Placebo analgesia Predrag Petrovic, MD, PhD Karolinska Institute, Stockholm, Sweden Wellcome...

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Placebo analgesia Predrag Petrovic, MD, PhD Karolinska Institute, Stockholm, Sweden Wellcome Institute of congnitive Neuroscience, London, UK

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Page 1: Placebo analgesia Predrag Petrovic, MD, PhD Karolinska Institute, Stockholm, Sweden Wellcome Institute of congnitive Neuroscience, London, UK.

Placebo analgesia

Predrag Petrovic, MD, PhDKarolinska Institute, Stockholm, Sweden

Wellcome Institute of congnitive Neuroscience, London, UK

Page 2: Placebo analgesia Predrag Petrovic, MD, PhD Karolinska Institute, Stockholm, Sweden Wellcome Institute of congnitive Neuroscience, London, UK.

Cognition and pain

Page 3: Placebo analgesia Predrag Petrovic, MD, PhD Karolinska Institute, Stockholm, Sweden Wellcome Institute of congnitive Neuroscience, London, UK.

Ret

SBlSTTaSTT

Amy

PAG

PBn

dlPT / LC

RVM

mObfc

vmPfc

rACC

cACC

lObfc

Ant Ins

Post Ins

MDvcILVMp/bVMP VPL VPI

S2 / iPC

S1Hyp

vlPFC

Basal gangliaBasal ganglia

Page 4: Placebo analgesia Predrag Petrovic, MD, PhD Karolinska Institute, Stockholm, Sweden Wellcome Institute of congnitive Neuroscience, London, UK.

Main effect of pain

Petrovic et al Science 295 (1737-1740) 2003

Page 5: Placebo analgesia Predrag Petrovic, MD, PhD Karolinska Institute, Stockholm, Sweden Wellcome Institute of congnitive Neuroscience, London, UK.
Page 6: Placebo analgesia Predrag Petrovic, MD, PhD Karolinska Institute, Stockholm, Sweden Wellcome Institute of congnitive Neuroscience, London, UK.
Page 7: Placebo analgesia Predrag Petrovic, MD, PhD Karolinska Institute, Stockholm, Sweden Wellcome Institute of congnitive Neuroscience, London, UK.
Page 8: Placebo analgesia Predrag Petrovic, MD, PhD Karolinska Institute, Stockholm, Sweden Wellcome Institute of congnitive Neuroscience, London, UK.
Page 9: Placebo analgesia Predrag Petrovic, MD, PhD Karolinska Institute, Stockholm, Sweden Wellcome Institute of congnitive Neuroscience, London, UK.
Page 10: Placebo analgesia Predrag Petrovic, MD, PhD Karolinska Institute, Stockholm, Sweden Wellcome Institute of congnitive Neuroscience, London, UK.

Jackson et al Neuroimage 771-779 2005

Can we feel pain wihout noxious input

Page 11: Placebo analgesia Predrag Petrovic, MD, PhD Karolinska Institute, Stockholm, Sweden Wellcome Institute of congnitive Neuroscience, London, UK.

Jackson et al Neuroimage 771-779 2005

Can we feel pain wihout noxious input

Page 12: Placebo analgesia Predrag Petrovic, MD, PhD Karolinska Institute, Stockholm, Sweden Wellcome Institute of congnitive Neuroscience, London, UK.

Anticipation of pain

Jensen et al Neuron 40 1251-1257 2003

Page 13: Placebo analgesia Predrag Petrovic, MD, PhD Karolinska Institute, Stockholm, Sweden Wellcome Institute of congnitive Neuroscience, London, UK.

Empathy for pain

Singer et al Science 1157-1152 2004

Page 14: Placebo analgesia Predrag Petrovic, MD, PhD Karolinska Institute, Stockholm, Sweden Wellcome Institute of congnitive Neuroscience, London, UK.

vs.

Saarelet al Cerebral Cortex 2006

Empathy for pain

Page 15: Placebo analgesia Predrag Petrovic, MD, PhD Karolinska Institute, Stockholm, Sweden Wellcome Institute of congnitive Neuroscience, London, UK.

