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Clinical and Applied Physiology Program at the Department of Neuroscience University of Turin Medical School Turin, Ital

Clinical and Applied Physiology Program at the Department of Neuroscience University of Turin Medical School Turin, Italy www.personalweb.unito.it / fabrizio.benedetti. Symbols. molecules. RECEPTORS. Drugs. Therapeutic effects. Negative effects. evolution.

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Clinical and Applied Physiology Program at the Department of Neuroscience University of Turin Medical School Turin, Ital

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  1. Clinical and Applied Physiology Program at the Department of Neuroscience University of Turin Medical School Turin, Italy www.personalweb.unito.it / fabrizio.benedetti

  2. Symbols molecules RECEPTORS Drugs Therapeutic effects Negative effects

  3. evolution

  4. Egbert et al. (1964) N Engl J Med 270: 825 Post-operative pain Pre-operative phase 1st post-operative day 1.187 Pain intensity 26 mg Morphine intake 1.735 Pain intensity 38 mg Morphine intake

  5. Thomas (1987) Br Med J 294: 1200 Cough Sore throat Cold Abdominal pain Back pain Giddiness Leg pain Headache Tiredness Chest pain Nasal congestion Muscular pain Earache Painful arm Breast pain Neck pain Consultation Two weeks later This treatment will certainly make you better 64 % who got better I am not sure that this treatment will have an effect 39 % who got better

  6. 1st model: Placebo administration 2nd model: Open-hidden paradigm This treatment will certainly make you better

  7. Placebo effect = Context effect Words Sight Touch Dummy treatment Medical treatment Smell

  8. Conscious Unconscious PSYCHOSOCIAL CONTEXT Conditioned response • COGNITION • Expectation • Belief • Trust • Hope Conditioned stimulus Effect Unconditioned stimulus (e.g. drug)

  9. Placebo-related effects ICD-10 of the World Health Organization

  10. Colloca and Benedetti (2005) Nature Rev. Neurosci. 6: 545-552

  11. 30 Pain tolerance (minutes) 25 20 15 DAY1 DAY2 DAY3 DAY4 DAY5 Zubieta et al. (2005) J. Neurosci. 25: 7754 –7762 MOR MOR PLA NAL Amanzio & Benedetti (1999) J. Neurosci. 19: 484-94

  12. Remifentanil Placebo ACC PAG Pons Medulla Petrovic et al. (2002) Science 295: 1737-40

  13. Colloca and Benedetti (2005) Nature Rev. Neurosci. 6: 545-552

  14. 3 Pain intensity (NRS) 2 1 0 PROGLUMIDE CCK-A (CCK-1) CCK-B (CCK-2) receptor antagonist Control Nocebo- induced anxiety Benedetti et al. (1997) Pain 71: 135-140

  15. Placebo suggestions Nocebo suggestions Colloca and Benedetti (2005) Nature Rev. Neurosci. 6: 545-552

  16. Nocebo suggestions Colloca and Benedetti (2005) Nature Rev. Neurosci. 6: 545-552

  17. Placebo-related effects ICD-10 of the World Health Organization

  18. Parkinson’s disease Decrease of raclopride binding de la Fuente-Fernandez et al. ( 2001) Science 293: 1164-6

  19. P r e – p l a c e b o P o s t – p l a c e b o

  20. Firing rate (spikes/s) 30 s Benedetti et al. (2004) Nature Neurosci, 7: 587-588

  21. 1st model: Placebo administration 2nd model: Open-hidden paradigm This treatment will certainly make you better

  22. Benedetti et al. (1995) Lancet 346: 1231

  23. hidden drug Benedetti et al. (1995) Lancet 346: 1231

  24. computer Open injection Hidden injection BUPRENORPHINE TRAMADOL KETOROLAC METAMIZOL open hidden open hidden open hidden open hidden 0 Pharmacodynamic effect -1 Pain reduction Psychological effect -2 -3 Benedetti et al (1995) Lancet 346: 1231 Amanzio et al. (2001) Pain 90:205-15 Colloca et al (2004) Lancet Neurol. 3: 679-684

  25. Placebo-related effects ICD-10 of the World Health Organization

  26. Cognitive impairment Benedetti et al (2006) Pain 121: 133-144

  27. P l a c e b o buprenorphine 1.2 1.15 mg/patient 1.0 0.8 -33.8% buprenorphine request 0.76 mg/patient 0.6 Buprenorphine intake/patient (mg) 0.4 0.2 0 0 10 20 30 40 50 60 70 Pollo et al. (2001) Pain 93: 77-84 Hours from surgery

  28. Is mind as real as matter? Symbols molecules RECEPTORS Drugs Therapeutic effects Negative effects

  29. Clinical and Applied Physiology Program at the Department of Neuroscience University of Turin Medical School Turin, Italy www.personalweb.unito.it / fabrizio.benedetti NEUROLOGY Bruno Bergamasco Leonardo Lopiano Innocenzo Rainero Giovanni Asteggiano Luisella Tarenzi Elena Torre NEUROPHYSIOLOGY Luana Colloca Antonella Pollo Sergio Vighetti SURGERY Giuliano Maggi Caterina Casadio Anna Arslanian PSYCHOLOGY Martina Amanzio Claudia Arduino Sara Costa RESPIRATORY PATHOPHYSIOLOGY Sergio Baldi NEUROSURGERY Michele Lanotte Antonio Melcarne

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