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• W2805921644 abstract "The use of brain imaging as a pharmacodynamic biomarker may provide objective evidence that could be used to guide treatment. The challenge is to deliver information that can be used to individualise treatment. The study by Wanigasekera and colleagues1Wanigasekera V. Wartolowska K. Huggins J.P. et al.Disambiguating pharmacological mechanisms from placebo in neuropathic pain using functional neuroimaging.Br J Anaesth. 2018; 120: 299-307Abstract Full Text Full Text PDF PubMed Scopus (33) Google Scholar has provided some tantalising insights into the effect of gabapentinoids and placebo on neural activity. The absence of subjective evidence of analgesia with pregabalin despite the presence of drug-induced changes in neural activity has been explained by the relatively short duration of therapy and small sample size. Although history of failure to respond to gabapentinoids and tramadol was an exclusion criterion, most subjects had not previously tried these drugs, raising the possibility that some of them might be non-responders. This could explain the lack of subjective response considering the relatively modest number needed to treat (NNT) for pregabalin and tramadol in the treatment of neuropathic pain. Differences in neural activity between responders and non-responders to analgesic medications have been identified in previous studies.2Kim S. Mun C. Lee S. Lee J. Kim G. Lee Y. Basal fMRI differences between pregabalin responders and non-responder in fibromyalgia.J Pain. 2012; 13: S31Google Scholar, 3Kim S. Geun-Tae K. Lee S. Kang M.J. Mun C.W. Basal fMRI differences between milnacipran responders and non-responder in fibromyalgia.Ann Rheum Dis. 2014; 73: 294Crossref Google Scholar It would have been interesting to explore any differences in this study. The study identified significant placebo-induced connectivity between the brainstem and the rostral anterior cingulate cortex that may relate to an expectation-induced effect. Response to chronic placebo dosing has been explored previously in fibromyalgia where lower baseline functional connectivity between the anterior cingulate cortex and the dorsolateral prefrontal cortex was associated with strong placebo response.4Schmidt-Wilcke T. Ichesco E. Hampson J.P. et al.Resting state connectivity correlates with drug and placebo response in fibromyalgia patients.NeuroImage Clin. 2014; 6: 252-261Crossref PubMed Scopus (79) Google Scholar Similarly, in a study of osteoarthritis-induced pain, placebo response was predicted by right midfrontal gyrus degree count.5Tétreault P. Mansour A. Vachon-Presseau E. Schnitzer T.J. Apkarian A.V. Baliki M.N. Brain connectivity predicts placebo response across chronic pain clinical trials.PLoS Biol. 2016; 14 (e1002570)Crossref PubMed Scopus (103) Google Scholar The variable effects of expectation in the presence of active treatment is interesting and challenges the assumption that the effects of placebo and active treatment responses are additive. There was no difference between chronic placebo and duloxetine in terms of subjective pain relief, but the right midfrontal gyrus counts did not predict response to duloxetine, suggesting that a linear additive relationship may not always be valid.5Tétreault P. Mansour A. Vachon-Presseau E. Schnitzer T.J. Apkarian A.V. Baliki M.N. Brain connectivity predicts placebo response across chronic pain clinical trials.PLoS Biol. 2016; 14 (e1002570)Crossref PubMed Scopus (103) Google Scholar The use of brain imaging to evaluate the effect of medications on neural activity and the extent of placebo response needs to be further explored. The author declares that they have no conflict of interest." @default.
• W2805921644 created "2018-06-13" @default.
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• W2805921644 date "2018-10-01" @default.
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• W2805921644 title "Brain imaging of analgesic and placebo responses. Comment on Br J Anaesth 2018; 120: 299–307" @default.
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• W2805921644 doi "https://doi.org/10.1016/j.bja.2018.05.005" @default.
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