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Brain activity associated with expectancy-enhanced placebo analgesia as measured by functional magnetic resonance imaging.

In this study, a well established expectancy manipulation model was combined with a novel placebo intervention, a validated sham acupuncture needle, to investigate the brain network involved in placebo analgesia. Sixteen subjects completed the experiment. We found that after placebo acupuncture treatment, subjective pain rating reduction (pre minus post) on the placebo-treated side was significantly greater than on the control side. When we calculated the contrast that subtracts the functional magnetic resonance imaging (fMRI) signal difference between post-treatment and pretreatment during pain application on placebo side from the same difference on control side [e.g., placebo (post - pre) - control (post - pre)], significant differences were observed in the bilateral rostral anterior cingulate cortex (rACC), lateral prefrontal cortex, right anterior insula, supramarginal gyrus, and left inferior parietal lobule. The simple regression (correlation) analysis between each subject's fMRI signal difference of post-treatment and pretreatment difference on placebo and control side and the corresponding subjective pain rating difference showed that significant negative correlation was observed in the bilateral lateral/orbital prefrontal cortex, rACC, cerebellum, right fusiform, parahippocampus, and pons. These results are different from a previous study that found decreased activity in pain-sensitive regions such as the thalamus, insula, and ACC when comparing the response to noxious stimuli applied to control and placebo cream-treated areas of the skin. Our results suggest that placebo analgesia may be configured through multiple brain pathways and mechanisms.

Pubmed ID: 16407533


  • Kong J
  • Gollub RL
  • Rosman IS
  • Webb JM
  • Vangel MG
  • Kirsch I
  • Kaptchuk TJ


The Journal of neuroscience : the official journal of the Society for Neuroscience

Publication Data

January 11, 2006

Associated Grants

  • Agency: NCCIH NIH HHS, Id: P01-AT002048
  • Agency: NCCIH NIH HHS, Id: R21 AT002860
  • Agency: NCCIH NIH HHS, Id: R21 AT00949

Mesh Terms

  • Acupuncture Analgesia
  • Adult
  • Brain Mapping
  • Cerebellum
  • Cerebral Cortex
  • Culture
  • Echo-Planar Imaging
  • Female
  • Forearm
  • Gyrus Cinguli
  • Hot Temperature
  • Humans
  • Magnetic Resonance Imaging
  • Male
  • Pain
  • Pain Measurement
  • Parahippocampal Gyrus
  • Parietal Lobe
  • Placebo Effect
  • Pons
  • Prefrontal Cortex