The sweetest pill to swallow: how patient neurobiology can be harnessed to maximise placebo effects

Abstract

The burgeoning interest in placebo effects over the last 10-15 years has fallen into two main research areas: elucidation of the neurobiological mechanisms recruited following placebo administration, and investigations into the situations and contexts in which placebo effects are evoked. There has been little attention focused on bridging these two i.e. how to actively translate and apply these neurobiological mechanisms into daily clinical practice in a responsible way. This article addresses this gap, first through a narrative review of the last 15 years of neuroscience findings with special attention focussed on the elucidation of the neurotransmitters, pathways and mechanisms involved in placebo effects, and secondly, at how these psycho(neuro)biological effects could be harnessed in medical care.

Keywords: CB; DA; DLPFC; Doctor–patient communication; Dopamine; Expectancy; INS; NAC; Neurobiology; Neuropsychology; OFC; Opioids; PAG; PET; Placebo effect; Reward; SNr; STN; Thal; V. str.; VA; VLa; VTA; aINS; anterior insula; cannabinoid; dopamine; dorsal str.; dorsal striatum; dorsolateral prefrontal cortex; insula; nucleus accumbens; orbitofrontal cortex; pINS; periaqueductal grey; positron emission tomography; posterior insula; rACC; rostral anterior cingulate cortex; substantia nigra pars reticulate; subthalamic nucleus; thalamus; ventral anterior thalamus; ventral striatum; ventral tegmental area.; ventrolateral thalamus.