Department of Physiology, Northwestern University Feinberg School of Medicine, 710N Lake Shore Drive, Room 1020, Chicago, IL, 60611, USA.
Healthcare and Life Sciences Department, IBM Watson Research Center, 1101 Kitchawan Rd, Yorktown Heights, NY, 10598, USA.
Nat Commun. 2018 Sep 12;9(1):3397. doi: 10.1038/s41467-018-05859-1.
The placebo response is universally observed in clinical trials of pain treatments, yet the individual characteristics rendering a patient a 'placebo responder' remain unclear. Here, in chronic back pain patients, we demonstrate using MRI and fMRI that the response to placebo 'analgesic' pills depends on brain structure and function. Subcortical limbic volume asymmetry, sensorimotor cortical thickness, and functional coupling of prefrontal regions, anterior cingulate, and periaqueductal gray were predictive of response. These neural traits were present before exposure to the pill and most remained stable across treatment and washout periods. Further, psychological traits, including interoceptive awareness and openness, were also predictive of the magnitude of response. These results shed light on psychological, neuroanatomical, and neurophysiological principles determining placebo response in RCTs in chronic pain patients, and they suggest that the long-term beneficial effects of placebo, as observed in clinical settings, are partially predictable.
安慰剂效应在疼痛治疗的临床试验中普遍存在，但使患者成为“安慰剂反应者”的个体特征仍不清楚。在这里，我们在慢性背痛患者中通过 MRI 和 fMRI 证明，对安慰剂“镇痛”丸的反应取决于大脑结构和功能。皮质下边缘体积不对称、感觉运动皮质厚度以及前额叶区域、前扣带和导水管周围灰质的功能耦合可预测反应。这些神经特征在接触药丸之前就存在，并且在治疗和洗脱期间大多数保持稳定。此外，包括内感受意识和开放性在内的心理特征也可以预测反应的幅度。这些结果揭示了决定慢性疼痛患者 RCT 中安慰剂反应的心理、神经解剖和神经生理学原则，并表明在临床环境中观察到的安慰剂的长期有益效果在一定程度上是可以预测的。
