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The “Nocebo” Effect on the Brainstem and Chronic Pain

Your brain is so powerful that it can trick the body to believe it is healing with medicine when your body has ingested no medicine at all.

Is healing in the brain and we just have to figure out better ways to trick the brain into healing the body?

Studies have long showed that the placebo effect gives just as much powerful relief as actual medicines sometimes. But a new study is delving into how placebos and their fake therapies with fake side effects have real impact on your brain. Studies like this can help scientists learn and create more effective and better treatments for chronic pain sufferers.

How can a sugar pill be just as effective to relieve certain pains in certain patients than medicines with active ingredients? Some patients, however, can be told a pill has harmful side effects that result in the patients feeling harmful side effects when the pill actually has no active ingredients. This phenomenon is called the “nocebo” effect. Is it the medicine, our brains’ processes or a combination of both that control pain and healing?

Researchers at the University of Melbourne brought 27 participants in to try and understand the placebo-nocebo effect. Of the 27 participants, 14 were women and 13 were men. They average in age around 23. The researchers put a device called a “thermode” on each participants arm that heated to a moderate but painful temperature. The participants were then told they were applying one of three creams to the painful area. The three creams included a pain reliever, a pain inducer that would make pain worse, and a control cream that will have no effect. But the participants were unaware that all three creams were just petroleum jelly labeled differently.

The scientists then used functional magnetic resonance imaging (fMRI) to scan the participants to detect areas of the brain that were most active. Close to one-third of the participants reported less pain after the “pain reliever” cream was applied. More than half the participants reported more pain when the “pain inducer” was applied (the nocebo).

The researchers reported in The Journal of Neuroscience that the imaging results of this study indicate that “both the placebo and nocebo effects influenced activity in the brain stem.” Specifically, the imaging indicated that the participants who reported less pain after the “pain reliever” was applied showed an increased activity in the area of the brain called “rostral ventromedial medulla” and decreased activity in the periaqueductal gray (PAG), which is the “primary control center for descending pain modulation,” i.e. it produces cells that suppress pain. The study indicated that the participants experiencing the nocebo effect had the opposite brain responses.

Because the study was done using high resolution fMRI, it helps doctors more specifically identify which parts of the brainstem that play more critical roles in pain control.

Lewis Crawford, a neuroscientists and lead researcher,, says this study may open up new avenues of treating chronic pain. For decades, as Crawford indicated, doctors have been using deep brain stimulation with only mixed success, to treat burning “neuropathic” pains. These types of pains are normally caused by nerve damage. Deep brain stimulation have been used to treat carpal tunnel syndrome, and cancer-related pains as well. The difficulty with this treatment, however, has always been an inability to identify which parts of the brainstem was causing the modulation of pain. Now by narrowing the nocebo-and-placebo-induced sensations to more specific brain locations, this new Melbourne study could help doctors focus more precisely the areas of the brain that need to be stimulated to reduce pain.

About the blogger: ShonSpeaks is the managing member of the The Fleming-Bruce Law Firm, P.L.L.C.. She also has her own blog at and is is a certified brain health professional. If you would like to know more about brain health and what you can do to strengthen your brain function and develop brain envy, connect with me at

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