Cited by 277Pain Management and Placebo EffectPain Mechanisms and TreatmentsNeurotransmitter Receptor Influence on Behavior

Neurobiological Mechanisms of Placebo Responses

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Zubieta, Jon‐Kar, Stohler, Christian S.·2009·Annals of the New York Academy of Sciences

Abstract

Expectations, positive or negative, are modulating factors influencing behavior. They are also thought to underlie placebo effects, potentially impacting perceptions and biological processes. We used sustained pain as a model to determine the neural mechanisms underlying placebo‐induced analgesia and affective changes in healthy humans. Subjects were informed that they could receive either an active agent or an inactive compound, similar to routine clinical trials. Using PET and the μ‐opioid selective radiotracer [11 C]carfentanil we demonstrate placebo‐induced activation of opioid neurotransmission in a number of brain regions. These include the rostral anterior cingulate, orbitofrontal and dorsolateral prefrontal cortex, anterior and posterior insula, nucleus accumbens, amygdala, thalamus, hypothalamus, and periaqueductal grey. Some of these regions overlap with those involved in pain and affective regulation but also motivated behavior. The activation of endogenous opioid neurotransmission was further associated with reductions in pain report and negative affective state. Additional studies with the radiotracer [11 C]raclopride, studies labeling dopamine D2/3 receptors, also demonstrate the activation of nucleus accumbens dopamine during placebo administration under expectation of analgesia. Both dopamine and opioid neurotransmission were related to expectations of analgesia and deviations from those initial expectations. When the activity of the nucleus accumbens was probed with fMRI using a monetary reward expectation paradigm, its activation was correlated with both dopamine, opioid responses to placebo in this region and the formation of placebo analgesia. These data confirm that specific neural circuits and neurotransmitter systems respond to the expectation of benefit during placebo administration, inducing measurable physiological changes.

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  • Neuroimaging studies suggest that central opioid system activations overlap with central maternal activations in the mesocorticolimbic circuitry.

    “Although the association between the EO and maternal brain responses remains unknown in humans using direct hormone measurements, neuroimaging studies suggest that central opioid system activations (62) overlap with central maternal activations (4,5) in the mesocorticolimbic circuitry.”

    From Neuroendocrinology of Parental Response to Baby‐Cry (2011) · cites this paper as [62]

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  1. Ader R Harrington A The role of conditioining in pharmacotherapy The placebo effect: an interdisciplinary exploration 1997 Cambridge, MA Harvard UP 138 165

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Authors
Zubieta, J., & Stohler, C. S.
Affiliations
University of Maryland, Baltimore (US)
Corresponding author
Zubieta, Jon‐Kar
Venue
Annals of the New York Academy of Sciences
Publisher
Wiley
Published
2009-03
Volume
1156
Issue
1
Pages
198-210
ISSN
  • 0077-8923 (ISSN-L)
  • 1749-6632
OpenAlex
W2034413814
Cited by
277
References
81
Citations by year
2026: 3 · 2025: 8 · 2024: 16 · 2023: 4 · 2022: 14 · 2021: 11 · 2020: 9 · 2019: 9 · 2018: 23 · 2017: 13 · 2016: 16 · 2015: 19 · 2014: 21 · 2013: 16 · 2012: 36
FWCI
2.36
Type
journal article
Language
en
Open access
Locations
  • Annals of the New York Academy of Sciences (publishedVersion)
  • PubMed (publishedVersion)
  • Europe PMC (PubMed Central) (acceptedVersion)
  • PubMed Central (acceptedVersion)
Funders
  • National Institute on Drug Abuse (R01DA016423)
  • National Center for Complementary and Alternative Medicine
  • National Center for Complementary and Integrative Health (R01AT001415)
Topics
  • Life Sciences › Neuroscience › Cognitive Neuroscience › Pain Management and Placebo Effect
  • Health Sciences › Medicine › Physiology › Pain Mechanisms and Treatments
  • Life Sciences › Neuroscience › Cellular and Molecular Neuroscience › Neurotransmitter Receptor Influence on Behavior
Keywords
placebo effect, placebo analgesia, expectations, mu-opioid receptor, nucleus accumbens, dopamine, negative affect, sustained pain, brain activation, reward anticipation
MeSH terms
Analgesia, Brain Mapping, Dopamine, Humans, Models, Biological, Nerve Net, Nervous System Physiological Phenomena, Synaptic Transmission, Placebos, Placebo Effect, Opioid Peptides

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