Petrovic et al Pain 85 (1-2) 2000

Distraction and pain

Page 16: Placebo analgesia Predrag Petrovic, MD, PhD Karolinska Institute, Stockholm, Sweden Wellcome Institute of congnitive Neuroscience, London, UK.

?

Page 17: Placebo analgesia Predrag Petrovic, MD, PhD Karolinska Institute, Stockholm, Sweden Wellcome Institute of congnitive Neuroscience, London, UK.

Cognitive modulation of pain

Page 18: Placebo analgesia Predrag Petrovic, MD, PhD Karolinska Institute, Stockholm, Sweden Wellcome Institute of congnitive Neuroscience, London, UK.

Placebo analgesia

Page 19: Placebo analgesia Predrag Petrovic, MD, PhD Karolinska Institute, Stockholm, Sweden Wellcome Institute of congnitive Neuroscience, London, UK.

Bottlenecks in Placebo analgesia

Expectation Opioid system

Page 20: Placebo analgesia Predrag Petrovic, MD, PhD Karolinska Institute, Stockholm, Sweden Wellcome Institute of congnitive Neuroscience, London, UK.

Pain presentation

Treatment expectation and Placebo analgesia

Expectation manipulationand learning

Placebo manipulation

Rating: 75 Rating: 25 Rating: 50

Voundouris et al J Per Soc Psychol 48 (47-53) 1985Voundouris et al pain 38 (109-116) 1989Voundouris et al pain 43 (121-128) 1990Montgomery and Kirsch Pain 72 (107-113) 1997

Placebo cream Placebo cream

Page 21: Placebo analgesia Predrag Petrovic, MD, PhD Karolinska Institute, Stockholm, Sweden Wellcome Institute of congnitive Neuroscience, London, UK.

Opioid analgesia Placebo analgesia

Naloxone

- -

The Opioid system and Placebo analgesia

Page 22: Placebo analgesia Predrag Petrovic, MD, PhD Karolinska Institute, Stockholm, Sweden Wellcome Institute of congnitive Neuroscience, London, UK.

pop wop

ppl wpl

wp

HeatPain

Non-painfulWarrm stim

Opioids (remifentanil)

Placebo (saline)

No treatment

Placebo and opioid analgesia

Petrovic et al Science 295 (1737-1740) 2003

Page 23: Placebo analgesia Predrag Petrovic, MD, PhD Karolinska Institute, Stockholm, Sweden Wellcome Institute of congnitive Neuroscience, London, UK.

Pain network

Petrovic et al Science 295 (1737-1740) 2003

Page 24: Placebo analgesia Predrag Petrovic, MD, PhD Karolinska Institute, Stockholm, Sweden Wellcome Institute of congnitive Neuroscience, London, UK.

Opioid effects and Placebo analgesia

(PPL – P)(POP+WOP)-(P+W)

Petrovic et al Science 295 (1737-1740) 2003

Page 25: Placebo analgesia Predrag Petrovic, MD, PhD Karolinska Institute, Stockholm, Sweden Wellcome Institute of congnitive Neuroscience, London, UK.

Orbitofrontal cortex

(PPL – P)

Petrovic et al Science 295 (1737-1740) 2003

Page 26: Placebo analgesia Predrag Petrovic, MD, PhD Karolinska Institute, Stockholm, Sweden Wellcome Institute of congnitive Neuroscience, London, UK.

Kong et al. J Neurosci. 2006 Jan 11;26(2):381-8.

Placebo and expectation modulation

Page 27: Placebo analgesia Predrag Petrovic, MD, PhD Karolinska Institute, Stockholm, Sweden Wellcome Institute of congnitive Neuroscience, London, UK.

Bingel et al. Pain. 2006 Jan;120(1-2):8-15

Placebo and expectation modulation

Page 28: Placebo analgesia Predrag Petrovic, MD, PhD Karolinska Institute, Stockholm, Sweden Wellcome Institute of congnitive Neuroscience, London, UK.

Wager et al. Science. 2004 Feb 20;303(5661):1162-7.

Placebo and expectation modulation

Page 29: Placebo analgesia Predrag Petrovic, MD, PhD Karolinska Institute, Stockholm, Sweden Wellcome Institute of congnitive Neuroscience, London, UK.

