Brain and psychological determinants of placebo pill response in chronic pain patients.
Etienne Vachon-PresseauSara E BergerTaha B AbdullahLejian HuangGuillermo A CecchiJames W GriffithThomas J SchnitzerA Vania ApkarianPublished in: Nature communications (2018)
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.
Keyphrases
- clinical trial
- double blind
- chronic pain
- end stage renal disease
- ejection fraction
- newly diagnosed
- chronic kidney disease
- resting state
- functional connectivity
- prognostic factors
- peritoneal dialysis
- white matter
- randomized controlled trial
- gene expression
- neuropathic pain
- depressive symptoms
- spinal cord
- dna methylation
- magnetic resonance
- patient reported outcomes
- working memory
- case report
- blood brain barrier
- room temperature
- drug induced
- transcranial magnetic stimulation
- replacement therapy