Cited by 463Pain Management and Placebo EffectPain Mechanisms and TreatmentsPain Management and Treatment

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How expectations shape pain

Atlas, Lauren Y., Wager, Tor D.·2012·Neuroscience Letters

DOI 10.1016/j.neulet.2012.03.039

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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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Authors: Atlas, L. Y., & Wager, T. D.
Affiliations: New York University (US)
University of Colorado Boulder (US)
Corresponding author: Atlas, Lauren Y.
ORCID: Atlas, Lauren Y.
Wager, Tor D.
Venue: Neuroscience Letters
Publisher: Elsevier BV
Published: 2012-06
Volume: 520
Issue: 2
Pages: 140-148
ISSN: 0304-3940 (ISSN-L)
DOI: 10.1016/j.neulet.2012.03.039
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
Licence: www.elsevier.com/tdm/userlicense/1.0/ (tdm)
Locations: Neuroscience Letters (publishedVersion)
PubMed (publishedVersion)
Topics: Life Sciences › Neuroscience › Cognitive Neuroscience › Pain Management and Placebo Effect
Health Sciences › Medicine › Physiology (medical) › 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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