Wager et al. Science. 2004 Feb 20;303(5661):1162-7.

Placebo and expectation modulation

Page 30: Placebo analgesia Predrag Petrovic, MD, PhD Karolinska Institute, Stockholm, Sweden Wellcome Institute of congnitive Neuroscience, London, UK.

Lieberman et al. Neuroimage. 2004 May;22(1):447-55.

Placebo in chronic pain patients

Page 31: Placebo analgesia Predrag Petrovic, MD, PhD Karolinska Institute, Stockholm, Sweden Wellcome Institute of congnitive Neuroscience, London, UK.

Placebo analgesia effect- activation of cognitive modulatory network

Page 32: Placebo analgesia Predrag Petrovic, MD, PhD Karolinska Institute, Stockholm, Sweden Wellcome Institute of congnitive Neuroscience, London, UK.

ACC and Placebo

Page 33: Placebo analgesia Predrag Petrovic, MD, PhD Karolinska Institute, Stockholm, Sweden Wellcome Institute of congnitive Neuroscience, London, UK.

Opioid effects and Placebo analgesia

Petrovic et al Science 295 (1737-1740) 2003

Page 34: Placebo analgesia Predrag Petrovic, MD, PhD Karolinska Institute, Stockholm, Sweden Wellcome Institute of congnitive Neuroscience, London, UK.

The Cortical Opioid System

Rostral ACC

Willoch et al 1999

Page 35: Placebo analgesia Predrag Petrovic, MD, PhD Karolinska Institute, Stockholm, Sweden Wellcome Institute of congnitive Neuroscience, London, UK.

High Placebo responders Low Placebo responders

Opioid analgesia

(POP-P)(POP-P)

Petrovic et al Science 295 (1737-1740) 2003

Page 36: Placebo analgesia Predrag Petrovic, MD, PhD Karolinska Institute, Stockholm, Sweden Wellcome Institute of congnitive Neuroscience, London, UK.

Opioid receptor imaging

Zubieta et al 2005

Page 37: Placebo analgesia Predrag Petrovic, MD, PhD Karolinska Institute, Stockholm, Sweden Wellcome Institute of congnitive Neuroscience, London, UK.

Filelds et al Nature NeuroscienceReviews 2004

Page 38: Placebo analgesia Predrag Petrovic, MD, PhD Karolinska Institute, Stockholm, Sweden Wellcome Institute of congnitive Neuroscience, London, UK.

POP PPL P

Regression analysis

Petrovic et al Science 295 (1737-1740) 2003

Page 39: Placebo analgesia Predrag Petrovic, MD, PhD Karolinska Institute, Stockholm, Sweden Wellcome Institute of congnitive Neuroscience, London, UK.

Emotional Counting Stroop

Counting Stroop

ThreeThreeThreeThree

MurderMurderMurderMurder

Bush et a. Trends in Cognitive Sciences 4 (6) 2000

ACC and Cognition - Conflict monitoring or conflict resolution ?

Page 40: Placebo analgesia Predrag Petrovic, MD, PhD Karolinska Institute, Stockholm, Sweden Wellcome Institute of congnitive Neuroscience, London, UK.

• Anterior Cingulate Cortex: – Interaction with cognitive attentional systems

that regulate conflicting processes.– Modulation of pain processing through opioid

system.

Page 41: Placebo analgesia Predrag Petrovic, MD, PhD Karolinska Institute, Stockholm, Sweden Wellcome Institute of congnitive Neuroscience, London, UK.

Obfc / vlPFC and Placebo

Page 42: Placebo analgesia Predrag Petrovic, MD, PhD Karolinska Institute, Stockholm, Sweden Wellcome Institute of congnitive Neuroscience, London, UK.

Placebo. Petrovic et al 2002

Petrovic et al Science 295 (1737-1740) 2003

Page 43: Placebo analgesia Predrag Petrovic, MD, PhD Karolinska Institute, Stockholm, Sweden Wellcome Institute of congnitive Neuroscience, London, UK.

