This PhD research dealt with neurobiological and behavioral aspects of pain. Previous research has demonstrated that pain sensitivity can be worsened as a result of learned negative expectations, a... Show moreThis PhD research dealt with neurobiological and behavioral aspects of pain. Previous research has demonstrated that pain sensitivity can be worsened as a result of learned negative expectations, a phenomenon termed nocebo hyperalgesia –a counterpart to placebo analgesia. This PhD dissertation describes neuroimaging and biobehavioral experimental studies as well as a review and a meta-analysis concerned with such learned effects on pain. The research adds to a growing literature that has been challenging antiquated understandings of pain as a bottom-up process. We conducted a series of biobehavioral studies to further our understanding of how bottom-up pain signaling can be influenced by top-down processing. We examined the types of experiences, such as receiving negative information or experiencing a negative effect first-hand, that may lead to stronger nocebo effects. Behavioral paradigms were used to model real-life pain experiences, through validated methods, novel learning manipulations, as well as a close examination of emotional correlates such as fear. Concurrently, innovative neuroscientific methods –including pharmacological manipulations– were used to examine the biobehavioral underpinnings of learned nocebo responses. Our findings add to the growing knowledgebase from the field of nocebo hyperalgesia, demonstrating that learning by experience can decisively influence the processing and perception of noxious stimuli. Show less
Placebo and nocebo effects are positive or negative treatment effects respectively, unrelated to the treatment mechanism, which are induced by patients’ expectations. Placebo and nocebo effects are... Show morePlacebo and nocebo effects are positive or negative treatment effects respectively, unrelated to the treatment mechanism, which are induced by patients’ expectations. Placebo and nocebo effects are known to play a role in treatment effects for various symptoms and conditions, especially in the field of pain. The aim of the current disseration was to increase understanding of placebo and nocebo effects on itch.The results of the studies presented in this thesis further underline that placebo and nocebo effects play a role in itch perception. We found that itch is highly susceptible to suggestions and placebo and nocebo effects can be induced on itch by verbal suggestion and conditioning. Most notably, our findings show for the first time that particularly the combination of conditioning with verbal suggestion is most promising for inducing both placebo and nocebo effects on itch, which is in accordance with placebo research on pain. Moreover, a new and promising finding is that counterconditioning has shown to reverse nocebo effects on itch. Future research may build upon the findings of this thesis to further enlarge our knowledge on placebo and nocebo effects on itch and how to maximize or minimize them, respectively, also in a clinical setting, to eventually optimize available interventions for patients suffering from chronic itch. Show less
This dissertation investigated placebo and nocebo effects in itch. Placebo and nocebo effects are positive and negative treatment outcomes respectively, that cannot be attributed to active... Show moreThis dissertation investigated placebo and nocebo effects in itch. Placebo and nocebo effects are positive and negative treatment outcomes respectively, that cannot be attributed to active treatment ingredients. Consistent with previous research, the dissertation shows that these effects play an important role in itch. The studies moreover illustrate that placebo effects can still occur when people are informed about them.The results described in this dissertation show that expectations about itch can be formed in various ways. People's expectations of treatment outcomes have been found underlie placebo and nocebo effects. For instance, the information that is given about how much itch an experimental test elicits (i.e., verbal suggestions) can influence expectations and lead to placebo or nocebo effects. The results also show that placebo effects can be automatically induced for itch by associative learning (through pharmacological conditioning). In addition, these effects may also occur when people know they are placebo effects. These results illustrate the importance of expectations and the psychosocial context in the treatment of somatic symptoms complaints such as itch. The results of this thesis may help improve existing treatments for itch. For example, medicine use can potentially be reduced by applying pharmacological conditioning, existing treatment can be improved by providing optimal treatment information, and the importance of expectations for treatment outcomes can be discussed with patients. Show less
Placebo effects are health improvements, for example pain reduction, due to an inert treatment. These effects are typically ascribed to a person’s expectations about the beneficial outcomes of... Show morePlacebo effects are health improvements, for example pain reduction, due to an inert treatment. These effects are typically ascribed to a person’s expectations about the beneficial outcomes of the placebo. The literature and experimental research in the current dissertation shows that expectancies, and thereby placebo effects, can be induced via verbal suggestion, conditioning, and mental imagery. Especially verbal suggestions may enhance analgesic treatments for patients. We found, for the first time, that mental imagery of reduced pain can induce analgesia via its effects on pain expectancies. We also observed that people’s expectations about the effectiveness of medications depend on the route of administration and targeted symptom. These findings suggest that harnessing placebo effects by targeting expectancies is promising for enhancing standard clinical care of physical symptoms. Show less
