Brain and psychological determinants of placebo pill response in chronic pain patients

Etienne Vachon-Presseau, Sara E. Berger, Taha B. Abdullah, Lejian Huang, Guillermo A. Cecchi, James W. Griffith, Thomas J. Schnitzer and A. Vania Apkarian ()
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Etienne Vachon-Presseau: Northwestern University Feinberg School of Medicine
Sara E. Berger: Northwestern University Feinberg School of Medicine
Taha B. Abdullah: Northwestern University Feinberg School of Medicine
Lejian Huang: Northwestern University Feinberg School of Medicine
Guillermo A. Cecchi: IBM Watson Research Center
James W. Griffith: Northwestern University Feinberg School of Medicine
Thomas J. Schnitzer: Northwestern University Feinberg School of Medicine
A. Vania Apkarian: Northwestern University Feinberg School of Medicine

Nature Communications, 2018, vol. 9, issue 1, 1-15

Abstract: Abstract 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.

Date: 2018
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DOI: 10.1038/s41467-018-05859-1

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