Opioid effects:

Placebo effects:

Page 44: Placebo analgesia Predrag Petrovic, MD, PhD Karolinska Institute, Stockholm, Sweden Wellcome Institute of congnitive Neuroscience, London, UK.

Opioid effects:

Placebo effects:

Page 45: Placebo analgesia Predrag Petrovic, MD, PhD Karolinska Institute, Stockholm, Sweden Wellcome Institute of congnitive Neuroscience, London, UK.

Relation between rACC and vlPFC in Placebo 1

Page 46: Placebo analgesia Predrag Petrovic, MD, PhD Karolinska Institute, Stockholm, Sweden Wellcome Institute of congnitive Neuroscience, London, UK.

Orbitofrontal cortex- goals and expectations

Page 47: Placebo analgesia Predrag Petrovic, MD, PhD Karolinska Institute, Stockholm, Sweden Wellcome Institute of congnitive Neuroscience, London, UK.

Orbitofrontal cortex- goals and expectations

Page 48: Placebo analgesia Predrag Petrovic, MD, PhD Karolinska Institute, Stockholm, Sweden Wellcome Institute of congnitive Neuroscience, London, UK.

Orbitofrontal cortex- goals and expectations

Page 49: Placebo analgesia Predrag Petrovic, MD, PhD Karolinska Institute, Stockholm, Sweden Wellcome Institute of congnitive Neuroscience, London, UK.

Aversive temporal difference prediction error

Seymour et al Nature Neuroscience 8 (1234-1240) 2005

Page 50: Placebo analgesia Predrag Petrovic, MD, PhD Karolinska Institute, Stockholm, Sweden Wellcome Institute of congnitive Neuroscience, London, UK.

• Anterior Cingulate Cortex: – Interaction with cognitive attentional systems

that regulate conflicting processes.– Modulation of pain processing through opioid

system.

• Orbitofrontal Cortex:– Emotional and motivational goals and

expectations.– Computing errors between expected and real

outcome.

Page 51: Placebo analgesia Predrag Petrovic, MD, PhD Karolinska Institute, Stockholm, Sweden Wellcome Institute of congnitive Neuroscience, London, UK.

Emotional Placebo

Page 52: Placebo analgesia Predrag Petrovic, MD, PhD Karolinska Institute, Stockholm, Sweden Wellcome Institute of congnitive Neuroscience, London, UK.

Emotional Placebo

Page 53: Placebo analgesia Predrag Petrovic, MD, PhD Karolinska Institute, Stockholm, Sweden Wellcome Institute of congnitive Neuroscience, London, UK.

International Affective Picture System (IAPS)

Page 54: Placebo analgesia Predrag Petrovic, MD, PhD Karolinska Institute, Stockholm, Sweden Wellcome Institute of congnitive Neuroscience, London, UK.

Pain presentation

Manipulation of treatment expectation

Expectation manipulationand learning

Placebo manipulation

Rating: 75 Rating: 25 Rating: 50

Voundouris et al J Per Soc Psychol 48 (47-53) 1985Voundouris et al pain 38 (109-116) 1989Voundouris et al pain 43 (121-128) 1990Montgomery and Kirsch Pain 72 (107-113) 1997

Placebo cream Placebo cream

Page 55: Placebo analgesia Predrag Petrovic, MD, PhD Karolinska Institute, Stockholm, Sweden Wellcome Institute of congnitive Neuroscience, London, UK.

Lanexate i.v.

Bezodiazepines i.v.

5129

61

IAPS IAPS IAPS

Day 1 – Induction of expectation

Rating of unpleasantness

Page 56: Placebo analgesia Predrag Petrovic, MD, PhD Karolinska Institute, Stockholm, Sweden Wellcome Institute of congnitive Neuroscience, London, UK.

Day 2 - fMRI of the placebo effect

IAPS IAPSx3

Rating of unpleasantness

36

Information:Bezodiazepines(Anxiety reducing drug)

51

Information:Lanexate(No anxiety reduction)

Page 57: Placebo analgesia Predrag Petrovic, MD, PhD Karolinska Institute, Stockholm, Sweden Wellcome Institute of congnitive Neuroscience, London, UK.

