelle.Mots clés Douleurs chroniques · Structure de prise en charge de la douleur · Médecines complémentaires · Hypnose · Acupuncture Abstract Chronic pain patients as well than pain center medical staff have a growing interest for complementary medicine. This one plays a major role on pain cognitive factor modulation and implementation of new coping strategies by patients. Pain medicine could be a model to support a reflection about integrative medicine.

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The importance of context: When relative relief renders pain pleasant

Abstract: SummaryWhen moderate pain was presented in a context of intense pain, it induced a relief and ‘hedonic flip’ such that pain was reported as pleasant.

Cited by 151 publications

References 67 publications

Placebo improves pleasure and pain through opposite modulation of sensory processing

Placebo improves pleasure and pain through opposite modulation of sensory processing

Powerful Effects of Placebo Needles

Complementary medicine and chronic pain management

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