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Academia Mexicana de Neurología, A.C.

2006, Number 4

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Rev Mex Neuroci 2006; 7 (4)

Neurobiology of the placebo effect

Aguilar E

Language: Spanish
References: 79
Page: 300-307
PDF size: 88.29 Kb.


ABSTRACT

Introduction: Recent progress in our understanding of the neurobiological mechanisms of the placebo effect originates from the fields of pain and depression. Brain imaging studies provide information about the regions that are involved in placebo analgesia. Placebo induces the activation of the anterior cingulate cortex, the orbitofrontal cortex, and the anterior insula; there is also activity in lower pons, in medulla, and in the periacqueductal grey. Another study showed that placebo reduces nociceptive transmission along the pain pathways, particularly in the thalamus, anterior insula and anterior cingulate. During the anticipation phase of the placebo analgesic response, activation of the prefrontal cortex and the periacqueductal grey was found, which indicates that a cognitive-evaluative network is activated just before the placebo response. Material and methods: The release of endogenous opioids might be activated in the anticipatory phase of the placebo response. The data indicate that a descending pain-modulating circuit is involved in placebo analgesia. Administration of placebo results also in a clinical response indistinguishable from that seen with active antidepressant treatment. Placebo response in depressives associates with regional metabolic increases involving the prefrontal cortex, anterior and posterior cingulate, posterior insula, and metabolic decreases in the subgenual cingulate, parahippocampus, and thalamus. The pattern of cortical activation and limbic-paralimbic deactivation in placebo responders suggests that facilitation of these changes may be necessary for depression remission. Conclusion: As placebo effect is induced by the psychosocial context in which the treatment is given and elicits expectations of therapeutic benefit, it is concluded that placebos activate top-down expectation pathways.


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