How expectations shape pain
Abstract
Pain is highly modifiable by psychological factors, including expectations. However, pain is a complex phenomenon, and expectations may work by influencing any number of processes that underlie the construction of pain. Neuroimaging has begun to provide a window into these brain processes, and how expectations influence them. In this article, we review findings regarding expectancy effects on brain markers of nociception and how expectations lead to changes in subjective pain. We address both expectations about treatments (placebo analgesia and nocebo effects) and expectations about the environment (e.g. expectations about pain itself). The body of work reviewed indicates that expectancies shape pain-intensity processing in the central nervous system, with strong effects on nociceptive portions of insula, cingulate and thalamus. Expectancy effects on subjective experience are driven by responses in these regions as well as regions less reliably activated by changes in noxious input, including the dorsolateral prefrontal cortex and the orbitofrontal cortex. Thus, multiple systems are likely to interact and mediate the pain-modulatory effects of expectancies. Finally, we address open questions regarding the psychological processes likely to play an intervening role in expectancy effects on pain.
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Placebo responses are associated with the release of dopamine and endogenous opioids, whereas nocebo responses are associated with the release of cholecystokinin.
“Placebo and nocebo responses are also associated with different neurotransmitters; placebo responses are associated with the release of dopamine and endogenous opioids, whereas nocebo responses are associated with the release of cholecystokinin32–34.”
From Boundary effects of expectation in human pain perception (2019) · cites this paper as [34]
Pain can be shaped by different types of expectancies.
“Pain can be shaped by different types of expectancies [1,2].”
From Nocebo hyperalgesia and other expectancy-related factors in daily fibromyalgia pain: Combining experimental and electronic diary methods (2024) · cites this paper as [1]
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- Authors
- Atlas, L. Y., & Wager, T. D.
- Affiliations
- New York University (US)
- University of Colorado Boulder (US)
- Corresponding author
- Atlas, Lauren Y.
- Venue
- Neuroscience Letters
- Publisher
- Elsevier BV
- Published
- 2012-06
- Volume
- 520
- Issue
- 2
- Pages
- 140-148
- ISSN
- 0304-3940 (ISSN-L)
- OpenAlex
- W2155155895
- Cited by
- 463
- References
- 94
- Citations by year
- 2026: 32 · 2025: 37 · 2024: 44 · 2023: 61 · 2022: 30 · 2021: 53 · 2020: 26 · 2019: 29 · 2018: 28 · 2017: 28 · 2016: 29 · 2015: 27 · 2014: 23 · 2013: 13 · 2012: 3
- FWCI
- 1.67
- Type
- journal article
- Language
- en
- Open access
- closed
- Locations
- Neuroscience Letters (publishedVersion)
- PubMed (publishedVersion)
- Topics
- Life Sciences › Neuroscience › Cognitive Neuroscience › Pain Management and Placebo Effect
- Health Sciences › Medicine › Physiology › Pain Mechanisms and Treatments
- Health Sciences › Medicine › Anesthesiology and Pain Medicine › Pain Management and Treatment
- Keywords
- pain anticipation, placebo analgesia, nocebo effect, pain modulation, nociception, insula, cingulate cortex, thalamus, dorsolateral prefrontal cortex, orbitofrontal cortex, subjective pain, neuroimaging of pain
- MeSH terms
- Analgesia, Animals, Brain, Brain Chemistry, Culture, Humans, Hyperalgesia, Learning, Pain, Pain Perception, Nociception, Pain Management, Neuroimaging
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