Neurobiology of Placebos (BSP 122)

Understanding the neurobiology of placebos could have a huge impact on the lives of both patients and physicians, but it remains a relatively under appreciated area of research. This month I am reposting the interview I conducted with Dr. Fabrizio Benedetti (University of Turin). Dr. Benedetti is the recognized leader in this field and his has published two highly readable books: The Patient's Brain: The neuroscience behind the doctor-patient relationship and Placebo Effects: Understanding the mechanisms in health and disease (now in its 2nd edition).

First, it is critical to appreciate the difference between the neurobiologist's approach to placebo compared to its use in clinical research.  Dr. Benedetti explained, "To the clinical trialist, a placebo effect means any improvement which may take place after placebo administration.  To the neurobiologist, a placebo response, or placebo effect means only something active in the brain happening after placebo administration: learning, anxiety reduction, activation of reward mechanisms." But "The real placebo response, the real placebo effect is a psychobiological phenomenon.  It is something active happening in the brain after placebo administration: like learning, like anxiety reduction, and such like."

This means that from the neurobiological perspective the placebo response is a real neurobiological phenomena, which can be measure objectively. It is anything that is not caused by the active treatment or medication, which means it can also occur when one gets an active treatment. An example would be when a patient gets greater pain relief when they know they have gotten medication than they do when the medicine is given without their knowledge.

This interview is an excellent introduction to the topic and I hope to interview Dr. Benedetti again soon to get an update on his research efforts.

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