The imagined itch: brain circuitry supporting nocebo‐induced itch in atopic dermatitis patients
Background Psychological factors are known to significantly modulate itch in patients suffering from chronic itch. Itch is also highly susceptible to both placebo and nocebo (negative placebo) effects. Brain activity likely supports nocebo‐induced itch, but is currently unknown. Methods We collected...
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| Published in | Allergy (Copenhagen) Vol. 70; no. 11; pp. 1485 - 1492 |
|---|---|
| Main Authors | , , , , , , , , , , , , |
| Format | Journal Article |
| Language | English |
| Published |
Denmark
Blackwell Publishing Ltd
01.11.2015
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| Subjects | |
| Online Access | Get full text |
| ISSN | 0105-4538 1398-9995 1398-9995 |
| DOI | 10.1111/all.12727 |
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| Abstract | Background
Psychological factors are known to significantly modulate itch in patients suffering from chronic itch. Itch is also highly susceptible to both placebo and nocebo (negative placebo) effects. Brain activity likely supports nocebo‐induced itch, but is currently unknown.
Methods
We collected functional MRI (fMRI) data from atopic dermatitis (AD) patients, in a within‐subject design, and contrast brain response to nocebo saline understood to be allergen vs open‐label saline control. Exploratory analyses compared results to real allergen itch response and placebo responsiveness, evaluated in the same patients.
Results
Nocebo saline produced greater itch than open saline control (P < 0.01). Compared to open saline, nocebo saline demonstrated greater fMRI response in caudate, dorsolateral prefrontal cortex (dlPFC), and intraparietal sulcus (iPS) – brain regions important for cognitive executive and motivational processing. Exploratory analyses found that subjects with greater dlPFC and caudate activation to nocebo‐induced itch also demonstrated greater dlPFC and caudate activation, respectively, for real allergen itch. Subjects reporting greater nocebo‐induced itch also demonstrated greater placebo reduction of allergen‐evoked itch, suggesting increased generalized modulation of itch perception.
Conclusions
Our study demonstrates the capacity of nocebo saline to mimic both the sensory and neural effects of real allergens and provides an insight to the brain mechanisms supporting nocebo‐induced itch in AD, thus aiding our understanding of the role that expectations and other psychological factors play in modulating itch perception in chronic itch patients. |
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| AbstractList | Psychological factors are known to significantly modulate itch in patients suffering from chronic itch. Itch is also highly susceptible to both placebo and nocebo (negative placebo) effects. Brain activity likely supports nocebo-induced itch, but is currently unknown.BACKGROUNDPsychological factors are known to significantly modulate itch in patients suffering from chronic itch. Itch is also highly susceptible to both placebo and nocebo (negative placebo) effects. Brain activity likely supports nocebo-induced itch, but is currently unknown.We collected functional MRI (fMRI) data from atopic dermatitis (AD) patients, in a within-subject design, and contrast brain response to nocebo saline understood to be allergen vs open-label saline control. Exploratory analyses compared results to real allergen itch response and placebo responsiveness, evaluated in the same patients.METHODSWe collected functional MRI (fMRI) data from atopic dermatitis (AD) patients, in a within-subject design, and contrast brain response to nocebo saline understood to be allergen vs open-label saline control. Exploratory analyses compared results to real allergen itch response and placebo responsiveness, evaluated in the same patients.Nocebo saline produced greater itch than open saline control (P < 0.01). Compared to open saline, nocebo saline demonstrated greater fMRI response in caudate, dorsolateral prefrontal cortex (dlPFC), and intraparietal sulcus (iPS) - brain regions important for cognitive executive and motivational processing. Exploratory analyses found that subjects with greater dlPFC and caudate activation to nocebo-induced itch also demonstrated greater dlPFC and caudate activation, respectively, for real allergen itch. Subjects reporting greater nocebo-induced itch also demonstrated greater placebo reduction of allergen-evoked itch, suggesting increased generalized modulation of itch perception.RESULTSNocebo saline produced greater itch than open saline control (P < 0.01). Compared to open saline, nocebo saline demonstrated greater fMRI response in caudate, dorsolateral prefrontal cortex (dlPFC), and intraparietal sulcus (iPS) - brain regions important for cognitive executive and motivational processing. Exploratory analyses found that subjects with greater dlPFC and caudate activation to nocebo-induced itch also demonstrated greater dlPFC and caudate