Placebo och unpleasantness- activation of cognitive modulatory network

Petrovic et al Neuron - In Press

Page 58: Placebo analgesia Predrag Petrovic, MD, PhD Karolinska Institute, Stockholm, Sweden Wellcome Institute of congnitive Neuroscience, London, UK.

Placebo och unpleasantness- correlation with the expectation effect

Petrovic et al Neuron - In Press

Page 59: Placebo analgesia Predrag Petrovic, MD, PhD Karolinska Institute, Stockholm, Sweden Wellcome Institute of congnitive Neuroscience, London, UK.

Relation between rACC and vlPFC in Placebo

PET-study fMRI-study

Page 60: Placebo analgesia Predrag Petrovic, MD, PhD Karolinska Institute, Stockholm, Sweden Wellcome Institute of congnitive Neuroscience, London, UK.
Page 61: Placebo analgesia Predrag Petrovic, MD, PhD Karolinska Institute, Stockholm, Sweden Wellcome Institute of congnitive Neuroscience, London, UK.

Prof Martin IngvarProf Per HanssonProf Eija Kalso

Katrina CarlssonKarl Magnus Petersson

Per Hamid GhatanPeter Fransson

Jesper Andersson


10. Petrovic I. - Diferencijalna Dijagnoza Parkinsonizma

10. Petrovic I. - Diferencijalna Dijagnoza Parkinsonizma

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praxis index 1965 1973 - · PDF fileAndrija Kresic, Ivan Kuvacic, Mihailo Markovic, Gajo Petrovic, Svetozar Stojanovic, Rudi Supek, Ljubomir Tadic, Predrag Vranicki, Miladin Zivotic

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Teoria Del Servosistema (Petrovic

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AliEn in ALICE Predrag Buncic

AliEn in ALICE Predrag Buncic

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Desa Petrovic - Financial management

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Context Analysis of the...Djordje Popovic, Predrag Petrovic, Gorana Odanovic, Jelena Radoman Different versions of this paper were reviewed by BCSP (Miroslav Hadzic and Sonja Stoja-

Context Analysis of the...Djordje Popovic, Predrag Petrovic, Gorana Odanovic, Jelena Radoman Different versions of this paper were reviewed by BCSP (Miroslav Hadzic and Sonja Stoja-

Documents.tips Novinski Clanci Drazen Petrovic 1995pdf

Documents.tips Novinski Clanci Drazen Petrovic 1995pdf

Anja Petrovic Portfolio

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By Dejan Petrovic...By Dejan Petrovic Author: Dan Petrovic, Dejan SEO, 2011 - Approved for commercial re-use and citation. Link attribution mandatory.

By Dejan Petrovic...By Dejan Petrovic Author: Dan Petrovic, Dejan SEO, 2011 - Approved for commercial re-use and citation. Link attribution mandatory.

6. Predrag Milos 35-40

6. Predrag Milos 35-40

Snezana Petrovic - Energetska sertifikacija.pdf

Snezana Petrovic - Energetska sertifikacija.pdf

T-tests, ANOVA and regression Methods for Dummies February 1 st 2006 Jon Roiser and Predrag Petrovic.

T-tests, ANOVA and regression Methods for Dummies February 1 st 2006 Jon Roiser and Predrag Petrovic.

Petrovic Soco

Petrovic Soco

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Agencije Za OSJ_Mario Petrovic

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Branko Pavicevic - Petar I Petrovic Njegos

Filip Petrovic

Filip Petrovic

Maria Daskalaki, Christina Butler & Jelena Petrovic.

Maria Daskalaki, Christina Butler & Jelena Petrovic.

Predrag Hrnjak COLLEGE OF ENGINEERING ... - ains.rs · Predrag Hrnjak COLLEGE OF ... Hrnjak, Predrag Stojan Birth Date: 8/5/1952 2. Present Academic Rank: Research Professor 4. ...

Predrag Hrnjak COLLEGE OF ENGINEERING ... - ains.rs · Predrag Hrnjak COLLEGE OF ... Hrnjak, Predrag Stojan Birth Date: 8/5/1952 2. Present Academic Rank: Research Professor 4. ...