NEUR30004 Lecture Notes - Lecture 16: Thalamus, Insular Cortex, Posterior Grey Column
13 Aug 2018
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L16
Pain, Placebo and belief
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- how changes in the pathway can occur
- complex issues about pain and the syndromes
- bring back feedback:
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- pain experience when you feel it is correlated with activation of nociceptors
- not always the case
- nociception is usualy the cause of pain but sometimes there is activated when
nociception is activated or just by touch
- the converse is true where nociceptors are activated but does not lead to pain
- how we experience pain and the variables on how we experience them
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- shakespear and experience
- even though pain is a perception a product of our mental state there is also
something real about it
- pain is something in my mind doesn’t help much when you have to deal with
it
- interested in the issue fo mind and body and how the mind relates to the
world
- because we can only know through perception and sessers then all senses
should exist in realist
- when Johnson was talking about this when nothing may be real
- Johnson said yes and then kicked a rock and said that was real
- pain is a construct like the images in front of us
- internal universe that is real
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- one particular aspect
- the placebo effect
- a process that happens that moderates your pain in certain context
- placebo has been known for a long time
- accounts but usually accounts are sceptics
- the basis for there being some way to measure the size of the effect
- crucial for developing a treatment on pain
- modulating expectations, mood and personalities and other factors
- how it works
- expectations interact with nociceptive pathways
- can you use that?
- means to treat pain are not particularly sophisticated
- drugs or opiots have been there for age
- not much out there to treat pain
- placebo effect and how to maximize the effects
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- lots of placebo effects and now talking about pain
- involves the nervous system somehow
- via the action of the nervous system and that process
- its not just something that can occur or sometimes crops up
- is very reall and has to be quantified effect
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- getting treatment which might be an opiod and hidden application means the
person doesn’t know
- can see whether that lowers their pain experience
- open application and that the opoid is seen by the pateient who then knows
that drug is being administered and then this is where expectation comes into
play
- two conditions and look at what happesn
- in the hidden condition there is pain relief and pain decreases
- the additional affect may be the expectiations give something to help the
patient
- to measure the effect of the drug the drug company wants to look at its effect
and power in pain relief
- combine opiod and sugar pill you condition it so that if you give the pill alone
after pairing it then the neutral pill will evoke some effect compared to if you
have not given
- expectation and effects on pain relief
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- there are other factors as well now
- top panel:
- when in an open condition with the drug and expectation
- expectation only vs. expectation and drug
- the placebo effect how do we know its just the expectation?
- sometimes medical conditions start getting better over time on their own or
they might get worse
- another phenomenon called reggression to the mean
- top 10 studenst and do more testing, from this top group there will be people
who were luckier in guessing and others who knew as much but not lucky
with the guess
- and so of the top 10 there will be a variation in scores again
- happening with diseases again when you look at the responders
- other things as well
- somewhere in there is the general placebo effect
- tease out these things
- in panel B shows you can accommodate natural progression by assigning
patients with the drug at random times
- starting the placebo vs drug is randomized
- this is a standar design now
- another factor too
- heres the effect of the drug and the effect of the placebo
- drug interacts with the response to the placebo stimuli
- more or less susceptible to placebo effect
- how the pharmaceutical industry approaches the issue
- whether the treatment is expectation or effect
Document Summary
When johnson was talking about this when nothing may be real. Modulating expectations, mood and personalities and other factors. More or less susceptible to placebo effect. Whether the treatment is expectation or effect how the pharmaceutical industry approaches the issue. With the capacity to respond to the placebo between a child or a person of alzeihmers. Mood anxiety and depression summarizing talking about the top left thing the role of cognition and expectation how you value things. What we know about placebo effect when it occurs. When you have an effect of placebo if you also give opiod antagonist the relies on certain thing placebo doesn"t work as well altering neurochemical pathways in terms of pain there are changes in the brain. When you have the placebo effect there is activation of descending pain modulatinf networks. More about what i think will happen.
