The context of values in pain control: understanding the price effect in placebo analgesia.


Author: Lee YS1, Jung WM2, Bingel U3, Chae Y4

Affiliation: <sup>1</sup>Acupuncture and Meridian Science Research Center, College of Korean Medicine, Kyung Hee University, Seoul, Korea; Department of Anatomy and Acupoint, College of Korean Medicine, Gachon University, Seongnam, Korea.

<sup>2</sup>Acupuncture and Meridian Science Research Center, College of Korean Medicine, Kyung Hee University, Seoul, Korea.

<sup>3</sup>Department of Neurology, Essen University Hospital, Essen, Germany.

<sup>4</sup>Acupuncture and Meridian Science Research Center, College of Korean Medicine, Kyung Hee University, Seoul, Korea; Department of Neurology, Essen University Hospital, Essen, Germany. Electronic address: ybchae@khu.ac.kr.
Conference/Journal: J Pain.
Date published: 2019 Nov 13
Other:
  Pages: S1526-5900(19)30854-5   ,  Special Notes: doi: 10.1016/j.jpain.2019.11.005. [Epub ahead of print]   ,  Word Count: 245  
    The experience of pain relief arises from physiological and psychological factors, and attributes such as the commercial features of analgesic treatments have been shown to influence placebo analgesia by affecting treatment expectations. Therefore, treatment valuation from price information should influence the placebo analgesic effect. This hypothesis was tested in a functional magnetic resonance imaging (fMRI) study in which healthy subjects were enrolled in a two-day experiment. On day 1, the participants (n=19) had treatment experiences with two different placebo creams during a conditioning session without receiving information on treatment price. On day 2, placebo analgesia was tested after providing price information (high vs. low) while fMRI was performed. The results showed that the higher-priced placebo treatment lead to enhanced pain relief. Placebo analgesia in response to the higher priced treatment was associated with activity in the ventral striatum, ventromedial prefrontal cortex and ventral tegmental area. The behavioral results indicate that the experience of pain was influenced by treatment valuation from price. Our findings reveal that the context of values in pain control is associated with activity in expectation- and reward-related circuitry. Perspective: Treatment with higher price was associated with enhanced placebo analgesia, and this effect was influenced by activities in expectation and reward processing brain areas. The context of value such as medical cost influences cognitive evaluation processes to modulate pain. Our study may help evaluate a patient's preference toward high-priced drugs.



Copyright © 2019. Published by Elsevier Inc.



KEYWORDS: pain; placebo; price; reward; valuation



PMID: 31733362  DOI: 10.1016/j.jpain.2019.11.005