activation, respectively, for real allergen itch. Subjects reporting greater nocebo-induced itch also demonstrated greater placebo reduction of allergen-evoked itch, suggesting increased generalized modulation of itch perception.Our study demonstrates the capacity of nocebo saline to mimic both the sensory and neural effects of real allergens and provides an insight to the brain mechanisms supporting nocebo-induced itch in AD, thus aiding our understanding of the role that expectations and other psychological factors play in modulating itch perception in chronic itch patients.CONCLUSIONSOur study demonstrates the capacity of nocebo saline to mimic both the sensory and neural effects of real allergens and provides an insight to the brain mechanisms supporting nocebo-induced itch in AD, thus aiding our understanding of the role that expectations and other psychological factors play in modulating itch perception in chronic itch patients. Background Psychological factors are known to significantly modulate itch in patients suffering from chronic itch. Itch is also highly susceptible to both placebo and nocebo (negative placebo) effects. Brain activity likely supports nocebo-induced itch, but is currently unknown. Methods We collected functional MRI (fMRI) data from atopic dermatitis (AD) patients, in a within-subject design, and contrast brain response to nocebo saline understood to be allergen vs open-label saline control. Exploratory analyses compared results to real allergen itch response and placebo responsiveness, evaluated in the same patients. Results Nocebo saline produced greater itch than open saline control (P < 0.01). Compared to open saline, nocebo saline demonstrated greater fMRI response in caudate, dorsolateral prefrontal cortex (dlPFC), and intraparietal sulcus (iPS) - brain regions important for cognitive executive and motivational processing. Exploratory analyses found that subjects with greater dlPFC and caudate activation to nocebo-induced itch also demonstrated greater dlPFC and caudate activation, respectively, for real allergen itch. Subjects reporting greater nocebo-induced itch also demonstrated greater placebo reduction of allergen-evoked itch, suggesting increased generalized modulation of itch perception. Conclusions Our study demonstrates the capacity of nocebo saline to mimic both the sensory and neural effects of real allergens and provides an insight to the brain mechanisms supporting nocebo-induced itch in AD, thus aiding our understanding of the role that expectations and other psychological factors play in modulating itch perception in chronic itch patients. Psychological factors are known to significantly modulate itch in patients suffering from chronic itch. Itch is also highly susceptible to both placebo and nocebo (negative placebo) effects. Brain activity likely supports nocebo-induced itch, but is currently unknown. We collected functional MRI (fMRI) data from atopic dermatitis (AD) patients, in a within-subject design, and contrast brain response to nocebo saline understood to be allergen vs open-label saline control. Exploratory analyses compared results to real allergen itch response and placebo responsiveness, evaluated in the same patients. Nocebo saline produced greater itch than open saline control (P < 0.01). Compared to open saline, nocebo saline demonstrated greater fMRI response in caudate, dorsolateral prefrontal cortex (dlPFC), and intraparietal sulcus (iPS) - brain regions important for cognitive executive and motivational processing. Exploratory analyses found that subjects with greater dlPFC and caudate activation to nocebo-induced itch also demonstrated greater dlPFC and caudate activation, respectively, for real allergen itch. Subjects reporting greater nocebo-induced itch also demonstrated greater placebo reduction of allergen-evoked itch, suggesting increased generalized modulation of itch perception. Our study demonstrates the capacity of nocebo saline to mimic both the sensory and neural effects of real allergens and provides an insight to the brain mechanisms supporting nocebo-induced itch in AD, thus aiding our understanding of the role that expectations and other psychological factors play in modulating itch perception in chronic itch patients. Background Psychological factors are known to significantly modulate itch in patients suffering from chronic itch. Itch is also highly susceptible to both placebo and nocebo (negative placebo) effects. Brain activity likely supports nocebo‐induced itch, but is currently unknown. Methods We collected functional MRI (fMRI) data from atopic dermatitis (AD) patients, in a within‐subject design, and contrast brain response to nocebo saline understood to be allergen vs open‐label saline control. Exploratory analyses compared results to real allergen itch response and placebo responsiveness, evaluated in the same patients. Results Nocebo saline produced greater itch than open saline control (P < 0.01). Compared to open saline, nocebo saline demonstrated greater fMRI response in