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Dopamine-based reward and learning mechanisms have been suggested to contribute to placebo effects. However, the exact role of dopaminergic neurotransmission in their generation and maintenance is still unclear. This study aimed to shed light on the causal role of dopamine in establishing positive treatment expectations, as well as on the magnitude and duration of their effect on pain. To this end, we used an established placebo analgesia paradigm in combination with 2 opposing pharmacological modulations of dopaminergic tone, i.e., the dopamine antagonist sulpiride and the dopamine precursor L-dopa which were both applied in an experimental, double-blind, randomized, placebo-controlled trial with a between-subject design in N = 168 healthy volunteers. The study medication successfully altered dopaminergic tone during the conditioning procedure. Contrary to our hypotheses, the medication did not modulate the formation of positive treatment expectation and placebo analgesia tested 1 day later. Placebo analgesia was no longer detectable on day 8 after conditioning. Using a combined frequentist and Bayesian approach, our data provide strong evidence against a direct dopaminergic influence on the generation and maintenance of placebo effects. Further exploration of the neurochemical mechanisms underlying placebo analgesia remains paramount in the quest to exploit these effects for optimal treatment outcomes. Trial registration: ClinicalTrials.gov German Clinical Trials Register, ID: DRKS00029366, https://drks.de/search/en/trial/DRKS00029366. Dopamine signalling has been linked to pain analgesia and placebo effects but whether there is causal relationship remains unclear. This pre-registered study shows that enhancing dopaminergic tone does not alter the generation of positive treatment expectations or placebo analgesia. [ABSTRACT FROM AUTHOR]

This scientific commentary discusses a study by Schenk et al. that explores the potential for side effects to enhance the efficacy of a drug. The study involved 77 healthy volunteers who were given a placebo nasal spray, either alone or with experimentally induced side effects. The results showed that the placebo with side effects led to a stronger analgesic effect and increased engagement of the pain modulatory network in the brain. The study suggests that the belief that more potent treatments have more side effects can influence treatment expectations and outcomes. However, it is important to consider the limitations and ethical implications of using side effects to enhance treatment effectiveness. [Extracted from the article]

Recent research on moral decision-making has suggested that many common moral judgments are based on immediate intuitions. However, some individuals arrive at highly counterintuitive utilitarian conclusions about when it is permissible to harm other individuals. Such utilitarian judgments have been attributed to effortful reasoning that has overcome our natural emotional aversion to harming others. Recent studies, however, suggest that such utilitarian judgments might also result from a decreased aversion to harming others, due to a deficit in empathic concern and social emotion. The present study investigated the neural basis of such indifference to harming using functional neuroimaging during engagement in moral dilemmas. A tendency to counterintuitive utilitarian judgment was associated both with "psychoticism", a trait associated with a lack of empathic concern and antisocial tendencies, and with "need for cognition", a trait reflecting preference for effortful cognition. Importantly, only psychoticism was also negatively correlated with activation in the subgenual cingulate cortex (SCC), a brain area implicated in empathic concern and social emotions such as guilt, during counterintuitive utilitarian judgments. Our findings suggest that when individuals reach highly counterintuitive utilitarian conclusions, this need not reflect greater engagement in explicit moral deliberation. It may rather reflect a lack of empathic concern, and diminished aversion to harming others. (Contains 4 figures and 4 footnotes.)

Studies on functional and structural changes in the primary somatosensory cortex (S1) have provided important insights into neural mechanisms underlying several chronic pain conditions. However, the role of S1 plasticity in postherpetic neuralgia (PHN) remains elusive. Combining psychophysics and magnetic resonance imaging (MRI), we investigated whether pain in PHN patients is linked to S1 reorganization as compared with healthy controls. Results from voxel‐based morphometry showed no structural differences between groups. To characterize functional plasticity, we compared S1 responses to noxious laser stimuli of a fixed intensity between both groups and assessed the relationship between S1 activation and spontaneous pain in PHN patients. Although the intensity of evoked pain was comparable in both groups, PHN patients exhibited greater activation in S1 ipsilateral to the stimulated hand. Pain‐related activity was identified in contralateral superior S1 (SS1) in controls as expected, but in bilateral inferior S1 (IS1) in PHN patients with no overlap between SS1 and IS1. Contralateral SS1 engaged during evoked pain in controls encoded spontaneous pain in patients, suggesting functional S1 reorganization in PHN. Resting‐state fMRI data showed decreased functional connectivity between left and right SS1 in PHN patients, which scaled with the intensity of spontaneous pain. Finally, multivariate pattern analyses (MVPA) demonstrated that BOLD activity and resting‐state functional connectivity of S1 predicted within‐subject variations of evoked and spontaneous pain intensities across groups. In summary, functional reorganization in S1 might play a key role in chronic pain related to PHN and could be a potential treatment target in this patient group. [ABSTRACT FROM AUTHOR]

The neural mechanisms underlying placebo analgesia have attracted considerable attention over the recent years. In contrast, little is known about the neural underpinnings of a nocebo‐induced increase in pain. We previously showed that nocebo‐induced hyperalgesia is accompanied by increased activity in the hippocampus that scaled with the perceived level of anxiety. As a key node of the neural circuitry of perceived threat and fear, the hippocampus has recently been proposed to coordinate defensive behaviour in a context‐dependent manner. Such a role requires close interactions with other regions involved in the detection of and responses to threat. Here, we investigated the functional connectivity of the hippocampus during nocebo‐induced hyperalgesia. Our results show an increase in functional connectivity between hippocampus and brain regions implicated in the processing of sensory‐discriminative aspects of pain (posterior insula and primary somatosensory/motor cortex) as well as the periaqueductal grey. This nocebo‐induced increase in connectivity scaled with an individual's increase in anxiety. Moreover, hippocampus connectivity with the amygdala was negatively correlated with the pain intensity reported during nocebo hyperalgesia relative to the placebo condition. Our findings suggest that the hippocampus links nocebo‐induced anxiety to a heightened responsiveness to nociceptive input through changes in its crosstalk with pain‐modulatory brain areas. [ABSTRACT FROM AUTHOR]

Stimulating the skin with intensities close to the sensory threshold causes erroneous localization of the site of stimulation. Previous studies using manual methods for applying faint tactile stimuli have shown that localization errors obey a somatotopic principle in which tactile stimuli are preferentially mislocalized to sites adjacent to the stimulated skin region. However, manual testing of mislocalization is time consuming and only partially objective because results depend on the skills of the tester. To improve the testing procedure, an automated apparatus was developed. The procedure adjusted stimulus intensity adaptively during testing to remain near the individual subject's sensory threshold, so that mislocalizations occurred often enough to assess somatotopic organization. The new method was applied to 12 healthy subjects. In each subject, the five digits of the right hand were stimulated singly in random order. Localization errors were distributed preferentially to fingers close to the stimulated finger rather than to distant fingers. The profile of mislocalization differed significantly from that expected on the basis of response bias or guessing behavior. The present results replicate previous findings obtained for manual testing with improved sensitivity and indicate that the new technique is a useful tool for the study of somatosensory processing on a perceptual level. Index Terms--Instrumentation, mislocalization, perception, psychophysics, sensory threshold, somatosensory system.