Peak B endorphin concentration in cerebrospinal fluid: reduced in chronic pain patients and increased during the placebo response

Lipman, Jonathan J.; Miller, Barney E.; Mays, Kit S.; Miller, Merry N.; North, William C.; Byrne, William L.

doi:10.1007/bf02245754

Cited by 77 publications

(30 citation statements)

References 30 publications

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“…The investigators found a disruption of placebo analgesia after naloxone administration, which indicates the involvement of endogenous opioids in the placebo analgesic effect. The involvement of the endogenous opioid network in the analgesic placebo response was then confirmed by a number of studies (148,210,220).…”

Section: Both Endogenous Opioids and Endocannabinoids May Take Part Imentioning

confidence: 84%

Placebo and the New Physiology of the Doctor-Patient Relationship

Benedetti

2013

Physiological Reviews

339

320

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Modern medicine has progressed in parallel with the advancement of biochemistry, anatomy, and physiology. By using the tools of modern medicine, the physician today can treat and prevent a number of diseases through pharmacology, genetics, and physical interventions. Besides this materia medica, the patient's mind, cognitions, and emotions play a central part as well in any therapeutic outcome, as investigated by disciplines such as psychoneuroendocrinoimmunology. This review describes recent findings that give scientific evidence to the old tenet that patients must be both cured and cared for. In fact, we are today in a good position to investigate complex psychological factors, like placebo effects and the doctor-patient relationship, by using a physiological and neuroscientific approach. These intricate psychological factors can be approached through biochemistry, anatomy, and physiology, thus eliminating the old dichotomy between biology and psychology. This is both a biomedical and a philosophical enterprise that is changing the way we approach and interpret medicine and human biology. In the first case, curing the disease only is not sufficient, and care of the patient is of tantamount importance. In the second case, the philosophical debate about the mind-body interaction can find some important answers in the study of placebo effects. Therefore, maybe paradoxically, the placebo effect and the doctor-patient relationship can be approached by using the same biochemical, cellular and physiological tools of the materia medica, which represents an epochal transition from general concepts such as suggestibility and power of mind to a true physiology of the doctor-patient interaction. I.WHAT I. WHAT IS A PLACEBO RESPONSE? A. Placebos Were Introduced to Validate the Efficacy of Medical TreatmentsAncient physicians have always used bizarre and odd treatments to cure their patients, with scarce, if any, knowledge of anatomy and physiology. As the anatomical and physiological details of both the animal and the human body started emerging, the need of a scientific explanation of many medical treatments became an imperative objective of physicians and the scientific community. An important historical period whereby scientific skepticism emerged about the efficacy of some medical remedies is approximately in the second half of 1700 and involved treatments like mesmerism, perkinism, and homeopathy (178).To take mesmerism as an example, this was introduced in the second half of 1700 by Franz Anton Mesmer, who claimed to have discovered a healing fluid which he called animal magnetism. To assess the very nature and the efficacy of mesmerism in treating many diseases and symptoms, Louis XVI appointed a commission that was headed by Benjamin Franklin. This commission performed what can be considered one of the first blind assessments and sham (placebo) interventions in the history of medicine. Some women were blindfolded and asked where the mesmeric energy was being applied. As reported by the members of the commission th...

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Section: Both Endogenous Opioids and Endocannabinoids May Take Part Imentioning

confidence: 84%

Placebo and the New Physiology of the Doctor-Patient Relationship

Benedetti

2013

Physiological Reviews

339

320

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“…A modified Logan graphical analysis (Logan et al, 1996) was used to calculate the tracer transport and BP ND , obviating the need for arterial blood sampling. The occipital cortex, an area devoid of MORs, was used as the reference region.…”

Section: Methodsmentioning

confidence: 99%

Alterations in Endogenous Opioid Functional Measures in Chronic Back Pain

et al. 2013

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The absence of consistent end organ abnormalities in many chronic pain syndromes has led to a search for maladaptive CNS mechanisms that may explain their clinical presentations and course. Here, we addressed the role of brain regional -opioid receptor-mediated neurotransmission, one of the best recognized mechanisms of pain regulation, in chronic back pain in human subjects. We compared -opioid receptor availability in vivo at baseline, during pain expectation, and with moderate levels of sustained pain in 16 patients with chronic nonspecific back pain (CNBP) and in 16 age-and gender-matched healthy control subjects, using the -opioid receptor-selective radioligand [ 11 C]carfentanil and positron emission tomography. We found that CNBP patients showed baseline increases in thalamic -opioid receptor availability, contrary to a previously studied sample of patients diagnosed with fibromyalgia. During both pain expectation and sustained pain challenges, CNBP patients showed regional reductions in the capacity to activate this neurotransmitter system compared with their control sample, further associated with clinical pain and affective state ratings. Our results demonstrate heterogeneity in endogenous opioid system functional measures across pain conditions, and alterations in both receptor availability and endogenous opioid function in CNBP that are relevant to the clinical presentation of these patients and the effects of opioid analgesics on -opioid receptors.

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“…1). In one additional study in chronic pain patients, it was found that placebo responders showed higher concentration of endorphins in the CSF than placebo nonresponders (Lipman et al, 1990).…”

Section: The Pharmacological Approachmentioning

confidence: 96%