caudate, dorsolateral prefrontal cortex (dlPFC), and intraparietal sulcus (iPS) – brain regions important for cognitive executive and motivational processing. Exploratory analyses found that subjects with greater dlPFC and caudate activation to nocebo‐induced itch also demonstrated greater dlPFC and caudate activation, respectively, for real allergen itch. Subjects reporting greater nocebo‐induced itch also demonstrated greater placebo reduction of allergen‐evoked itch, suggesting increased generalized modulation of itch perception. Conclusions Our study demonstrates the capacity of nocebo saline to mimic both the sensory and neural effects of real allergens and provides an insight to the brain mechanisms supporting nocebo‐induced itch in AD, thus aiding our understanding of the role that expectations and other psychological factors play in modulating itch perception in chronic itch patients. |
| Author | Schalock, P. C. Rosen, B. R. Pfab, F. Napadow, V. Ring, J. Kaptchuk, T. J. Li, A. Mawla, I. Kim, J. Tran, T. N. Lerner, E. A. Desbordes, G. Loggia, M.L. |
| AuthorAffiliation | 3 Department of Dermatology, Massachusetts General Hospital, Harvard Medical School, Boston, MA, 02129, USA 5 Program in Placebo Studies, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, MA, 02215, USA 1 Martinos Center for Biomedical Imaging, Massachusetts General Hospital, Harvard Medical School, Charlestown, MA, 02129, USA 2 Department of Radiology, Logan University, Chesterfield, MO, 63017, USA 4 Department of Dermatology and Allergy, Technische Universität München, Munich, 85748, Germany 6 Department of Prevention and Sports Medicine, Technische Universität München, Munich, 85748, Germany |
| AuthorAffiliation_xml | – name: 1 Martinos Center for Biomedical Imaging, Massachusetts General Hospital, Harvard Medical School, Charlestown, MA, 02129, USA – name: 2 Department of Radiology, Logan University, Chesterfield, MO, 63017, USA – name: 3 Department of Dermatology, Massachusetts General Hospital, Harvard Medical School, Boston, MA, 02129, USA – name: 6 Department of Prevention and Sports Medicine, Technische Universität München, Munich, 85748, Germany – name: 4 Department of Dermatology and Allergy, Technische Universität München, Munich, 85748, Germany – name: 5 Program in Placebo Studies, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, MA, 02215, USA |
| Author_xml | – sequence: 1 givenname: V. surname: Napadow fullname: Napadow, V. organization: Logan University – sequence: 2 givenname: A. surname: Li fullname: Li, A. organization: Harvard Medical School – sequence: 3 givenname: M.L. surname: Loggia fullname: Loggia, M.L. organization: Harvard Medical School – sequence: 4 givenname: J. surname: Kim fullname: Kim, J. organization: Harvard Medical School – sequence: 5 givenname: I. surname: Mawla fullname: Mawla, I. organization: Harvard Medical School – sequence: 6 givenname: G. surname: Desbordes fullname: Desbordes, G. organization: Harvard Medical School – sequence: 7 givenname: P. C. surname: Schalock fullname: Schalock, P. C. organization: Harvard Medical School – sequence: 8 givenname: E. A. surname: Lerner fullname: Lerner, E. A. organization: Harvard Medical School – sequence: 9 givenname: T. N. surname: Tran fullname: Tran, T. N. organization: Harvard Medical School – sequence: 10 givenname: J. surname: Ring fullname: Ring, J. organization: Technische Universität München – sequence: 11 givenname: B. R. surname: Rosen fullname: Rosen, B. R. organization: Harvard Medical School – sequence: 12 givenname: T. J. surname: Kaptchuk fullname: Kaptchuk, T. J. organization: Harvard Medical School – sequence: 13 givenname: F. surname: Pfab fullname: Pfab, F. organization: Technische Universität München |
| BackLink | https://www.ncbi.nlm.nih.gov/pubmed/26280659$$D View this record in MEDLINE/PubMed |
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| Keywords | pruritus atopic dermatitis caudate placebo nocebo |
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Psychological factors are known to significantly modulate itch in patients suffering from chronic itch. Itch is also highly susceptible to both... Psychological factors are known to significantly modulate itch in patients suffering from chronic itch. Itch is also highly susceptible to both placebo and... Background Psychological factors are known to significantly modulate itch in patients suffering from chronic itch. Itch is also highly susceptible to both... |
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| SubjectTerms | Adolescent Adult Allergens - immunology atopic dermatitis Brain - physiopathology caudate Dermatitis Dermatitis, Atopic - diagnosis Dermatitis, Atopic - psychology Female Humans Magnetic Resonance Imaging Male Neuropsychology nocebo Nocebo Effect placebo pruritus Pruritus - diagnosis Pruritus - psychology Sensory perception Skin Tests Young Adult |
| Title | The imagined itch: brain circuitry supporting nocebo‐induced itch in atopic dermatitis patients |
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