Cited by 153Pain Management and Placebo EffectPain Mechanisms and TreatmentsPain Management and Treatment

Facilitation of Pain in the Human Spinal Cord by Nocebo Treatment

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Geuter, Stephan, Büchel, Christian·2013·The Journal of Neuroscience

Abstract

Nocebo hyperalgesia is an increase in subjective pain perception after a patient or subject underwent an inert treatment without any active ingredient. For example, verbal suggestion of increased pain can enhance both pain experience and responses in pain-related cortical brain areas. However, changes in cortical pain responses may be secondary to earlier amplification of incoming pain signals within the spinal cord. To test for a potential early enhancement of pain signals in the dorsal horn of the spinal cord, we combined a nocebo heat pain paradigm with spinal functional magnetic resonance imaging in healthy volunteers. We found that local application of an inert nocebo cream on the forearm increased pain ratings compared with a control cream, and also reduced pain thresholds on the nocebo-treated skin patch. On the neurobiological level, pain stimulation induced a strong activation in the spinal cord at the level of the stimulated dermatomes C5/C6. Comparing pain stimulation under nocebo to a control pain stimulation of the same physical intensity revealed enhanced pain-related activity in the ipsilateral dorsal horn of the spinal cord. Importantly, the activation of the main effect of pain and the nocebo effect spatially overlapped. The current study thus provides direct evidence for a pain-facilitating mechanism in the human spinal cord before cortical processing, which can be activated by cognitive manipulations such as nocebo treatments.

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Crossref · 10.1523/jneurosci.2191-13.2013

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  • Expectations could modulate reinforcement signals, and if such manipulations affect the reinforcement signal used in calculating prediction errors, it would short-circuit learning by suppressing cue-inconsistent prediction errors.

    “If these manipulations affect the reinforcement signal used in calculating prediction errors, it would short-circuit learning by suppressing cue-inconsistent prediction errors.”

    From Social information creates self-fulfilling prophecies in judgments of pain, vicarious pain, and cognitive effort (2026) · cites this paper as [46]

    The Discussion (page unavailable) reports that nocebo expectations amplify spinal pain signals before cortical processing, supporting the premise that expectations can alter an incoming pain signal. It does not identify that signal as the reinforcement signal used to calculate prediction errors or address suppression of cue-inconsistent prediction errors and its effect on learning. (LLM, conf=0.82)

    Experimental — accuracy not yet measured
  • Study participants who believed they were given a stimulant perceived an increase of their tension, despite having taken a muscle relaxant.

    “Study participants who believed that they were given a stimulant perceived an increase of their tension, despite having taken a muscle relaxant.44”

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Authors
Geuter, S., & Büchel, C.
Affiliations
University Medical Center Hamburg-Eppendorf (DE)
Venue
The Journal of Neuroscience
Published
2013-08-21
Volume
33
Issue
34
Pages
13784-13790
ISSN
  • 0270-6474 (ISSN-L)
  • 1529-2401
OpenAlex
W2076677238
Cited by
152
References
53
Citations by year
2026: 8 · 2025: 10 · 2024: 8 · 2023: 17 · 2022: 8 · 2021: 18 · 2020: 13 · 2019: 6 · 2018: 14 · 2017: 8 · 2016: 10 · 2015: 18 · 2014: 13 · 2013: 1
FWCI
7.68
Type
journal article
Language
en
Open access
Locations
  • Journal of Neuroscience (publishedVersion, cc-by-nc-sa)
  • PubMed Central (publishedVersion)
  • PubMed (publishedVersion)
Funders
Deutsche Forschungsgemeinschaft (SFB 936)
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
nocebo effect, nocebo hyperalgesia, dorsal horn, pain facilitation, thermal pain, pain perception, pain threshold, placebo effect, cognitive manipulation
MeSH terms
Adult, Capsaicin, Female, Humans, Hyperalgesia, Image Processing, Computer-Assisted, Magnetic Resonance Imaging, Male, Oxygen, Pain, Pain Measurement, Surveys and Questionnaires, Spinal Cord, Time Factors, Pain Threshold, Young Adult, Pain Perception

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