Brain and psychological determinants of placebo pill response in chronic pain patients

Etienne Vachon-Presseau, Sara E. Berger, Taha B. Abdullah, Lejian Huang, Guillermo A. Cecchi, James W Griffith, Thomas J Schnitzer, Apkar Apkarian*

*Corresponding author for this work

Research output: Contribution to journalArticle

5 Citations (Scopus)

Abstract

The placebo response is universally observed in clinical trials of pain treatments, yet the individual characteristics rendering a patient a ‘placebo responder’ remain unclear. Here, in chronic back pain patients, we demonstrate using MRI and fMRI that the response to placebo ‘analgesic’ pills depends on brain structure and function. Subcortical limbic volume asymmetry, sensorimotor cortical thickness, and functional coupling of prefrontal regions, anterior cingulate, and periaqueductal gray were predictive of response. These neural traits were present before exposure to the pill and most remained stable across treatment and washout periods. Further, psychological traits, including interoceptive awareness and openness, were also predictive of the magnitude of response. These results shed light on psychological, neuroanatomical, and neurophysiological principles determining placebo response in RCTs in chronic pain patients, and they suggest that the long-term beneficial effects of placebo, as observed in clinical settings, are partially predictable.

Original languageEnglish (US)
Article number3397
JournalNature communications
Volume9
Issue number1
DOIs
StatePublished - Dec 1 2018

Fingerprint

pain
determinants
Chronic Pain
Magnetic resonance imaging
brain
Analgesics
Brain
Placebos
Psychology
long term effects
Periaqueductal Gray
transponders
fallout
Gyrus Cinguli
Back Pain
Magnetic Resonance Imaging
asymmetry
Clinical Trials
Pain
Therapeutics

ASJC Scopus subject areas

  • Chemistry(all)
  • Biochemistry, Genetics and Molecular Biology(all)
  • Physics and Astronomy(all)

Cite this

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abstract = "The placebo response is universally observed in clinical trials of pain treatments, yet the individual characteristics rendering a patient a ‘placebo responder’ remain unclear. Here, in chronic back pain patients, we demonstrate using MRI and fMRI that the response to placebo ‘analgesic’ pills depends on brain structure and function. Subcortical limbic volume asymmetry, sensorimotor cortical thickness, and functional coupling of prefrontal regions, anterior cingulate, and periaqueductal gray were predictive of response. These neural traits were present before exposure to the pill and most remained stable across treatment and washout periods. Further, psychological traits, including interoceptive awareness and openness, were also predictive of the magnitude of response. These results shed light on psychological, neuroanatomical, and neurophysiological principles determining placebo response in RCTs in chronic pain patients, and they suggest that the long-term beneficial effects of placebo, as observed in clinical settings, are partially predictable.",
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Brain and psychological determinants of placebo pill response in chronic pain patients. / Vachon-Presseau, Etienne; Berger, Sara E.; Abdullah, Taha B.; Huang, Lejian; Cecchi, Guillermo A.; Griffith, James W; Schnitzer, Thomas J; Apkarian, Apkar.

In: Nature communications, Vol. 9, No. 1, 3397, 01.12.2018.

Research output: Contribution to journalArticle

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